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Hello!
Welcome to the April 2009 issue of THE PATHFINDER.
I'm sitting at my desk this morning with a list of topics for us to cover this month. I've been trying to prioritize them in terms of space requirements, but frankly, there's a whole lot of change coming our way. It's best that we just start down the list!
Did you dial-in for the Special Open Door Forum provided by CMS on Recovery Audit Contractors (RACs)? If you missed the conference call, an audio-recording and transcript will be available on the CMS site on the Special Open Door Forum page for 30 days beginning 4/16/09.
I would recommend that you read all the information you can on this newest audit mechanism by CMS. With the United States divided into 4 geographic regions, the RAC contracted for your region will perform the recovery audit services for all Medicare claim types in that region. The contractor phase-in program began March 1.
With a list of what "improper payments" will and will not be subject to RAC review identified and with the RACs required to follow Medicare policies in making determinations, Medicare providers will be subjected to "automated" reviews and "complex" reviews.
In preparation, providers need to
- educate all levels of their organization about the RAC program;
- proactively audit perceived organizational vulnerabilities and take corrective action;
- develop a plan and internal processes to respond to RAC medical records requests, reviews and determinations;
- know how to navigate the Medicare appeals process
Without much fanfare, it appears that Congress is beginning to act on the concept of "bundling" payments which is scheduled to begin in 2013. "Bundling" is projected to increase DRG payments to hospitals and requiring the hospitals to provide ALL POST ACUTE CARE for a period of 30 days. If the post-acute services are ineffective, the hospitals would be at financial risk.
Therefore, if this proposal is adopted, hospitals will be highly motivated to choose providers who can document their outcomes. For a home health provider that means your re-hospitalization rate must clearly demonstrate your ability to keep patients out the hospital after a post-acute stay.
With nearly 20% of all Medicare beneficiaries rehospitalized within 30 days of a hospital stay and with an estimate of $17.4billion in Medicare cost in unplanned rehospitalizations in 2004, there is no avoiding the need to focus on this area for substantial improvement.
On 4/9/09, the FDA reversed its decision which had previously ordered manufacturers to stop making liquid morphine. (Liquid morphine was developed so long ago that it never received FDA approval.) After protests by hospices, the FDA reconsidered its previous direction. Liquid morphine can continue to be manufactured and dispensed until it is replaced by an approved version or some equivalent therapy.
Last bit of news - President Obama has established a new office -White House Office of Health Reform - by executive order and appointed Nancy-Ann DeParle as its Director. (Oh my!)
I feel that we are fortunate this month to have our newsletter articles written by Lynn Serra and Barbara Gray, both Senior Associates for Beth Carpenter and Associates.
In the first of a two-part series, Lynn Serra will bring us "up to speed" on ACHC, the newest accreditation organization.
And Barbara Gray writes the first of her two articles on Continuous Care services - a poorly understood hospice benefit.
So on this spring day with the Easter bunny a recent visitor and with the memory of my granchildren's squeals as they found the chocolate treasures, I wish you bright sunny days, beautiful spring flowers to enjoy and a reliable list of recipes for left-over hard boiled eggs!
If we can provide you with any assistance, please do not hesitate to contact us.
Best wishes, Beth Carpenter
"Let us realize that the privilege to work is a gift, that the power to work is a blessing, that the love of work is success" David O. McKay
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