Download or read book The Hospice Guide to Billing and Reimbursement written by Casey Fenton and published by . This book was released on 2016-07-21 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Hospice Guide to Billing and Reimbursement: Durable Guidance and Strategy for a Shifting Payment Landscape Casey Grimes Catherine Stapleton, MS The industrywide march toward standardized performance measurement and unified value-based payment structures requires hospice agencies to stay on top of CMS regulatory guidance. "The Hospice Guide to Billing and Reimbursement"is your comprehensive solution to implementing accurate, compliant, and competent billing practices at your organization. This book will help you provide the best training possible to your administrative staff and those who impact billing, increasing their competence and confidence about billing requirements and practices. It will equip providers with the broad frameworks and processes needed to develop billing systems and financial plans that meet CMS ever-sharper scrutiny. This book will help you understand: Regulators expectations surrounding billing and reimbursement for the Medicare hospice benefitRecent updates to payment terms, such as the introduction of the Service Intensity Add-on (SIA) and the two-tiered reimbursement structure for the provision of routine homecareWhat you need to do to prepare for the major changes still ahead (e.g., value-based purchasing models)How not to leave money on the table or be penalized unnecessarily Table of Contents: Today s Hospice Reimbursement and Billing Landscape at a GlanceOverview of the Medicare hospice benefitFoundations of hospice billing and reimbursementKey developments in recent yearsLarge-scale changes on the horizonLinking Hospice Philosophy, Care Practices and Outcomes, Operational Processes, and Received PaymentPromoting Ongoing Compliance With Long-Standing Components of Hospice Payment and BillingHonoring patient eligibility requirementsUnderstanding sequential billingDistributing Medicare coverage noticesCreating effective cost reportsResponding to additional development requests (ADR)Withstanding auditsAdapting Practices and Processes to Accommodate Recent, Industrywide Payment Rate and Process ChangesThe SIA and two-tiered RHC payment model introduced through 2016 rulemakingRecent adjustment to hospice caps calculation methodologyIntegrating the hospice PEPPER report (including recently updated coverage areas) into internal billing compliance initiativesAdhering to quality reporting expectations to avoid payment penaltiesPromoting timely filing of election notices and recertifications, as well as timely completion of face-to-face documentationCurbing high rates of recertification and revocationImplementing effective compliance strategies surrounding the launch of ICD-10 and general coding-related practices (including clinical documentation) that can influence paymentRecognizing and Readying Internal Systems for the Prospective Impact of Continuumwide Payment Reform InitiativesValue-based purchasingBundled paymentsAccountable care organizations (ACO)Implementing Enduring Billing Best Practices, Strategies, and Systems to Facilitate the Receipt of Deserved ReimbursementComplying with setting-specific guidelines, rules, and regulations, especially those governing hospitals, skilled nursing facilities, and assisted living facilitiesDeveloping effective initial and ongoing staff training"

