Blog - Consulting

Leading with Confidence: Be Prepared for Surveys and Audits

Posted: 09.25.14 | Category: Consulting

Effective documentation and monitoring has never been so critical. Last month, CMS announced that due to the continued delay in awarding new Recovery Auditor contracts, they are initiating contract modifications to the current Recovery Auditor contracts that will allow the Recovery Auditors to restart some reviews. Read more.

Last week’s passage of the IMPACT Act creates additional reasons for hospices to dial up their readiness for audits and reviews. The Act requires that CMS conduct surveys of hospice providers, minimally, every 36 months and also makes a technical correction to the ACA that will allow CMS to move forward with medical review of hospices with a high proportion of long-stay patients.

Ensure your staff understands how to document right the first time, and make sure you have processes in place to prevent problems before they become pervasive.

TCG Has Your Back

Providers facing the increased scrutiny of audits and surveys need an expert in their corner to:

  1. Evaluate their current compliance “fitness” level, including a third-party review of current documentation compliance
  2. Determine the best training schedule to achieve peak performance
  3. Rebound quickly in response to audit or survey findings

TCG audit specialists are available, both on-site and off-site, to help your organization respond to surveys and ADR, RAC, ZPIC and other audit requests. Our experts will also serve as your team to perform routine audits on a recurring quarterly, annual or otherwise needed basis, to give an objective view of your level of compliance.

Click below for helpful resource links: 
MAC Contract Status 

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TCG Can Help you avoid a cycle of denials and appeals. We can provide clinical documentation experts to help you conduct one-time or recurring third-party reviews and/or test your processes

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The July 1st deadline is here.

Posted: 07.02.14 | Category: Consulting

July 1, 2014 is the effective date for several policies from the Centers for Medicare & Medicaid Services (CMS). See below to review a checklist of new requirements every hospice and home health provider must start following.

√    5 Day Payment Limit for Respite Care

This item eliminates the use of occurrence code M2 on claims when there is more than one respite period in a billing period. The language states any claims submitted with more than five consecutive days billed for respite care will be returned to the provider. The change is not in the policy itself, but in the commitment by CMS to enforce the practice with the threat of potential penalties.

        Direct Submission of HIS Admission and Discharge Records

For each patient admitted after July 1, 2014, a Medicare-certified hospice must collect Hospice Item Set (HIS) electronic records. Failure to meet the reporting requirement will result in a 2 percent reduction in hospice payments for FY 2016. Click to read the proposed rule by CMS on hospice payment rates.

        Medicare Advantage Requires HIPPS Coding

After being delayed twice to allow home health agencies to make systems and operational adjustments, after July 1, 2014, CMS will require Health Insurance Prospective Payment System (HIPPS) codes on Medicare Advantage (MA) plan claims. This directive also applies to contracted providers of MA plans.

        Certifying and Attending Physicians Subject to Enrollment

For episodes that begin on or after July 1, 2014, certifying and attending physicians must be enrolled in the Provider Enrollment, Chain and Ownership System (PECOS). Home health agencies are now required to report the name and the National Provider Identifier of the physician who certifies/re-certifies the patient’s eligibility to receive services under the Medicare home health benefit. The same reporting must be done if there is a separate attending physician who signs the patient’s plan of care.

        Agencies Subject to Alternative Sanctions

Home health agencies not complying with the July 1, 2014 conditions can have sanctions placed on their participation. CMS has the authority to impose civil money penalties, suspension of payment for new admissions, temporary management of the HHA, a directed plan of correction and in-service training. Click to read the survey and enforcement process outlined by CMS for home health agencies.


You crossed the finish line … but the path to a successful merger continues

Posted: 06.30.14 | Category: Consulting, Talent Solutions, TCG CHEX eLearning

The amount of mergers and acquisitions increased by 16 percent between the second and third quarters last year, according to a June 19 report by FierceHealthFinance.  “There is a natural momentum right now in … the economy as a whole for merger & acquisition, and people don’t want to be the last one picked at the kickball game,” President and CEO Russell Branzell of the College of Healthcare Information Management Executives, a non-profit organization designed to promote collaboration by health care leaders, told FierceHealthFinance in June.  The increase means a large set of companies, often with the help of consultants, have identified the risks and rewards of a merger or acquisition and taken the leap.  Now as the consolidations are completed, these businesses are taking the next step … moving forward as one seamless company.

The steep climb in the number of mergers and acquisitions is evident in the health care industry. Although the Affordable Care Act has created an uncertain climate on future growth and profitability for the home care industry, businesses are acting now to meet both the challenges and opportunities, according to a November 2013 report by HomeCare, After Health Care Reform: Developing Merger and Acquisition Strategies.”  The report on “mergers and acquisition options in the new era” emphasizes the vast body of state and federal laws are changing.  Even though the regulatory and compliance requirements can complicate a transaction process, “Every privately held health care business ever created will, at some point, be sold, merged, bequeathed or closed,” Jonathan M. Sadock reveals in the HomeCare piece.

The merger is complete, but the strategic work continues

Click to learn more about the many solutions TCG offers to navigate you through the potential pitfalls on your path through a merger.

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