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Category: Reimbursement

Take These 10 Steps To Prepare For PDGM Before It Rocks Your World

  • By Sandy McCleve
  • January 11, 2019
  • No Comments

Don’t let paradigm-shifting payment reform put you at risk next year. A year from now, you’ll be a few weeks into a radically revised payment system. To survive and thrive … Continue Reading →

HOSPICE CAP REPORTING: ARE YOU PREPARED TO FILE

  • By Sandy McCleve
  • January 9, 2019
  • 1 Comment

As you know, as published in the Federal Register on August 22, 2014, CMS released the new requirements for hospice cap reporting and overpayment remittances.  Effective for the Cap year … Continue Reading →

Hospice Cap Procrastination Could Cost You

  • By Sandy McCleve
  • January 8, 2019
  • No Comments

If you’ve never accessed your own PS&R data to calculate your self-reported hospice cap, you’d better get moving. “Providers will be required to obtain their own PS&R data in order to … Continue Reading →

New Hospice Compare Measure Debuts This Month

  • By Sandy McCleve
  • November 30, 2018
  • No Comments

Plus: New preview reports will be here soon. Will you be thankful for the new measure Medicare has added to its Hospice Compare website? If you’ve checked out the new … Continue Reading →

Patient-Driven Groupings Model: PDGM’s New Admission Source Factor Could Bust — Or Boost — Your Reimbursement

  • By Sandy McCleve
  • November 29, 2018
  • No Comments

Source of admission might add thousands of dollars to your episode. Whether you sink or swim under the new payment reform model taking effect in January 2020 may depend on … Continue Reading →

Be Ready To Pounce On Institutional Billing Details

  • By Sandy McCleve
  • November 28, 2018
  • No Comments

Pointer: Start checking HETS reports for hospital billing ASAP. Not only does the new case mix factor on institutional versus community admission source complicate reimbursement levels, it also complicates the billing … Continue Reading →

Medicare Cost Report: What is it?

  • By Sandy McCleve
  • November 15, 2018
  • No Comments

All Medicare certified institutional providers are required file an annual cost report to their respective Medicare Administrative Contract (“MAC”). But what is a Medicare cost report and what is the … Continue Reading →

Billing: PPS Rule Finalizes First Step Of RAP Elimination

  • By Sandy McCleve
  • November 14, 2018
  • No Comments

New HHAs no longer will receive RAP payments under PDGM. Despite many strident industry comments opposing the elimination of Requests for Anticipated Payments, Medicare has started down that path anyway. … Continue Reading →

Reimbursement: CMS Hangs Onto Behavioral Assumption Adjustment Cuts, Despite Industry Outcry

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

Industry needs Congress’ help. While the Patient-Driven Groupings Model is supposed to be a budget-neutral reform to how Medicare pays home health agencies, in realityproviders will see a big cut in transitioning … Continue Reading →

2019 Rate Increase Largest In More Than A Decade

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

Plus: Outlier formula tweak will make them a little easier to obtain. Not surprisingly, home health agencies are consumed with the details of the payment reform model included in the … Continue Reading →

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About Me

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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