lwconsulting

Federal Regulations Governing the Resident Assessment Instrument Process

The statutory authority for the Resident Assessment Instrument (RAI) is located in the Social Security Act  amended by the Omnibus Budget Reconciliation Act (OBRA) of 1987 at Section 1819(f)(6)(A-B) for Medicare and 1919(f)(6)(A-B) for Medicaid. The Social Security Act requires the Secretary of the Department of Health and Human Services to specify a tool of core elements for use in conducting assessments of nursing home residents. The tool is called the Minimum Data Set (MDS). It…

Part 1 – Section GG Expansion to OBRA Assessments July 1, 2021

Nursing Facilities (NFs) in Pennsylvania are in for a change effective July 1, 2021. Section GG coding is required for the Omnibus Budget Reconciliation Act (OBRA) assessments. If your facility is not in Pennsylvania, don’t stop reading now. Some other states have already made the change to require Section GG coding for OBRA assessments. States have the option to require the completion of specific sections of the MDS since October 1, 2020. LW Consulting Inc…

Supporting Medical Necessity of CPT Code 97016

On December 14, 2018, Noridian provided an update within their “Fees and News Update,” which was published on December 17, 2018 regarding billing of CPT code 97016 for Vasopnuematic devices. Noridian reported multiple outpatient reviews have noted insufficient documentation to support use and billing for the use of vasopnuematic devices to apply pressure to an extremity to reduce swelling.Noridian provided informational guidelines and documentation expectations to meet Medicare’s coverage to support 97016.  Here are the findings/guidelines from…