From PalmettoGBA – How are end of episode claims selected for review?

PalmettoGBA, the Medicare Administrative Contractor, has FAQ’s related to Jurisdiction 11 Home Health and Hospice issues. Occasionally they share them by email, which is the genesis of the rest of the post:

This FAQ discusses how end of episode claims are selected for a probe review. Please share this with your staff.

http://www.palmettogba.com/palmetto/providers.nsf/ls/Jurisdiction%2011%20Home%20Health%20and%20Hospice~9EBSBT7435?opendocument&utm_source=J11HHHL&utm_campaign=J11HHHLs&utm_medium=email

If you are a home health or hospice and don’t get these emails, click on this link.

Marc

Palmetto GBA Home Health Notice – Overpayment Demand Letters with reason code 7INAP

This is a notice from Palmetto GBA to Juridiction 11 Home Health Agencies regarding overpayment demand letters with a code 7INAP. If you receive one of these letters, you need to consider your options in an expeditious manner as there are deadlines for filing appeals! The text of the notice: Some home health providers are…

ANA Publishes Book on Nurse Staffing

The American Nurses Association has published “Nurse Staffing 101: A Decision-making Guide for the RN,” a guide for nurses responsible for staffing or anyone else interested in nurse staffing issues. The book covers the following questions: Historical and political setting of safe staffing Workplace, safety, and quality considerations Examples of professional nursing practice models Staffing…

A Thank You to Houston ENA

I had a chance to speak to the Houston chapter of the Emergency Nurses Association last night. I want to thank the chapter for their hospitality. It was good see a few old friends (though, unfortunately not all of my friends with Houston ENA – I’m looking at you, Debbie McCrea!) and to talk with…

Do Administrative Hearings Require a Lawyer?

I pose this as a question, but the answer is a resounding YES! I post this because my friend, Chuck Newton, recently posted on a niche practice area for security clearances. And at the bottom of the first paragraph – there was the gem of wisdom that I just had to link too: If you…

Detroit Nurse Sentenced to 30 Months in $13.8M Fraud scheme

This is another in an escalating series of convictions for healthcare fraud that were initiated by the HEAT teams from the Departments of Justice and Health & Human Services and the Centers for Medicare and Medicaid. As with most of the big cases right now, this is a Home Health case, where the parties were…

US DOJ: Dallas Home Health Company Owner Pleads Guilty to Healthcare Fraud

A Dallas area owner of a home health company has plead guilty to a healthcare fraud scheme that allegedly netted him roughly $43M according to the Department of Justice in a press release dated October 12, 2012.  The scheme was directly related to the HEAT team takedown earlier this year of Dr. Jacques Roy, who…

HHS OIG issues 2013 Work Plan – Home Health Agencies

The Office of the Inspector General for the Department of Health and Human Services issued the FY 2013 Work Plan today.  The big story has been about the Hospital readmission issue, which is a big push with CMS and PPACA (Obamacare). However, there are many areas that Home Health Agencies (and nurses) need to pay…

Public Hearing on Changes to Texas Nursing Board Rules

Earlier, I had posted an excerpt from the Texas Register regarding a proposed change to the Rules of the Texas Board of Nursing.  On June 13th, the Board posted notice of a Public Hearing on the matter (The notice is after the jump). The timing of this is interesting, because as the President-elect of The…

California CRNA’s Score Big Win

About one year ago, a post where I mentioned a study of CRNA safety brought the most comments I have had on my blog.  Well, the CRNA issue is back in a California Court ruling in California Society of Anesthesiologists v. Brown, 204 Cal. App. 4th 390. All quotes included herein are from the ruling…