Corporate Compliance

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Up-date to ICD-10!

Changes to ICD-10 for 2018-2019 from the CDC!

CMS Quality Measurements Projects and the Goals

CMS is presently developing outcome core measures that are patient oriented and cross providers setting during the continuum of care.

Submitting Request for Records to Medicare Picture

Submitting Request for Records to Medicare

More than 47% of denials by PalmettoGBA for the period of 10/2017-12/2018 were related to...... Read More...

CMS Moratorium Extended!

CMS Moratorium extended! in the following geographical areas...

Tips

OASIS Tip - M1600 Patients discharged with an UTI on discharge and PAEs Report

Are your Potentially Avoidable Events (PAEs) Report showing an increase in patients being discharged while having an UTI?

Ready for CMS QAPI Program?

According to CMS in 2011 several nursing homes providers begun testing CMS QAPI Program, Quality Assurance (QA) and Performance Improvement (PI), Program which includes Five Elements...

Patient-Driven Grouping Model (PDGM)-Effective January 1, 2020 CMS Home Health Payment Methodology. Picture

Patient-Driven Grouping Model (PDGM)-Effective January 1, 2020 CMS Home Health Payment Methodology.

Have you downloaded the CMS PDGM Excel file from the CMS Home Health Agency Center?

Do you have a Corporate Compliance Plan?

If you don't, is in your organization's best interest to have one. The following documents were developed by the OIG to provide guidance to organizations that would like to, voluntarily develop a compliance plan.

Is better to be proactive than reactive and have a Corporate Compliance Plan in place, especially when you are dealing with a Federal funded program. In 2009 the federal government put in a place The Health Care Fraud Prevention and Enforcement Action Team (HEAT) Task Force. This task force is composed of multi-federal and state programs as the Department of Health, Department of Justice, FBI and other state organizations. HEAT's Task Force mission is to help prevent waste, fraud, and abuse in the Medicare and Medicaid programs, crack down on the people and organizations who abuse the system and cost Americans billions of dollars each year, reduce health care costs and improve quality of care by preventing fraudsters from preying on people with Medicare and Medicaid, highlight best practices by providers and organizations dedicated to ending waste, fraud, and abuse in Medicare and build upon the existing partnerships between HHS and DOJ to reduce fraud and recover taxpayer dollars.

According to the HEAT's Medicare Fraud Strike Force, they have charged more than 1,400 defendants who collectively falsely billed the Medicare program more than $4.8 billion since 2007 and in 2011 HEAT coordinated the largest-ever federal health care fraud takedown involving $530 million in fraudulent billing.