by Proactive LTC Consulting | Sep 29, 2021 | ADR, Appeals, Audits, Blog, Medical Review, Medicare
The Centers for Medicare & Medicaid Services (CMS) indicated in an August 2021 MLNConnects newsletter that the targeted probe and educate (TPE) program would resume ending the temporary suspension since in place since March 2020 due to the COVID-19 public health... by Proactive LTC Consulting | Sep 13, 2021 | Blog, Compliance, COVID-19, Documentation, Medical Review, Medicare, SNF
On Sept. 8, 2021, CMS updated SE20011 (see p. 13) regarding Emergency SNF QHS and benefit period requirements under Section 1812(f) of the Social Security Act which were implemented to help restore SNF coverage for patients affected by the emergency. The update... by Proactive LTC Consulting | Aug 31, 2021 | Blog, CMS, Medical Review
CMS announced on August 12, 2021 that the MAC’s Targeted Probe and Educate (TPE) Program is restarting after a temporary pause during the Public Health Emergency. TPE involves a process of selecting providers identified based on data analysis as being at high risk for... by Proactive LTC Consulting | Jun 17, 2021 | Audits, Blog, Compliance, Medical Review, Regulatory, Reimbursement
The MACs officially resumed post-payment medical review of items and services with dates of service prior to March 2020 this past August, but according to a June 3, 2021 announcement may now officially begin conducting post-payment medical reviews for later dates of... by Proactive LTC Consulting | Jun 15, 2021 | Audits, Blog, Compliance, Medical Review, Regulatory, Reimbursement
The MACs officially resumed post-payment medical review of items and services with dates of service prior to March 2020, but may now officially begin conducting post-payment medical reviews for later dates of service. The Targeted Probe and Educate program will... by Proactive LTC Consulting | Apr 21, 2021 | Audits, Compliance, Legal, Medicaid, Medical Review, Medicare
Following a year of little to no medical review and extensive government spending, most experts forecast reimbursement compliance audits ramping up in 2021. Multiple areas are ripe for potential scrutiny, including, but not limited to PDPM coding and supportive...