Posts tagged ‘cms’

December 4, 2012

CMS will not pick standardized risk of falls tool

CMS addresses valid risk of falls tools and M1910 …

Question: We see that a validation study has been published for the Missouri Alliance for Home Care’s Fall Risk Assessment Tool (MAHC-10). Does this mean that we can now use that tool as the single standardized, validated, multifactor tool to meet the “Yes” response for M1910? And if so, should the threshold of “4” or “6” be used to indicate fall risk?

Answer from CMS: Per existing guidance, if you want to report M1910 as “Yes” (that Fall Risk Assessment was conducted), you must use a multifactor standardized tool that has been scientifically tested and validated, and the tool must be appropriately administered based on established instructions. CMS does not approve or disapprove individual tools.

It is the agency’s responsibility to determine if the tool you are using includes these elements. If an agency has evidence (from published literature, the tool developer, or another authoritative source) that the tool they are using assesses multiple factors that contribute to the risk of falling, has been scientifically tested and validated on a population with characteristics similar to that of the patient being assessed, and shown to be effective in identifying people at risk for falls, and includes a standardized response scale, then the agency can consider the tool to meet the requirements for the OASIS-C best practice assessment.

In determining if a patient is at risk for falls, the standardized tool should have a standardized response scale, and/or established and validated threshold at which fall risk exists. A tool may have multiple thresholds identifying various levels of risk (i.e, “no risk”, “low risk”, “high risk”). Select Response 1 if the standardized response scale rates the patient as no-risk, low-risk, or minimal risk. Select Response 2 if the standardized response scale rates the patient as anything above low/minimal risk. If the tool does not provide various levels, but simply has a single threshold separating those “at risk” from those “not at risk”, then patients scoring “at risk” should be reported as Response 2.

See more CMS Q&As.

November 20, 2012

Communicating ICD-10 to payers

CMS is offering more advice and information on the ICD-10 transition. This focuses on talking to your payers:

As you prepare for ICD-10, check with your payers to be sure they are moving forward with ICD-10 planning. You will want to work together to ensure you meet the ICD-10 deadline – October 1, 2014.

Here are some questions to ask your payers:

  • Are you prepared to meet the ICD-10 deadline of October 1, 2014? Where is your organization in the transition process?
  • Who will be my primary contact at your organization for the ICD-10 transition?
  • Can we set up regular check-in meetings to keep our progress on track?
  • When will you be ready to accept test transactions from my practice?
  • What will we need to test with you?
  • Do you anticipate any changes in policies or delays in payments to result from the switch to ICD-10?

CMS’s ICD-10 website

November 7, 2012

Proposed legislation could put financial penalties on RACs

HealthLeaders is following some legislation introduced a few weeks ago in the U.S. House:

Healthcare recovery auditors (RACs) could face a potential financial penalty for every judgment against a provider that is overturned if a pending bill gets signed into law, according to HealthLeaders Media.

Currently, 75 percent of RAC judgments against providers get overturned when they are appealed, mostly at the administrative law level, where a federal judge is making a decision, according to the American Hospital Association Survey.

Read more at HealthLeaders.

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October 21, 2012

Procedure coding is no longer required

Question: I recently attended your conference you advised us about procedure coding–that it was no longer necessary to report them as CMS does not count that. Did I understand this correctly??

Lisa says: Procedure coding is no longer required as of 4/20/2011. M1012 must still be answered but you may answer NA or UK on everyone if you’d like. There is also no requirement for surgical procedures on the POC.

October 7, 2012

CMS arrests 91 for false billing fraud

The Centers for Medicare & Medicaid Services charged 91 people for Medicare fraud totaling $429.2 million in alleged false billing.

Most of the charged individuals, which include licensed medical professionals including doctors, nurses, and healthcare company owners, were arrested for charges including conspiracy to commit healthcare fraud, healthcare fraud, anti-kickback violations, and money laundering.

Thirty-three people were arrested in Miami for fraud that led to $204.5 million in false billings for home healthcare, mental health services, and occupational and physical therapy. Seven hospital administrators in Houston face charges for giving Medicare patients cigarettes and gift shop coupons in exchange for participating in a program involving mentally ill patients.

CMS has been increasing arrest and fraud enforcement. In May, more than 100 people were arrested and charged for fraud of more than $450 million.

Read CMS’s statement

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