Brett Rager

Time to celebrate Today kicks off NAHRI's 7th annual Revenue Integrity Week! Help us recognize the work these dedicated professionals do on a daily basis. What do we do? (the definition) The basis of revenue integrity is to prevent recurrence of issues that can cause revenue leakage and/or compliance risks through effective, efficient, replicable processes and internal controls across the continuum of patient care, supported by the appropriate documentation and the application of sound financial practices that are able to withstand audits at any point in time. What do we really do? Ask A LOT of questions! Play a detective role to find root causes of challenges and issues related to revenue. Build relationships & facilitate communication among cross line departments throughout the entire revenue cycle. Work with clinical and revenue producing departments to start up new programs & services. More great things coming later this week... Join NAHRI and our panel of revenue integrity leaders and experts on June 5 from 1 to 2 p.m. Eastern for a dive into NAHRI's 2024 State of the Revenue Integrity Industry Report. Learn about current and upcoming trends in revenue integrity program structure, priorities, and responsibilities, and insights into how organizations across the country are tackling denials management, chargemaster management and charge capture, and more! Attendees are eligible for 1 CHRI CEU. Register now. https://lnkd.in/eBKvMEeR

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Exclusive Update on Medicare Coverage Determination for Special Stains and IHC Stains by Palmetto and WPS Effective July 14, 2024, two Medicare Administrative Contractors (MACs), Palmetto and WPS, have finalized their Local Coverage Determinations (LCDs) concerning medical necessity guidelines for special stains and immunohistochemical (IHC) stains. These determinations, LCD L36805 (WPS) and LCD L35922 (Palmetto), provide clear and stringent criteria under which Medicare will cover these stains. Key Points of the LCDs: *Conditions for Coverage: 1.Medical Necessity: The special stains and IHC stains must be medically necessary to ensure a complete and accurate diagnosis is reported to the treating physician. 2.Communication and Utilization: The results of the stains must be communicated to and used by the treating physician in the patient's treatment plan. 3.Documentation: The pathologist must document in the pathology report the rationale for performing the additional stains. *Prohibitions and Requirements: -A statement in the pathology report that merely says "IHC confirms the diagnosis" will not be considered sufficient for coverage. -The necessity of the stains must be justified with specific documentation within the surgical pathology report, detailing why the stains were performed and the results obtained. *Specifics of the LCD L36805 (WPS): -This policy emphasizes that reflex templates or pre-orders for special stains and IHC stains before reviewing the routine hematoxylin and eosin (H&E) stain by the pathologist are not considered reasonable and necessary. -Only the pathologist may determine the need for special stains after reviewing the routine H&E stain. -Exceptions include recognized standards of care in certain biopsies and the suspicion of infectious diseases. *Specifics of the LCD L35922 (Palmetto): -Like WPS, Palmetto’s policy requires detailed documentation of the medical necessity for special stains or IHC studies and their results in the pathology report. -The policy delineates scenarios where over-utilization or incorrect billing of these stains may occur, such as the use of pre-orders for special stains without prior review of the H&E stain. Implications for Pathologists and Healthcare Providers These determinations highlight the critical role of pathologists in ensuring that the use of special stains and IHC stains is both necessary and properly documented. Healthcare providers must ensure compliance with these guidelines to secure Medicare coverage for these diagnostic tests. Proper documentation and communication with treating physicians are paramount to adhere to these new standards. For further details, you can review the complete LCDs on the CMS website using the following LCD IDs: L36805 and L35922. #Medicare #Healthcare #Pathology #MedicalNecessity #IHCStains #SpecialStains #Palmetto #WPS

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Vital Solutions is much more than just a medical billing company. We are a full service financial and administrative support organization that was designed specifically to meet the day to day needs of Behavioral Health facilities. Our goal is to help our clients perform at the highest level so that they can meet their financial and operational goals. #medicalbilling #revenuecyclemanagement #utilizationreview #verficationofbenefits #claimscollection #licensingandaccreditation #continuiouscompliance #payercredentialing #stafftraining #staffdevelopment #competencytesting #staffonboarding #clinicaldevelopment

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It's Time For You To Have High-Quality Provider Credentialing & Enrollment Services

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Great information on a difficult subject.

