Description
Accrediting agencies are looking at the Conditions of Participation (CoPs), however, the Centers for Medicare & Medicaid Services (CMS) uses the Medicare benefit policy manual which contains the conditions of payment; your agency needs to understand both. Backend Quality Assurance (QA) and Performance Improvement (PI) slows down both identification and resolution of issues and pushes the timeline for improvement in stars, Value-Based Purchasing (VBP) to a year or more. Agencies are often blind sided with Additional Documentation Reviews (ADR), Recovery Auditor Contractor (RAC), and Zone Program Integrtity Contractor (ZPIC) audits despite high marks on surveys because they are auditing from accrediting guidelines, not CMS triggers. CMS is using algorithms to look at every OASIS you submit. Top triggers are over utilization and indications that medical necessity and homebound status are questionable. New CoPs are only meeting the requirements accrediting agencies are already using.
Course Instructor - Kristi Bajer and Michael McGowan
Objectives
- Understand why a good survey does not protect against audits (or help you pass).
- Learn the difference between CMS and accrediting agencies audit triggers.
- Stop confusing your billing audit with a QAPI program.
- Understand how to get the data you need.
- Introduce the concept offront end QA — it’s too late to fix once CMS has it.
- Understanding the importance of using data to drive patient care.
Certificate
By completing/passing this course, you will attain the certificate HCAF Course Certificate
Learning Credits
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