Download or read book Medicare Audits in Long Term Care A Guide to Macs Racs and Zpics written by Wayne Van Halem and published by Hcpro Incorporated. This book was released on 2014-05-14 with total page 228 pages. Available in PDF, EPUB and Kindle. Book excerpt: The book Medicare Audits in Long-Term Care: A Guide to MACs, RACs, and ZPICs describes the different types of Medicare audits that nursing homes face and helps you take a proactive approach to audit preparedness. You also receive detailed descriptions of what you can expect during the different types of Medicare audits, how to conduct an internal audit, specific ways to prepare for an audit, and what to do once you have been audited.
Download or read book Medicare Audits in Long term Care written by Maureen McCarthy and published by . This book was released on 2016-10-28 with total page 238 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare Audits: A Survival Guide for Skilled Nursing Facilities Maureen McCarthy, RN, BS RAC-MT, CQP-MT Reduce the fear of an impending audit and take a proactive approach to preparedness. Medicare Audits: A Survival Guide for Skilled Nursing Facilities provides detailed guidance on the various Medicare audits SNFs face. Author Maureen McCarthy, RN, BS RAC-MT, CQP-MT, breaks down RAC, MAC, and ZPIC audits; CERT reviews; and more. Detailed descriptions, case studies, and example scenarios provide readers with the tools to understand how to prepare for each phase of an audit and what to expect once the audit is over. This book will help facilities: Gain a comprehensive understanding of the agencies responsible for conducting Medicare audits Grasp the processes and steps taken by auditors Conduct an internal audit with the provided checklists Learn their specific risk areas and vulnerabilities Understand where to focus internal compliance efforts and controls
Download or read book The Medicare Recovery Audit Contractor Program written by Duane C. Abbey and published by CRC Press. This book was released on 2017-11-15 with total page 139 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare fraud is big business, but while only a few profit from intentional malfeasance, the Centers for Medicare and Medicaid Services is now taking a closer look at everyone. The Medicare Recovery Audit Contractor Program, already infamously known as the RAC, swings into full operation in 2010 and every healthcare provider that receives payment
Download or read book Homecare Audit Prevention written by Annette Lee and published by Beacon Health, a Division of Blr. This book was released on 2010-09-24 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Homecare Audit Prevention: Compliance Tools to Protect Your Medicare Payment Annette Lee, RN, MS, COS-C, with contributions from Wayne van Halem, AHFI, CFE Home health care is under more layers of regulatory scrutiny than ever before. Plus, under health care reform, the Department of Health and Human Services will mandate that agencies have compliance programs in place. Homecare Audit Prevention is a one-of-a-kind manual that gives you guidance and tools to avoid compliance problems that could jeopardize payment. Part I outlines the current audit threats to the industry--including RACs, MACs, and ZPICs. Part II provides a sound structure to model or refine your Medicare compliance program to minimize audit risk. The companion CD-ROM is chock full of customizable compliance checklists, forms, and tests to educate staff and monitor care delivery and documentation. Use this manual to: You will learn how to: Implement or refine a Medicare compliance program to avoid audit scrutiny Protect appropriate payment by ensuring services are reasonable and necessary Compare and contrast the threats posed by new, renamed, and existing auditing bodies Learn ways to prevent and respond to RAC, MAC, and ZPIC audits Educate, monitor, and test your staff's comprehension of care delivery and documentation with customizable tools The binder includes valuable forms and checklists, including: Personnel Records Agency Education Agency Policies and Procedures Supervisory Review of Documentation Justify Home Health Aide Services Restorative Therapy Services Physician Orders Coordination of Services Home Health Aide Assignment and Supervision Patient Rights Notification During Initial Visit Ideal for homecare administrators, directors, quality improvement managers, staff educators, compliance officers, and risk managers.
