Tag Archives: medicare

What We’re Reading – Investigation Finds Drug Abusers Exploiting Medicare Benefit

An investigation in 2008, by the Government of Accountability Office, found approximately 170,000 Medicare recipients with suspicious prescription-use patterns. The study identified 14 frequently abused medications and found that patients were “doctor shopping” in order to obtain multiple prescriptions for … Read Full Post

Tagged drug abuse, exploiting medicare benefit, medicare, medicare prescription drug program, medicare recipients, providers |

Part One: What type of care do I want to provide?

Home health agencies can provide skilled or non-skilled care. Skilled care requires the skills of a licensed professional, such as a nurse or therapist. Non-skilled care is custodial or personal in nature, encompassing assistance with Activities of Daily Living (ADLs) … Read Full Post

Tagged caregivers, home health agency, long-term care, medicare, non-skilled care, skilled agency, skilled care |

New CMS ABN Booklet Available

CMS has revised a booklet that explains the Advance Beneficiary Notice of Noncoverage(ABN) Form. An ABN is a standardized form that health care providers must give Medicare beneficiary when the provider believes that Medicare may not pay for an item … Read Full Post

Tagged abn, cms, medicare, medicare beneficiary, notice of noncoverage |

What We’re Reading – 10 Ways to Reduce Hospital Readmissions

In order to prevent reduced Medicare reimbursements under CMS’ Hospital Readmissions Reduction Program and being penalized under CMS’ Hospital Value-Based Purchasing Program for having high rates of preventable readmissions, the author suggests 10 proven ways hospitals can reduce their number … Read Full Post

Tagged cms, home health, hospital readmissions, medicare, medicare reimbursements, preventable readmissions |

Are You Ready for 5010?

Home Health Agencies should ask their homecare software vendor if they are ready for the new required software changes for claims submission. All covered entities must submit Medicare electronic claims using X12 version 5010 effective January 1, 2012. If your … Read Full Post

Tagged 5010 transition, electronic claims, home health, home health billing, homecare software, imark billing, medicare |

Alcohol Abuse vs. Dependence: Is it Fraudulent to Knowingly Soft-Pedal a Diagnosis?

Do you think a provider would chart heart disease for a patient with – say – hypertrophic cardiomyopathy because it’s a ‘warmer, fuzzier’ diagnosis? Or try to scare a patient with metabolic disorder into losing weight by diagnosing her prematurely … Read Full Post

Tagged addiction, alcohol abuse, alcohol dependence, diagnosis, fraud, medicare, risk adjustment, soft-pedaling |

The Top Three MRA Mistakes: How much are these costing your practice?

When a medical group’s risk score is low despite a chronically ill patient population, the culprit is generally one of three very common practitioner habits. Let’s explore each one: Failure to connect diabetic manifestations: This is probably the low-hanging fruit … Read Full Post

Tagged cardiac disease, diabetic, icd-9, improper documentation, medical practice, medicare, practitioner, risk adjustment |

Common Medicare Home Health Billing Errors and How to Avoid Them

Today’s home health care billing is more critical than ever. Shrinking reimbursement and increased regulations are forcing agencies to optimize their billing process. With many layers of complexity in the billing process, agencies have found that even a small number … Read Full Post

Tagged billing errors, diagnosis codes, home health, home health billing, icd-9, Imark consulting, medicare, payment losses |

Why is my Risk Score so low when my patients are so sick?

A risk score is a numeric representation of the health status of your patients based on factors developed by the Centers for Medicare and Medicaid Services (CMS). Each patient has a risk score and your practice has one too. The … Read Full Post

Tagged cms, diagnoses, icd-9, medicaid, medicare, patients, risk adjustment, risk score |

What is MRA?

MRA – Medicare Risk Adjustment – was established in 2003 and phased in over a five year period. Through this payment methodology, the MedicareAdvantage Plan’s (and the provider’s) capitation is adjusted based on the risk assumed for the patient’s care, … Read Full Post

Tagged chronic care, diagnosis, icd-9, medicare, mra, patient, payment, provider, risk adjustment |