The Illinois RCD Experience: Preclaim Review Success


[3272] The Illinois RCD Experience: Preclaim Review Success
An on-demand, rich-media recording of Part Two of the June 19, 2019 RCD Training Event in San Antonio.

NOW AVAILABLE - RELEASED 07/05/2019 This training program was presented on 06/19/2019 at the TAHC&H / Palmetto GBA RCD Training Event in San Antonio.

Presentation Info:

  • Presentation Date: June 19, 2019
  • TAHC&H Event: RCD - Review Choice Demonstration Training | San Antonio

Education-Training Credits:

  • TX HCSSA Administrator/Alternate Continuing Education
    • 2.0 Clock Hrs
  • Continuing Education for Nurses
    • 2.0 Contact Hr(s)
    • This program awards CNE until 06/19/2021

CE Approval Statements:
· This program meets continuing education requirements for Administrators and Alternates under Texas HCSSA licensing regulations.
· Texas Association for Home Care & Hospice is approved as a provider of nursing continuing professional development by the Texas Nurses Association - Approver, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

HCSSA Topic(s) Addressed:

  • §97.259[d][4]agency responsibilities
  • §97.260[a][6]risk assessment and management
  • §97.260[a][7]financial management

Program Description: Home Health Providers in Illinois, North Carolina, Ohio, Florida or Texas are gearing up for the implementation of the Review Choice Demonstration (RCD) in their states.

Following the Palmetto GBA RCD training presented 6/19/19, two distinguished Illinois providers - both board members of the Illinois HomeCare & Hospice Council - presented results of preclaim review and review choice in Illinois - the first state to begin. They present data from Illinois, issues impacting Illinois providers, and each one presents their own agency's experiences - along with practical tips and tested processes to help you be successful with RCD.

RCD Goals

  • Assist CMS in developing improved methods to identify, investigate, and prosecute potential fraud
  • Protect the Medicare Trust Fund
  • Reduce the rate of improper payments
  • Improve provider compliance with Medicare rules and requirements
  • Offers providers increased flexibility and choice
  • Risk-based changes to reward providers who show compliance with policies

Program Learning Outcome:

  • Participants will actively engage in the learning activity and indicate an intent to change their practice by effectively managing the Review Choice Demonstration process and ensuring appropriate clinical documentation thereby decreasing the number of non-affirmations related to poor or insufficient documentation.

TAHC&H Faculty/Presenters: Cheryl Adams, RN, BSN, MBA, Administrator, At-Home Health Care of Sparta Community Hospital and President, Illinois HomeCare & Hospice Council | Sheila Guither, MSN, RN, CWOCN, COS-C. OSF Home Care Services and Past President, Illinois HomeCare & Hospice Council

About the Presenters: Sheila Guither MSN RN, CWOCN, COS-C currently serves as Immediate Past President of the Illinois Home Care and Hospice Council. She works as the Manager of Clinical Practice and Staff Development for OSF Healthcare- Home Care and Post-Acute Services in Peoria, IL. Throughout the Illinois Preclaim Review demonstration, OSF achieved a 100% affirmation rate without compromising access to care. Sheila earned her Master’s Degree in Nursing Education from OSF Saint Francis College of Nursing, her BSN from Mennonite College of Nursing in Bloomington, IL and her Wound, Ostomy, and Continence Nurse (WOCN) certification from Emory University in Atlanta, GA. She has worked in the Home Care field for 23 years serving in various clinical and leadership roles. She resides in Bloomington, IL with her husband and three children.

Cheryl Adams RN, BSN, MBA with 40 years of clinical nursing and healthcare executive experience. Cheryl has been the administrator of At-Home Health Care of Sparta Community Hospital since its inception in 1996. Cheryl is responsible for developing, implementing and sustaining the business plan for the hospital based home health agency known as At-Home Health Care. The agency under her direction has a history of multiple deficiency free surveys, a reduction in acute care hospitalization rate, improved patient satisfaction and implementation of a telehealth program. Cheryl is credentialed as a Home Health ICD-10 Coder and OASIS Specialist. Cheryl is committed to having a voice for the home care industry and the people that are served. She feels it is important that leaders of home care ensure access to care but also quality of care to those we serve all while staying compliant with rules and regulations of home health. With the implementation of the pilot program of Pre-claim Review in IL, Cheryl has succeeded in achieving a 100% affirmation rate through the education and implementation of processes to ensure accurate, complete documentation.

[3272] The Illinois RCD Experience: Preclaim Review Success

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