CMS implemented the home health Probe and Educate Project in January 2016 to determine how well home health agencies are complying with the certification and recertification requirements under the Medicare home health care benefit.
The project requires that every one of the more than 6,000 certified home health agencies have an audit of a sample of five (5) pre-payment home health episodes. Agencies that receive denials on 2 or more of the sample records are subject to a second review of five more claims and the process can repeat as long as the agency has more than one record denied. The greatest fear is whether an agency can sustain the financial losses through repetitive cycles of these audits. The initial audits yielded denial rates as high as 97% of all claims reviewed.
Why Should You Attend:
Knowledge is power and the more home health agencies are prepared for these audits, the greater likelihood that your agency will be able to survive the audit and be able to continue to provide services to the vulnerable populations that require home health services.
Avoid the uncertainty and fear of the Probe and Educate Audit experience by ensuring your agency is fully knowledgeable of the process for the audits and a complete understanding of all of the regulatory requirements for certification and recertification of home health episodes.
Probe and Educate Audits are full audits reviewing the entire medical record for the selected episodesto determine if they support all of the regulatory requirements for certification and recertification plus the medical necessity of all services provided during the claim period under review.
There is no limit to the number of cycles an agency can be subject to. Due to the significant financial losses if claims are denied, every Medicare home health benefit must proactively implement adequate documentation to support the care provided.
Areas Covered in this Webinar:
Process and guidelines for the audits
Current denial statistics and common deficiencies identified
Detailed information required for all five aspects of certification including:
Qualifying services for home health
Confined to the home/homebound status
A plan of care has been established and periodically reviewed by a physician
Services are furnished while the patient is under the care of a physician
Face to face encounter
Details related to meeting recertification requirements
Tips and Hints to meet requirements
Follow-up after the survey
5 stages of the appeal process
Describe the process for Probe and Educate Audits
Identify the requirements for the 5 requirements of HH Certification
Identify the 5 stages of Appeal
Who Will Benefit:
Home Health Supervisors
Quality Improvement Coordinators/ Directors
Judy Adams’s experiences include working closely with regulators, third-party payers, occupational licensing boards and home care providers on numerous issues involving health and social supportive services in the home and community settings.
For the past 20+ years, she has provided a variety of operational and clinical consultative services to large and small home care and hospice organizations in several states in the eastern half of the United States and taught hundreds of teleconferences and day-long workshops ondiagnosis coding, OASIS, home health prospective payment system, coverage and documentation, and a variety of other clinical and regulatory home health and hospice topics for individual agencies, state associations and national organizations.
For more detail please click on this below link:
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