Download or read book Handbook of Home Health Standards E Book written by Tina M. Marrelli and published by Elsevier Health Sciences. This book was released on 2008-10-13 with total page 688 pages. Available in PDF, EPUB and Kindle. Book excerpt: Handbook of Home Health Standards: Quality, Documentation, and Reimbursement includes everything the home care nurse needs to provide quality care and effectively document care based on accepted professional standards. This handbook offers detailed standards and documentation guidelines including ICD-9-CM (diagnostic) codes, OASIS considerations, service skills (including the skills of the multidisciplinary health care team), factors justifying homebound status, interdisciplinary goals and outcomes, reimbursement, and resources for practice and education. The fifth edition of this “little red book has been updated to include new information from the most recently revised Federal Register Final Rule and up-to-date coding. All information in this handbook has been thoroughly reviewed, revised, and updated. Offers easy-to-access and easy-to-read format that guides users step by step through important home care standards and documentation guidelines Provides practical tips for effective documentation of diagnoses/clinical conditions commonly treated in the home, designed to positively influence reimbursement from third party payors. Lists ICD-9-CM diagnostic codes, needed for completing CMS billing forms, in each body system section, along with a complete alphabetical list of all codes included in the book in an appendix. Incorporates hospice care and documentation standards so providers can create effective hospice documentation. Emphasizes the provision of quality care by providing guidelines based on the most current approved standards of care. Includes the most current NANDA-approved nursing diagnoses so that providers have the most accurate and up-to-date information at their fingertips. Identifies skilled services, including services appropriate for the multidisciplinary team to perform. Offers discharge planning solutions to address specific concerns so providers can easily identify the plan of discharge that most effectively meets the patient’s needs. Lists the crucial parts of all standards that specific members of the multidisciplinary team (e.g., the nurse, social worker) must uphold to work effectively together to achieve optimum patient outcomes. Resources for care and practice direct providers to useful sources to improve patient care and/or enhance their professional practice. Each set of guidelines includes patient, family, and caregiver education so that health care providers can supply clients with necessary information for specific problems or concerns. Communication tips identify quantifiable data that assists in providing insurance case managers with information on which to make effective patient care decisions. Several useful sections make the handbook thorough and complete: medicare guidelines; home care definitions, roles, and abbreviations; NANDA-approved nursing diagnoses; guidelines for home medial equipment and supplies. Small size for convenient carrying in bag or pocket! Provides the most up-to-date information about the newest and predominant reimbursement mechanisms in home care: the Prospective Payment System (PPS) and Pay For Performance (P4P). Updated terminology, definitions, and language to reflect the federal agency change from Health Care Financing Administration (HCFA) to Centers for Medicare & Medicaid Services (CMS) and other industry changes. Includes the most recent NANDA diagnoses and OASIS form and documentation explanations. New interdisciplinary roles have been added, such as respiratory therapist and nutritionist.,/LI>

Download or read book Handbook of Home Health Standards written by T. M. Marrelli and published by Mosby. This book was released on 2009 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Handbook of Home Health Standards: Quality, Documentation, and Reimbursement includes everything the home care nurse needs to provide quality care and effectively document care based on accepted professional standards. This handbook offers detailed standards and documentation guidelines including ICD-9-CM (diagnostic) codes, OASIS considerations, service skills (including the skills of the multidisciplinary health care team), factors justifying homebound status, interdisciplinary goals and outcomes, reimbursement, and resources for practice and education. The fifth edition of this "little red book" has been updated to include new information from the most recently revised Federal Register Final Rule and up-to-date coding. All information in this handbook has been thoroughly reviewed, revised, and updated. Offers easy-to-access and easy-to-read format that guides users step by step through important home care standards and documentation guidelines Provides practical tips for effective documentation of diagnoses/clinical conditions commonly treated in the home, designed to positively influence reimbursement from third party payors. Lists ICD-9-CM diagnostic codes, needed for completing CMS billing forms, in each body system section, along with a complete alphabetical list of all codes included in the book in an appendix. Incorporates hospice care and documentation standards so providers can create effective hospice documentation. Emphasizes the provision of quality care by providing guidelines based on the most current approved standards of care. Includes the most current NANDA-approved nursing diagnoses so that providers have the most accurate and up-to-date information at their fingertips. Identifies skilled services, including services appropriate for the multidisciplinary team to perform. Offers discharge planning solutions to address specific concerns so providers can easily identify the plan of discharge that most effectively meets the patient's needs. Lists the crucial parts of all standards that specific members of the multidisciplinary team (e.g., the nurse, social worker) must uphold to work effectively together to achieve optimum patient outcomes. Resources for care and practice direct providers to useful sources to improve patient care and/or enhance their professional practice. Each set of guidelines includes patient, family, and caregiver education so that health care providers can supply clients with necessary information for specific problems or concerns. Communication tips identify quantifiable data that assists in providing insurance case managers with information on which to make effective patient care decisions. Several useful sections make the handbook thorough and complete: medicare guidelines; home care definitions, roles, and abbreviations; NANDA-approved nursing diagnoses; guidelines for home medial equipment and supplies. Small size for convenient carrying in bag or pocket! Provides the most up-to-date information about the newest and predominant reimbursement mechanisms in home care: the Prospective Payment System (PPS) and Pay For Performance (P4P). Updated terminology, definitions, and language to reflect the federal agency change from Health Care Financing Administration (HCFA) to Centers for Medicare & Medicaid Services (CMS) and other industry changes. Includes the most recent NANDA diagnoses and OASIS form and documentation explanations. New interdisciplinary roles have been added, such as respiratory therapist and nutritionist., /LI>

Download or read book Handbook of Home Health Standards Documentation Guidelines for Reimbursement written by T. M. Marrelli and published by Mosby Incorporated. This book was released on 2001 with total page 680 pages. Available in PDF, EPUB and Kindle. Book excerpt: Everything the home care nurse needs to provide quality care and effectively document care based on accepted professional standards is found in this handbook. Offers detailed standards and documentation guidelines for each of more than 60 clinical problems, including ICD-9 (diagnostic) codes, service skills (including the skills of the multidisciplinary health care team), factors justifying homebound status, and more.

