RAC Scrutiny, Audit Findings from RAC-like Surveys
Summary: Learn what's
coming in RAC audits.
HCSSA Topic(s) Addressed:
§558.259[d][4]agency responsibilities
Faculty: Cisneros, Arnie
Program Description: This program helps you prepare for audit
scrutiny. The presenter has had a front-row seat as audits performed by Fiscal
Intermediaries served as a warm-up for the RAC (Recovery Audit Contractor) era.
Having analyzed audited cases from multiple agencies in multiple states, this
program describes denied care in clinical terms that can help providers
identify claim concerns that exist in their programs. Specific dissections of
partial denials illustrate areas where clinical improvements can help agencies
re-wire care delivery for future stability and success. This program is
important for all levels of home health professionals.
Program Objectives: Upon completion of this program, the viewer will be able to:
Identify the challenges facing the Home Health industry as they confront more stringent regulatory constraints and audits
Discuss methods employed by other provider types to adapt care to meet requirements of reforms in their care delivery
Evaluate findings from Home Health audit/denial patterns experienced in other states to determine care modifications required for the audits
Outline action plans required for homecare providers to survive these challenges
About the Presenter: This program is presented by Arnie Cisneros, PT,
Owner and President of HomeHealth Strategic Management. Arnie is renowned for his adaptation of traditional care philosophies
to address current and future healthcare initiatives. A practicing clinician, Arnie provides working level insight into program
development and care consultation for providers. He authors "Home Health Forum", a bi-weekly column addressing homecare issues
and is a contributor to "The Remington Report", Caring, and Decision Health publications. He presents nationally on topics
including S.U.R.C.H. - UR for Home Health, OBQI case Conference, and PPS/P4P strategies.
Education-Training Credits:
1.5 Hrs HCSSA Administrator/Alternate
[1518] RAC Scrutiny, Audit Findings from RAC-like Surveys
[1520] S.U.R.C.H. - A Utilization Program for
Home Health
Summary:
Can hospital-like utilization review improve you agency productivity and clinical outcomes?
HCSSA Topic(s) Addressed:
§558.259[d][4]agency responsibilities
Faculty: Cisneros, Arnie
Program Description: This exciting QA program utilizes UR
mechanisms employed by hospitals to manage care. Agencies that have implemented
this methodology have enhanced clinical outcomes and improved productivity.
Accurate Start of Care programming is the first step in producing and
delivering audit-proof care, and a S.U.R.C.H.-like mechanism assures PPS
compliant programming. This program has been presented across the country and
featured in CARING magazine, The Remington Report, and Decision Health's Home
Care Outcomes in 2009.
Program Objectives: Upon completion of this program, the viewer will be able to:
Describe the history of the Medicare Home Health benefit
Discuss how the Prospective Pay System (PPS) model utilizes the Outcome and Assessment Information Set (OASIS) and
Outcome-Based Quality Improvement (OBQI) methods to identify programming
Evaluate the Service Utilization for Care in the Home (SURCH) method of utilization review and its effect on clinical and fiscal outcomes
Demonstrate the Clinical Synthesis method via interactive audience participation demos with specific nursing and rehab management scripting
Diane Levan, Director of Home Care for
South Jersey VNA states "Our nurses love SURCH..." when describing that it "can be
easily replicated by anyone".
About the Presenter: This program is presented by Arnie Cisneros, PT,
Owner and President of HomeHealth Strategic Management. Arnie is renowned for his adaptation of traditional care philosophies
to address current and future healthcare initiatives. A practicing clinician, Arnie provides working level insight into program
development and care consultation for providers. He authors "Home Health Forum", a bi-weekly column addressing homecare issues
and is a contributor to "The Remington Report", Caring, and Decision Health publications. He presents nationally on topics
including S.U.R.C.H. - UR for Home Health, OBQI case Conference, and PPS/P4P strategies.
Education-Training Credits:
1.5 Hrs HCSSA Administrator/Alternate
[1520] S.U.R.C.H. - A Utilization Program for
Home Health
[2735] Therapy Documentation: Required Rehab Content, Goal Writing, & Visit Note Production
Education-Training Credits:
1.25 Hr(s) HCSSA Administrator/Alternate
Summary: Rewiring your rehab concession to assure a skilled, audit-proof therapy program.
HCSSA Topic(s) Addressed:
§558.259[d][4]agency responsibilities
§558.260[a][3]basic principles of management in a licensed health-related setting
§558.260[a][7]financial management
Faculty: Cisneros, Arnie
Program Description: Home Health rehab reforms have
modified many therapy requirements including elimination of the 10-visit threshold, objective testing, and
ongoing re-assessment re]inement to name a few. Auditors have focused on the rehab elements of patient claims
as they produce denials for unskilled or unnecessary care delivery. The Affordable Care Act (ACA) bundling model
will focus on the rehab content in homecare programs as they seek greater efficiency under decreased utilization
to achieve cost reduction goals.
Therapy ST/LT goal production, skilled per visit documentation, patient compliance,
caregiver involvement, and discharge planning and management are all addressed by a PPS-compliant, objective test-based
therapy evaluation. Clinical case examples will outline the good and bad in current therapy documentation, with strategies
to manage successful therapy programs. Start today on rewiring your rehab concession to assure a skilled, audit-proof therapy program. Presentation Date: 08.12.2015
Program Objectives: Upon completion of this program, the viewer will be able to:
Identify current rehabilitation elements in the Medicare PPS (Prospective Payment System) Home Health model.
Describe Goal Writing for Home Health rehabilitation services.
Describe Visit Note Production for Home Health rehabilitation.
About the Presenter: Arnie Cisneros, PT, President of Home Health Strategic Management, is one of the most progressive speakers in Home Health today.
His legacy as a rehab provider across the care continuum allows for insight into contemporary healthcare delivery. He is renowned for his adaptation of traditional care philosophies to address current and
future healthcare initiatives. Arnie’s refinement of clinical delivery mechanisms, integration of new protocols at the staff level, and adaptation of traditional care philosophies has helped providers
of all sizes to achieve Medicare compliance. He has also become the leading clinical authority on the audit scrutiny that has come to the homecare industry, and is serving as a Post-Acute consultant for
CMS Pioneer ACO grant recipients.
Arnie is a contributor to CARING magazine and Decision Health publications, and presents nationally on homecare topics and care models proposed by CMS and
Med Pac for the future of the Home Health industry.
[2735] Therapy Documentation: Required Rehab Content, Goal Writing, & Visit Note Production