The Centers for Medicare & Medicaid Services (CMS) has issued Memo QSO-25-14-NH, “Revised Long-Term Care (LTC) Surveyor Guidance: Significant revisions to enhance the quality and oversight of the LTC survey process,” with an effective date of April 28, 2025. One key revision pertains to the admission, transfer, and discharge agreement. In the memo, CMS clarified guidance prohibiting admission agreements from containing language that requests or requires a third-party guarantee of payment, adding examples of non-compliance.
LW Consulting, Inc. (LWCI) is a recognized leader in providing compliance, reimbursement, operational, and clinical consulting solutions across the full continuum of healthcare delivery.
We are an Independent Review Organization (IRO), performing audits under Corporate Integrity Agreements (CIA), and an expert resource to providers, attorneys, and government agencies in ensuring organizations meet the myriad of guidelines, requirements, and statutes that regulate the delivery of healthcare services. We also provide interim staffing for post-acute care providers.
Today’s compliance and risk management challenges require innovative solutions.
LWCI has the expertise and experience to achieve them.
Suite of Services
Our team includes compliance professionals, reimbursement experts, RNs, therapists, auditor-coders, and consulting physicians. Many team members possess numerous industry certifications.
Our clients receive peace of mind knowing that they have received reliable advice and guidance that improves their business.
Independent Review Organization (IRO)
We often work with attorneys for providers in negotiating with the MACs, the OIG, federal prosecutors, US Attorneys and State Agencies in evaluating medical necessity, coding and billing procedures, and negotiating the adjudication of potential overpayment, denials, and disputed claims.
LW Consulting, Inc. uniquely blends its comprehensive knowledge of the healthcare industry with a proven ability to work as a partner with healthcare attorneys. We understand the ebb and flow of the legal process. We are flexible, responsive, and complete our work when and where it is needed.
Latest Posts
Our latest whitepaper provides essential insights on how Unified Program Integrity Contractors (UPICs) operate and the potential risks they pose to healthcare providers. In this whitepaper, you’ll learn: The role of UPICs in fraud detection for Medicare & Medicaid. How UPICs conduct audits and investigations. Critical strategies for managing UPIC audits and appeals effectively. Key insights into the appeals process and how to maximize your chances of success. Don’t let a UPIC audit catch you
New Surveyor Guidance is in effect and indicates that mental health disorders in nursing home facilities need to be diagnosed by a medical practitioner. Evidence-based criteria and professional standards, such as the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), must be used and supported by documentation in the resident’s medical record. Diagnoses such as Schizophrenia and schizoaffective disorder require supporting documentation such as a DSM assessment, like all other mental
