Does case management need to be a seven-day-a-week service, or can the service succeed with coverage five days per week? As a case manager, I need to retain staff but also provide some consistency to the patients.
This week’s Medicare updates include an advisory opinion on whether an excluded individual could be employed by an entity involved in federal healthcare programs; a pair of fact sheets on the cost and advancing care information performance category policies for MIPS in 2018; a video for medical offices on the new Medicare cards; and more!
Incorrect inpatient rehabilitation facility (IRF) claims led to $444,458 in overpayments at Memorial University Medical Center, a Savannah, Georgia-based hospital, according to a recent Office of Inspector General audit report. IRF billing compliance has been on the OIG’s radar for several years, and Medicare Administrative Contractors and supplemental medical review contractors have been placing these claims under increased scrutiny.
Inpatient rehabilitation facilities are a valuable postacute option for patients with complex medical and rehabilitative needs. But if you’re planning on referring a patient to one of these facilities, it’s becoming more important to make sure he or she meets medical criteria for the placement before making a recommendation.
Mr. A suffered a cerebrovascular accident, which has affected his ability to comprehend and communicate. Mr. A needs someone to consent for percutaneous endoscopic gastrostomy placement, but he lacks the capacity for decision-making, as certified by two physicians.
Healthcare organizations are facing challenging times. Shifting reimbursement models and the uncertainty surrounding federal programs may cause organizations to tighten their spending. Every department—from clinical to security—can feel the pinch as leadership prepares to weather the bumpy road ahead.
