All Medicare certified home care and hospice agencies are required to conduct quarterly clinical compliance chart reviews per the Conditions of Participation (COPs). HPS is prepared to help you meet this requirement. HPS can perform these reviews on a quarterly, semi-annually, annually or on an as needed basis. These reviews can be performed on-site or remotely at our offices.
The charts will be reviewed for following the frequency and duration of orders, physician orders being signed prior to billing, OASIS being submitted prior to billing, etc. You will also be provided a full Utilization Review Summary.
Our review staff will be available for one on one consultations with clinical staff that are struggling with home care or hospice documentation. All chart reviews will be conducted by qualified consultants with the clinical and billing expertise necessary to identify compliance and regulatory issues to maintain seamless documentation. .
Medicare ADR/RAC/ZPIC Chart Reviews
In the home care and hospice industry there is nothing more common place than multiple layers of review by governmental contractors. HPS can assist with reviewing charts that have been selected for Additional Development Request (ADR) reviews, Recovery Audit Contractors (RAC) reviews and Zone Program Integrity Contractors (ZPIC). These review processes can impact the agency from a cash flow/revenue standpoint and will hold agencies to the documentation requirements of the Conditions of Participation as well as applicable billing regulations. CMS has promised to increase the number of reviews to be performed. HPS will equip agencies to not only be successful at completing paperwork to be reviewed, but to be successful at decreasing denial levels due to improving documentation. HPS will provide guidance on every level of the appeals process
On a regular basis, home care and hospice agencies are surveyed as a requirement for State/Medicare licensure. HPS can provide qualified consultants to conduct a mock survey to help insure success when the State surveyors show up.
The mock survey will include, but not be limited to the following processes:
Review Home Care & Hospice Organization Structure
Review Agency Policies & Procedures Manual
Evaluate Agency Personnel Files, Including Independent Contractors
Review Agency Contracts (i.e. hospice and nursing facility/DME/pharmacy, etc.)
Review minutes of governing body and PAC meetings
Review Continuing Education Program
Review Infection Control Program
Review Performance Improvement Program
Review Emergency Preparedness Program
Review QAPI Program
Review Volunteer Program
Review Bereavement Program
In addition to the above procedures, HPS will also clinically review a sample of patient charts to identify compliance and regulatory documentation issues and perform home visits with a sample of clinicians.