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Home Health agencies, how are you managing your internal resource pool and contingent labor workforce?? _ _ _ _ I have heard from many connections who have or want to utilize a VMS that their major concern is they are built for acute care and hospital setting. What if there was a solution that was configured for home health and post acute? What if it came with a mobile app so your resources can apply for open positions that match their skillset and pick up different shifts on the fly? AMN Healthcare can help with our ShiftWise Flex and AMN Passport!! I am looking for some leaders in home health who want to better manage their workforce, to have some conversations with and get some valuable feedback on a solution that can be tailored to their needs. #internalresourcepool #contingentlabor #homehealth #postacute #vms

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In our work with healthcare organizations and communities across the country, one of our key areas of focus is talent retention. When looking at how to improve retention, Quint Studer, co-founder, discovered that employees today experience the phases of change (from accepting an offer to achieving mastery in the role) differently than they did pre-pandemic. 25-30% of employees who leave their job leave within the first 90 days and 50% leave within the first year. Effective selection and onboarding are the key to keeping people through this phase and helping them find a sense of belonging in your organization. In this 5-minute video, Quint takes a narrow focus on how to improve employee retention in your organization by guiding them through the five phases of change. Watch now: https://lnkd.in/ebek9NmA

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Remote Patient Monitoring (RPM) can offer several benefits for geriatric case managers: 1. Enhanced Monitoring: RPM allows case managers to remotely monitor the health status of their geriatric clients, including vital signs, symptoms, and medication adherence. This continuous monitoring enables early detection of health issues or changes in condition, allowing for timely intervention. Improved Care Coordination: RPM facilitates communication and collaboration among members of the healthcare team, including primary care physicians, specialists, caregivers, and family members. This ensures that everyone involved in the care of the geriatric client is informed and coordinated, leading to more comprehensive and effective care. 2. Increased Independence: RPM can support geriatric clients in maintaining their independence by providing assistance with activities of daily living (ADLs) and health management tasks while allowing them to remain in their own homes or preferred living environments. 3.Reduced Hospitalizations and Readmissions: By enabling early detection of health issues and timely intervention, RPM can help prevent hospitalizations and reduce the risk of readmissions for geriatric clients. This not only improves the quality of care but also reduces healthcare costs associated with acute care services. 4. Personalized Care Plans: RPM generates a wealth of data that can be used to tailor care plans to the individual needs and preferences of geriatric clients. This personalized approach to care ensures that interventions are targeted and effective, leading to better outcomes and higher client satisfaction. Peace of Mind for Family Members: RPM provides family members with peace of mind knowing that their loved ones are being monitored and supported, even when they are not physically present. This can alleviate caregiver stress and enhance the overall caregiving experience. 5. Proactive Management of Chronic Conditions: RPM can help case managers proactively manage chronic conditions such as diabetes, hypertension, and heart disease among geriatric clients. By monitoring key health indicators and providing timely interventions, RPM can help prevent complications and improve disease management. 6. Data-Driven Decision Making: RPM generates real-time data that can be analyzed to identify trends, patterns, and risk factors among geriatric clients. This data-driven approach to care enables case managers to make informed decisions and prioritize interventions based on the needs of their clients. Overall, RPM can enhance the quality of care, promote independence, and improve outcomes for geriatric clients while also supporting the work of care managers in providing comprehensive and coordinated care.

