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Month: July 2018

Quality: Say Farewell To 7 Quality Measures Under Proposed Rule

  • By Sandy McCleve
  • July 25, 2018
  • 1 Comment

Dropped measures will come with OASIS changes. Medicare continues to focus on fine-tuning its quality reporting program for home health agencies, according to the new 2019 Home Health Prospective Payment … Continue Reading →

Fraud & Abuse: Hospices Pay Out Millions In Fraud Cases

  • By Sandy McCleve
  • July 24, 2018
  • No Comments

Hospice coughs up $3 million for integrity agreement settlement. A whistleblower lawsuit filed by hospice physicians has cost one nonprofit Florida hospice $2.5 million — and it could have been … Continue Reading →

Patient Driven Groupings Model: Beware: Pay Reform Impact File Missing Major Adjustment

  • By Sandy McCleve
  • July 23, 2018
  • No Comments

Plus: See how much Medicare’s behavioural adjustments are stripping from base rate. If you thought your home health agency impact file outlining the Patient Driven Groupings Model’s effects is the … Continue Reading →

OASIS: Start Your Next OASIS-D Phase With New Manual

  • By Sandy McCleve
  • July 20, 2018
  • No Comments

CMS plans OASIS-D educational sessions. The wait is over — mostly. Medicare has released the guidance manual for the significant OASIS changes that are coming Jan. 1. Reminder: Back in March, … Continue Reading →

Prospective Payment System: Proposed Rule Addresses Remote Monitoring, Home Infusion, VBP, And More

  • By Sandy McCleve
  • July 19, 2018
  • No Comments

Change could lead to more accurate profit margin figures. Payment reform and rate increases may be grabbing most of the spotlight in the 2019 Home Health Prospective Payment System proposed … Continue Reading →

Regulations: Revised, Additional Factors To Determine Which Quality Measures Get Dropped

  • By Sandy McCleve
  • July 18, 2018
  • No Comments

CMS aims to reduce provider burden with new criterion. Medicare officials have made a lot of noise about reducing providers’ regulatory burdens. While home health agencies may not feel like … Continue Reading →

Certification: HHAs To See Some Relief With Physician Recert Estimates

  • By Sandy McCleve
  • July 17, 2018
  • No Comments

F2F reform is what’s really needed, expert urges. After years of punishing claims denials based on a physician requirement to furnish an estimate of service length for a recert, Medicare … Continue Reading →

Regulations: Medicare Provides More Info On Pay Reform This Time Around

  • By Sandy McCleve
  • July 16, 2018
  • No Comments

Data helps pinpoint winners, losers under new payment system. Aside from budget neutrality, the PDGM payment reform model Medicare has proposed for 2020 may look basically the same as last … Continue Reading →

Billing: Medicare Wants To Scrap RAPs Under Payment Reform

  • By Sandy McCleve
  • July 13, 2018
  • No Comments

LUPAs thresholds to vary under PDGM. The home care industry may hate the idea, but CMS is pushing ahead with its proposal to phase out Requests for Anticipated Payment under … Continue Reading →

Diagnosis Coding: Check Out The Secondary Dx Groups That Will Boost PDGM Pay

  • By Sandy McCleve
  • July 12, 2018
  • No Comments

CMS listened to HHGM commenters and revised the case mix category methodology. The newly proposed payment reform model will increase payment for an episode when the claim contains certain secondary … Continue Reading →

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Sandy McCleve is the Managing Director at Advantage Healthcare Consulting with nearly a decade of experience as an accounting and tax preparation consultant specifically for healthcare providers.

Sandy has developed proprietary tools and systems that allow Advantage Healthcare Consulting to provide the fastest, most accurate cost reports and truly qualifies him as a specialist in Medicare and Medicaid Cost Reporting for Home Health Care Agencies, Hospice Care Providers, and Skilled Nursing Facilities.

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