Download or read book CPT Professional 2022 written by American Medical Association and published by . This book was released on 2021-09-17 with total page 1200 pages. Available in PDF, EPUB and Kindle. Book excerpt: CPT(R) 2022 Professional Edition is the definitive AMA-authored resource to help healthcare professionals correctly report and bill medical procedures and services.

Download or read book The Home Health Guide to Medicare Service Delivery 2017 Edition written by J'Non Griffin and published by . This book was released on 2017-03-30 with total page 360 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Home Health Guide to Medicare Service Delivery, 2017 Edition J'non Griffin, RN, MHA, WCC, HCS-D, COS-C, HCS-H Updated to reflect the 2017 home health PPS final rule, new Conditions of Participation (CoP), and OASIS-C2, The Home Health Guide to Medicare Service Delivery, 2017 Edition, offers a one-stop solution for home health professionals that are looking for answers to their Medicare compliance questions. This book also enables agencies to ensure services are delivered according to current Medicare regulations and helps staff understand how to produce patient care documentation that supports compliance and proper payment claims. This manual provides: Quick access to concise, up-to-date CMS regulations, including new CoPs and interpretive analyses A go-to resource for anyone in the home health agency, useful for orientation, training, and reference when stumped by a regulatory or operational question An overview of the home health PPS final rule, featuring complete interpretation and compliance guidelines on all PPS regulations "Nuts and bolts" education--this book takes the most complicated aspects of Medicare healthcare services and explains them in an easy-to-understand way What's New? Updated regulations include: The 2017 home health PPS final rule Payment rebasing Home health quality changes Coding changes Changes in methodology used to calculate outlier payments (episodes of care with unusual variations in the type or amount of medically necessary care) Changes in payment for negative pressure wound therapy performed using a disposable device for patients under a home health plan of care Additions and modifications to the home health value-based purchasing model Table of Contents The Basics of Medicare Service Delivery: Presents the fundamentals of Medicare coverage criteria and the new Conditions of Participation. This includes a section dedicated to survey preparation. The Prospective Payment System (PPS): Gives an overview of critical concepts, including the Home Health Resource Group, consolidated billing requirements, and clinical issues with an impact on billing for the current payment system. All About the OASIS: Discusses the fundamentals of the OASIS-C2 and assessments. Compliance and Care Delivery: Highlights issues related to visits, physician orders, start of care, recertification, and discharge. Documentation Essentials: Looks at documentation fundamentals, the clinical record, diagnoses, and the plan of care. This includes a section related to the 485 and elements of content.

Download or read book LGBTQ Inclusive Hospice and Palliative Care written by Kimberly D. Acquaviva and published by Columbia University Press. This book was released on 2017-05-23 with total page 297 pages. Available in PDF, EPUB and Kindle. Book excerpt: This is the only handbook for hospice and palliative care professionals looking to enhance their care delivery or their programs with LGBTQ-inclusive care. Anchored in the evidence, extensively referenced, and written in clear, easy-to-understand language, LGBTQ-Inclusive Hospice and Palliative Care provides clear, actionable strategies for hospice and palliative physicians, nurses, social workers, counselors, and chaplains.