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Remote Patient Monitoring (RPM) can offer several benefits for geriatric case managers: 1. Enhanced Monitoring: RPM allows case managers to remotely monitor the health status of their geriatric clients, including vital signs, symptoms, and medication adherence. This continuous monitoring enables early detection of health issues or changes in condition, allowing for timely intervention. Improved Care Coordination: RPM facilitates communication and collaboration among members of the healthcare team, including primary care physicians, specialists, caregivers, and family members. This ensures that everyone involved in the care of the geriatric client is informed and coordinated, leading to more comprehensive and effective care. 2. Increased Independence: RPM can support geriatric clients in maintaining their independence by providing assistance with activities of daily living (ADLs) and health management tasks while allowing them to remain in their own homes or preferred living environments. 3.Reduced Hospitalizations and Readmissions: By enabling early detection of health issues and timely intervention, RPM can help prevent hospitalizations and reduce the risk of readmissions for geriatric clients. This not only improves the quality of care but also reduces healthcare costs associated with acute care services. 4. Personalized Care Plans: RPM generates a wealth of data that can be used to tailor care plans to the individual needs and preferences of geriatric clients. This personalized approach to care ensures that interventions are targeted and effective, leading to better outcomes and higher client satisfaction. Peace of Mind for Family Members: RPM provides family members with peace of mind knowing that their loved ones are being monitored and supported, even when they are not physically present. This can alleviate caregiver stress and enhance the overall caregiving experience. 5. Proactive Management of Chronic Conditions: RPM can help case managers proactively manage chronic conditions such as diabetes, hypertension, and heart disease among geriatric clients. By monitoring key health indicators and providing timely interventions, RPM can help prevent complications and improve disease management. 6. Data-Driven Decision Making: RPM generates real-time data that can be analyzed to identify trends, patterns, and risk factors among geriatric clients. This data-driven approach to care enables case managers to make informed decisions and prioritize interventions based on the needs of their clients. Overall, RPM can enhance the quality of care, promote independence, and improve outcomes for geriatric clients while also supporting the work of care managers in providing comprehensive and coordinated care. Call Today to Learn More About Chronica’s Medicare Part-B Funded Monitoring Harvey Bogarat, EVP Chronica Care 203:470.1073

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Discover all you need to know about CMS Exception Requests for Network Adequacy in Medicare Advantage plans! Learn about compliance rules for MAOs and ensure access to essential healthcare services. #QuestForSuccess

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One of the not-so-subtle subtexts from this Final Rule and the past several rounds of rulemaking is that CMS has grown tired of the standard Plan MO -- wait until after you see tentative Stars scores in Plan Preview II, then throw everything at the wall and see if anything sticks. CMS is cracking down and forcing Plans to check the individual measures' data long before CMS releases enough info to test whether it has a financial impact through an overall Star difference. This makes sense from CMS's perspective, but it creates a burden on Plans to police all data everywhere instead prioritizing based on impact. This, of course, leads into a shameless plug for BHA's services. We have a very good calculator underlying our Stars Multiplanner and we (and I'll be even more shameless to say me personally) are very good at picking out which measures, scores and contracts are likely to make a ratings impact. #medicareadvantage #medicarestarratings

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Today is the day! Please join Erica G. and Kevin Scalia from Netsmart for an insightful session on automating healthcare revenue cycle management. Learn how prioritizing #RCM automation can simplify reimbursement, empower staff and optimize outcomes. Secure your spot now to gain strategies driven by #data and industry trends. Register here: https://okt.to/8Eb65q #MeaningfulAI #AugmentedIntelligence #AINow

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Pesach is coming!! Long (days and) nights of cleaning and prepping are underway 😩 At Medcheck we can help clean up the complexities of the eligibility verification process! With tailored solutions for Home Health agencies, Managed Care Companies, and Med B Ancillary companies, we ensure your focus remains on growth and service excellence. 📈 #eligibilityverification #Medcheck #medicaid #medicare

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While the obvious barriers are quality and patient safety, the financial implications can be significant; Re-Work, Denials, Appeals, AR Aging, Cash and NPR = Revenue Leakage!

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Unlock the future of hospice care with our Strategic IT Review! 🌟 Our comprehensive assessment identifies technology needs for your hospice in the short, medium, and long term, perfectly aligning with your strategic objectives. Plus, we provide an easy-to-understand technology roadmap to guide you every step of the way. #HospiceTech #ITStrategy #CentralTechnology 🖥️🛣️

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Latest blog post for my Oncology Data Management/Cancer Registry connections!

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#MakingYouMoney #NoChangeToYourSystem #GetPaidWithUnisLink ✅💰If you want to learn out how message me directly… I promise you that you’ll find something valuable out of my conversation to take skills back to your practice to see where the revenue gaps are in your billing operations and processes.

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