Vol. 17, Issue 2, February 01, 2015
Feb 01, 2015
Billing Alert for Long-Term Care

QWe have chronic problems with delayed discharges from Care Improvement Plus because of their pre-certification system. They require initial PT and OT assessments before they will initiate a precert for acute rehab or NH, and then they have a 48-hour turnaround time for making a decision. We had a patient that was admitted on Mon with acute CVA, needing all three disciplines. We requested acute rehab, they denied acute rehab, and then I had to initiate another precertification for NH, waiting another 48 hours. Also, we had the weekend issue. The patient was discharged on Monday after a seven-day hospital stay. If she had been on regular Medicare, she would have discharged easily on day 3 or 4. This is substandard care for the patient and unfair delayed LOS for the hospital.

Feb 01, 2015
Billing Alert for Long-Term Care

Each year, CMS calculates the Medicare fee-for-service (FFS) improper payment rate through the Comprehensive Error Rate Testing (CERT) program. CERT evaluates a statistically valid random sample of claims to determine if they were paid properly under Medicare coverage, coding, and billing rules and publishes the Medicare Fee-for-Service Improper Payment Report. The estimated 2013 Medicare FFS compliance rate?the percentage of Medicare dollars paid correctly?was 89.9%. This calculation included claims submitted during the 12-month period from July 2011 through June 2012, meaning that Medicare paid an estimated $321.4 billion correctly during this time. The report documents the results of Recovery Audit Contractors' (RAC) fiscal year 2013 auditing efforts.

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