Download or read book Dying in America written by Institute of Medicine and published by National Academies Press. This book was released on 2015-03-19 with total page 470 pages. Available in PDF, EPUB and Kindle. Book excerpt: For patients and their loved ones, no care decisions are more profound than those made near the end of life. Unfortunately, the experience of dying in the United States is often characterized by fragmented care, inadequate treatment of distressing symptoms, frequent transitions among care settings, and enormous care responsibilities for families. According to this report, the current health care system of rendering more intensive services than are necessary and desired by patients, and the lack of coordination among programs increases risks to patients and creates avoidable burdens on them and their families. Dying in America is a study of the current state of health care for persons of all ages who are nearing the end of life. Death is not a strictly medical event. Ideally, health care for those nearing the end of life harmonizes with social, psychological, and spiritual support. All people with advanced illnesses who may be approaching the end of life are entitled to access to high-quality, compassionate, evidence-based care, consistent with their wishes. Dying in America evaluates strategies to integrate care into a person- and family-centered, team-based framework, and makes recommendations to create a system that coordinates care and supports and respects the choices of patients and their families. The findings and recommendations of this report will address the needs of patients and their families and assist policy makers, clinicians and their educational and credentialing bodies, leaders of health care delivery and financing organizations, researchers, public and private funders, religious and community leaders, advocates of better care, journalists, and the public to provide the best care possible for people nearing the end of life.

Download or read book Hospice and Palliative Care Handbook written by T. M. Marrelli and published by SIGMA Theta Tau International. This book was released on 2018 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Medical Fee Schedule written by and published by . This book was released on 1995 with total page 262 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book The Medicare Handbook written by and published by . This book was released on 1989 with total page 48 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book ICD 10 CM Official Guidelines for Coding and Reporting FY 2021 October 1 2020 September 30 2021 written by Department Of Health And Human Services and published by Lulu.com. This book was released on 2020-09-06 with total page 128 pages. Available in PDF, EPUB and Kindle. Book excerpt: These guidelines have been approved by the four organizations that make up the Cooperating Parties for the ICD-10-CM: the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), CMS, and NCHS. These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-CM itself. The instructions and conventions of the classification take precedence over guidelines. These guidelines are based on the coding and sequencing instructions in the Tabular List and Alphabetic Index of ICD-10-CM, but provide additional instruction. Adherence to these guidelines when assigning ICD-10-CM diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA). The diagnosis codes (Tabular List and Alphabetic Index) have been adopted under HIPAA for all healthcare settings. A joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. These guidelines have been developed to assist both the healthcare provider and the coder in identifying those diagnoses that are to be reported. The importance of consistent, complete documentation in the medical record cannot be overemphasized. Without such documentation accurate coding cannot be achieved. The entire record should be reviewed to determine the specific reason for the encounter and the conditions treated.

Download or read book Hospice and Palliative Care Handbook Fourth Edition Quality Compliance and Reimbursement written by Tina M. Marrelli and published by Sigma Theta Tau. This book was released on 2023-06-23 with total page 246 pages. Available in PDF, EPUB and Kindle. Book excerpt: “This book is a perfect blend of compassion and competence that addresses the core values of care, the interdisciplinary team, self-care of staff, and the needs of an aging society.” –Betty Ferrell, PhD, FAAN, FPCN, CHPN Professor and Director, Nursing Research, City of Hope Medical Center Principal Investigator, End-of-Life Nursing Education Consortium “A must-read for all hospice providers. It is a comprehensive overview of the core elements required to practice effectively, compliantly, safely, and compassionately. An indispensable addition to all hospice libraries.” – Kim Corral, MA Ed, BSN, RN, COS-C Director of Corporate Compliance, Quality and Education Bridge Home Health and Hospice “I have utilized Tina Marrelli’s home health and hospice handbooks to support training new clinical staff and students for decades and consider these resources to be the gold standard.” – Kimberly Skehan, MSN, RN, HCS-D, COS-C Vice President of Accreditation Community Health Accreditation Partner Hospice & Palliative Care Handbook, Fourth Edition, offers updated coverage of all aspects of hospice and palliative care for the entire healthcare team who provide important care while meeting difficult multilevel regulations. This edition includes examples and strategies covering key topics related to standards, guidelines, goals, and effective care planning. TABLE OF CONTENTS Prologue: Hospice and Covid-19: A Pandemic Part 1: Hospice Care: An Overview of Quality and Compassionate Care Part 2: Documentation: An Important Driver for Care and Coverage Part 3: Planning, Managing, and Coordinating Hospice Care Part 4: Hospice Diagnoses and Guidelines for Care Alzheimer’s Disease and Other Dementias Care Bedbound, Coma, and Skin Care Cancer Care Cardiac and Cerebrovascular Accident (Stroke) Care Frailty and Geriatric Care Liver Disease Care Neurological Disease Care Pediatric Care: A Very Special Patient Population Pulmonary Care Renal Disease Care Skin and Wound Care Resources ABOUT THE AUTHORS TINA. M. MARRELLI, MSN, MA, RN, FAAN, is the author of over 10 award-winning books. She is an international consultant specializing in home care and hospice and is the President of Marrelli & Associates, Inc., a publishing and consulting firm working in healthcare and technology for over 25 years. JENNIFER KENNEDY, EdD, BSN, RN, CHC, is the Vice President for Quality, Standards, and Compliance at Community Health Accreditation Partner (CHAP) and is a nationally recognized hospice expert. She has more than 35 years of experience as a leader and nurse in diverse healthcare settings and has worked in hospice and palliative care for more than 25 years.

