Healthcare Provider Solutions

Archives: 2020, February

Hospice Targeted Probe and Educate – Avoid Claim Denials

By Leslie Heagy, RN, COS-C / Posted on: February 25, 2020

Targeted Probe and Educate (TPE) is continuing to be a problem for Hospice providers with some advancing to rounds 2 and 3 of the audit. This demonstration, which includes hospices receiving 20-40 claim requests for Additional Development Requests (ADR) in each round, have hospices wondering if they are going to be targeted next. In order to avoid advancing to the next round of TPE, the hospice’s calculated error percentage at the end of each round must be less than the percentage set by the MAC.

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PDGM Series: Top Five Ways to Avoid Losses!

By Melinda A. Gaboury, CEO / Posted on: February 11, 2020

Agencies across the nation are trying to figure out the best practices for being successful under PDGM. Explore the Top 5 things agencies should focus on to avoid significant losses under PDGM.

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Documenting Hospice Eligibility for a Cardiopulmonary Diagnosis

By Leslie Heagy, RN, COS-C / Posted on: February 4, 2020

When documenting hospice eligibility for a cardiopulmonary diagnosis you MUST go beyond the disease-specific LCD guidelines to avoid denial under medical review.  Many people who suffer from advanced cardiopulmonary disease share multiple symptoms as the disease progresses, however, the symptoms affect each patient differently and therefore, must be documented this way in order to support each patient’s terminal condition.

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