Download or read book Observation Services Third Edition written by Deborah K. Hale and published by HC Pro, Inc.. This book was released on 2011-04-21 with total page 181 pages. Available in PDF, EPUB and Kindle. Book excerpt: Observation services insight from the industry's top expert Here is the essential guide for understanding observation services and the most recent regulatory guidance for inpatient admission. Author Deborah K. Hale, CCS, CCDS, uses case studies and real-life examples to examine regulatory guidelines and fiscal management, and also explains how to manage multiple payers and find an easier way to achieve reimbursement for observation services. You will also learn about the roles of nurses and physicians in observation services and how to foster an effective team approach for compliance and appropriate reimbursement. With your copy of Observation Services, Third Edition, you'll learn how to: * Assign proper level of care using real-life case studies * Implement an effective and compliant policy in accordance with the Medicare rules for observation services and instruction * Implement a payer-specific policy in compliance with the multiple payers' rules for observation services and instruction * Determine improvement opportunities and understand how to use internal and external data * Decipher the dos and don'ts for Condition Code 44 What's new in the Third Edition? * CMS and American Hospital Association interaction regarding observation use * Updated guidelines on the process for use of Condition Code 44 and proper billing * The 2011 version of ST PEPPER * New and improved strategies for accurate billing * New examples of provider liable claims * New CMS instructions required for payment * New policy and procedure examples and case studies Topics covered include: * Determining the right level of care * The consequences of incorrect level of care determination * Correcting level of care determinations * Condition Code 44 * Using data to determine improvement opportunities * The role of the physician advisor * Strategies for achieving accurate reimbursement * The Medicare appeals process Downloadable tools include: * Appeal letter templates * Level of care decision-making flowchart * Revised PEPPER report example * Observation pocket card reference * UR physician documentation templates for Condition Code 44 * Transmittal 299 Condition Code 44 * MLN Matters Clarification Condition Code 44 SE0622 Here are just a few of the tools and forms you'll find in Observation Services, Third Edition. * Appeal letter templates and sample reports * Site of service decision-making flowchart * Non-physician review worksheet * Transmittal 299 Condition Code 44 * MLN Matters Clarification Condition Code 44 SE0622 * Top volume Medicare MS-DRGs You'll receive instructions to download these and all of the forms and tools so you can use them right away!
Download or read book Practice Management Reference Guide First Edition written by AAPC and published by AAPC. This book was released on 2020-03-16 with total page 14 pages. Available in PDF, EPUB and Kindle. Book excerpt: Effectively manage the business side of medicine. Profit margin, collections, cash flow, compliance, human resources, health information, efficient business processes—the broad responsibilities and complex requirements of practice management are endless. Drop one ball in the daily juggle and the fallout can be costly. There’s never enough time, which makes it tough to stay on top of regulations and best practices. That’s where AAPC’s Practice Management Reference Guide becomes vital to your organization, providing you with one-stop access to the latest and best in practice management. From office operations to financial oversight, the Practice Management Reference Guide lays out essential guidance to help you optimize efficiency, security, and profitability. Benefit from actionable steps to streamline accounts receivable. Discover how to bring in new patients and keep the ones you have happy. Leverage real-world strategies to command payer relations, recruitment, training, employee evaluations, HIPAA, MACRA, Medicare, CDI, EHR … everything you need to ensure bountiful operations in 2020 and beyond. With the Practice Management Reference Guide, you’ll gain working knowledge covering the spectrum of practice management issues, including: Negotiating favorable payer contracts Preventing an appeals backlog Remaining audit-ready Correctly applying incident-to billing rules to maximize reimbursement Using assessment tools to evaluate your risk Preparing a risk plan and know what questions to ask Knowing how and why you should implement policies and protocols Complying with state and federal patient privacy rules
Download or read book Medical Language Instant Translator written by Davi-Ellen Chabner and published by Elsevier Health Sciences. This book was released on 2011-01-01 with total page 346 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Medical Language Instant Translator, 5th Edition equips you with the quick-reference information you need to understand even the most complicated and specialized medical terminology. This handy pocket book gives you instant access to everything from the top 100 prescription drugs to medical abbreviations, symbols, and acronyms. Based on Chabner's The Language of Medicine, this practical resource is ideal for any health care environment. Quick, portable access to key medical terms and other need-to-know information. Common diagnostic tests and procedures. Easily confused medical terms. Overview of body systems anatomy with full-color illustrations. Medical abbreviations, acronyms, symbols and more! NEW! Updated terms and definitions. NEW! Updated topics, including professional organizations and diagnostic categories.
Download or read book The Denials Management Training Handbook written by Tanja Twist and published by . This book was released on 2017-01-17 with total page 56 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Denials Management Training Handbook (Pack of 5) Tanja Twist, MBA/HCM Many hospitals struggle with denials management thanks to the complex regulations and various types of denials. Payers often send denials to the wrong person, and hospitals may lose valuable research and appeals time as a result. In addition, drafting effective appeals letters that follow Medicare's regulations can be time-consuming and difficult even for experienced staff. Worst of all, the hard work of managing denials and submitting appeals on the back end can all be wasted if there is no system to use denials data to address root causes on the front end. The Denials Management Training Handbook provides clear, concise explanations of the complex appeal guidelines for Medicare and other payers. This information is presented in an easy-to-understand handbook for distribution to staff members involved in preventing and handling appeals. This handbook will help you manage the denials management process by: Providing an overview of common denial types and appeal timelines Giving you sample forms and templates Exploring best practices for improving the denials management process throughout the revenue cycle Gliding in the use of denials data to track recurrent denials and address their causes
Download or read book Health Care Fraud and Abuse written by Aspen Health Law Center and published by . This book was released on 1998 with total page 156 pages. Available in PDF, EPUB and Kindle. Book excerpt: Stepped-up efforts to ferret out health care fraud have put every provider on the alert. The HHS, DOJ, state Medicaid Fraud Control Units, even the FBI is on the case -- and providers are in the hot seat! in this timely volume, you'll learn about the types of provider activities that fall under federal fraud and abuse prohibitions as defined in the Medicaid statute and Stark legislation. And you'll discover what goes into an effective corporate compliance program. With a growing number of restrictions, it's critical to know how you can and cannot conduct business and structure your relationships -- and what the consequences will be if you don't comply.