Download or read book Provider based Entities written by Gina M. Reese and published by Hcpro, a Division of Simplify Compliance. This book was released on 2017 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book serves as a comprehensive guide to provider-based clinics, from qualifying under CMS, to unique billing and coding rules, and the business decisions behind owning or acquiring these clinics. It will help readers sort through the complex regulations relevant to this unique provider type, and provide insight into recent changes, such as the introduction of Modifier -PO. CMS is looking to implement the Section 603 provisions of the Bipartisan Budget Act of 2015 regarding off-campus, provider-based departments (PBD) by January 1, 2017, according to the 2017 OPPS proposed rule. The agency is proposing to pay the nonfacility or office Medicare Physician Fee Schedule (MPFS) amount to the performing/supervising physician and preclude hospitals from billing on a UB-04 form or receiving OPPS payment for services performed at these locations for 2017, but plans to explore other options for 2018 and beyond. Physicians would be paid at the higher nonfacility rate of the MPFS, but only hospitals that have employed or contracted physicians that reassign their billing to the hospital would get paid under the MPFS for these services. Hospitals would be able to bill claims on CMS-1500 forms for physicians who have already reassigned their billing to the hospital, as in the case of employed physicians. Otherwise, hospitals would have the option of enrolling the location as the type of provider or supplier it wishes to bill to meet the requirements of that payment system (e.g., ambulatory surgery center or group practice).

Download or read book Medicaid Eligibility Quality Control written by United States. Social and Rehabilitation Service and published by . This book was released on 1975 with total page 460 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Care Without Coverage written by Institute of Medicine and published by National Academies Press. This book was released on 2002-06-20 with total page 213 pages. Available in PDF, EPUB and Kindle. Book excerpt: Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.

Download or read book Fast Facts for the Hospice Nurse written by Patricia Moyle Wright, PhD, MBA, MSN, CRNP, ACNS-BC, CHPN, CNE, FPCN and published by Springer Publishing Company. This book was released on 2017-01-28 with total page 209 pages. Available in PDF, EPUB and Kindle. Book excerpt: An on-the-go reference for hospice nurses and those interested in end-of-life care, this practical guide covers the essential elements in the compassionate and holistic care of terminally ill patients and their families. Nurses care for patients facing end-of-life issues in every practice specialty and, as the U.S. population continues to age, the need for proficiency in end-of-life skills will become increasingly important. Fast Facts for the Hospice Nurse: A Concise Guide to End-of-Life Care is an invaluable resource that provides emotional, administrative, and palliative support, whether in a hospice, long-term care facility, or acute care setting. This vital go-to text clearly and concisely lays out not only how to care for patients facing end-of-life issues, but also how to engage in self-care and cope with occupational stress. Beginning with an overview of hospice care, including its history and philosophy, this book offers a timeline of the growth of the hospice movement in the United States. Subsequent sections include up-to-date information on the clinical responsibilities of the hospice nurse in addressing the physical, psychological, and spiritual needs of terminally ill patients and their families in a culturally sensitive way. This book also outlines the administrative duties of the hospice nurse, including hospice documentation, a review of hospice regulations, and quality management. The closing section focuses on occupational stress in hospice nursing and how to engage in self-care. This text can serve as a useful clinical resource and also as a reference for nurses seeking hospice certification from the Hospice and Palliative Credentialing Center. Key Features Organized within the context of the scope and standards of practice of the Hospice and Palliative Nurses Association. Addresses key points about issues unique to hospice nursing and highlights evidence-based interventions Addresses important Medicare regulations and reimbursement Offers numerous clinical resources to assist with hospice nursing practice Serves as a concise study resource for hospice nursing certification