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Group vs. Concurrent Therapy Part 1: Are You Documenting Accurately?

Since October 1, 2019, for Medicare A recipients, the Resource Utilization Groups (RUGS) IV is out and the Patient Driven Payment Model (PDPM) is in. The first two years of the transition were complicated by COVID and the PHE. But since May 2023 when the PHE ended, things have been getting back to normal. It is important to remember that although the reimbursement model has changed, the regulations outlined in the Centers for Medicare &…

Why Healthcare Providers Need to Develop Organizational Intelligence, Part 3: Organizational Intelligence and Learning

This article is the third in a multi-part series discussing the concepts of organizational intelligence and their impact on healthcare providers. You can read Part 1 here or Part 2 here. How your organization receives, processes, and acts on information is at the heart of understanding your Organizational Intelligence. Loop Learning is an excellent model that can help you quickly identify at what level your business is operating – and how to help it evolve…

Compliance Risks: Not Conducting Exclusion Checks Can Be Costly

In 1977, physicians and other practitioners were mandated to be excluded from participation in Medicare and Medicaid by the Medicare-Medicaid Anti-Fraud and Abuse Amendments, Public Law 95-142 if convicted of program-related crimes. In 1981, the Civil Monetary Penalties Law (CMPL), Public 97-35, authorized the Office of Inspector General (OIG) to impose Civil Monetary Penalties (CMPs) and exclusions against persons having submitted false of fraudulent claims to Medicare and Medicaid. In 1996-1997 the OIG’s authority also…