Download or read book Managed Care Plans written by and published by . This book was released on with total page 20 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare Secondary Payer Improvements Needed to Enhance Debt Recovery Process written by and published by . This book was released on 2004 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare Payment Policies written by United States. Congress. Senate. Committee on Finance and published by . This book was released on 1995 with total page 160 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Improving Medicare written by Adam K. Brooks and published by . This book was released on 2011 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Medicare program enables millions of beneficiaries to obtain health care services; however, lacks many of the essential elements of a high-quality, high-value and efficient health system. Program spending and utilisation have increased substantially, without corresponding improvements in beneficiaries' health. This new and important book describes the need for Medicare to move away from payment policies that encourage service volume and are indifferent to quality and toward policies that promote better value for Medicare and its beneficiaries.
Download or read book Lead with Intent written by Arne Pedersen and published by . This book was released on 2007-08 with total page 132 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Civil False Claims and Qui Tam Actions written by John T. Boese and published by Aspen Publishers. This book was released on 2010-12 with total page 1970 pages. Available in PDF, EPUB and Kindle. Book excerpt: Civil False Claims and Qui Tam Actions is an essential weapon for bringing or defending a qui tam action. This Fourth Edition, two-volume treatise provides comprehensive analysis of The Civil False Claims Statute and a balanced approach to every important aspect of case preparation and litigation -- from establishing the merits of a whistleblower claim to determining the formula for arriving at the qui tam plaintiff's award. Civil False Claims and Qui Tam Actions, frequently cited by the courts, is clearly and concisely written to: walk you, step-by-step, through each phase of case preparation, from the perspective of both plaintiff-relator and whistleblower defendant spell out the unique procedural requirements in a civil false claims action -- from the applicability of statute of limitation rules to the scope of discovery under a andquot;civil investigation demandandquot; by the federal government explain how to draft a whistleblower complaint collect, organize and interpret the controlling case law direct you to the relevant statutory whistleblower provisions, rules and regulations that apply to the issues under discussion analyze the legislative history of The False Claims Act and explains why it is essential to the success of a prosecutor's or defense's cause of action and alert you to emerging trends in civil false claims and qui tam actions For the best guidance on how to bring or defend a qui tam action, consult the civil false claims specialist - John T. Boese. John T. Boese is an expert author and litigation partner in the Washington, DC law office of Fried, Frank, Harris, Shriver andamp; Jacobson. with more than 25 years of experience in civil fraud cases, both as a former DOJ attorney and as defense counsel. In a clear and straightforward manner, he offers his expert analysis of recent developments on: The Supreme Court's decision on andquot;original sourceandquot; in Rockwell The recent trend by state legislatures to enact false claims laws that mirror the federal law. The andquot;presentmentandquot; requirement Corporate liability under The Civil False Claims Act Interpreting the public disclosure bar and original source requirement Challenges to sufficiency of FCA complaints under Rule 9(b) The Civil False Claims Act has captured the attention of any organization doing business with the federal government, for very good reasons: Virtually any person that receives, spends or uses federal money may be liable under The Civil False Claims Act. Private individuals, including employees can be whistleblowers on contractor fraud by bringing a qui tam lawsuit on behalf of the federal government - and receive up to 30% of any judgment or settlement. The courts have upheld highly creative claims brought under The Civil False Claims Act. Don't get lost in the maze of changing, complicated, and confusing qui tam provisions, whistleblower rules, and civil false claims regulations!
Download or read book Glossary of Recreation Therapy and Occupational Therapy written by David R. Austin and published by Venture Publishing (PA). This book was released on 2001 with total page 86 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Glossary of Recreation Therapy and Occupational Therapy will serve as a study guide for students and reference book for practitioners. From AA (Alcoholics Anonymous) to yoga, readers will find an eclectic listing encompassing a full range of approaches and a wide variety of activities. This glossary will be extremely beneficial for those preparing for national certification examinations or graduate school comprehensive exams.In addition to defining and/or describing almost 1,000 terms, this publication also includes approximately 300 abbreviations and symbols common to recreation therapy and occupational therapy professionals.This practical handbook will be sure to function as a valuable reference for years to come.
Download or read book Monitoring and Auditing Practices for Effective Compliance written by John Steiner, Jr. and published by . This book was released on 2002-01-01 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: This book was prepared to assist compliance officers and compliance committee members with designing and maintaining an effective corporate compliance program by providing an in-depth look at monitoring and auditing strategies and tactics.
