Medicaid
When do patients switch from pediatric to adult waivers
On their 18th Birthday
Can we run back to back acute episodes?
No... there must be clinical justification and a 10 day break between acute episodes
Can Case Management Agencies have access to Atrezzo?
No, Atrezzo access will not be granted to CMAs. It is only to be used by HHAs to submit PARs and supporting documentation.
What 3 main things are needed in a F2F?
-Diagnosis/list need for skilled home health
-Date
-Physician signature
What is considered PHI?
individually identifiable health information
What entity manages Medicaid for Larimer County?
Foothills Gateway
When would we need a change in provider form filled out?
If we are SOCing a patient from another agency. The change in provider program transfers the PAR from one agency to another
What service provider will be first to start submitting PARs?
PT/OT/STs
Who is our biggest referral source?
WOM
Before we post pictures of patients on social media we must first obtain a....
Marketing Release Form
Where can you suggest for a parent caregiver to check on status of patient's Medicaid?
PEAK portal
Oasis starts at what age?
18
What documentation is required for a PAR?
Required documentation will include the Department-prescribed PAR Form, physician or allowed practitioner-approved Plan of Care/CMS-485, and any other medical information documenting the medical necessity for the home health services requested.
What office scored the highest for HCP surveys in Q3?
LOVELAND
What do you do if you realize there was a breach in PHI?
Contact supervisor, they will contact compliance
True or False. If a patient does not have Medicaid we will automatically turn away the referral
Fase
Timeline for timely reporting
24 hrs
Who will send the notice of action when a LTHH PAR is denied?
In the event of a denial, Acentra will be responsible for sending proper notification and will be responsible for the appeal process.
What is the best way to avoid duplication of services?
Care Coordination!!
What is the minimum necessary rule?
The HIPAA Privacy Rule requires a covered entity to make reasonable efforts to limit use, disclosure of, and requests for protected health information to the minimum necessary to accomplish the intended purpose.
What is the biggest benefit of a Medicaid waiver?
Protection from losing coverage due to assets or financial status being over the limit
True or False-
patients need a long-term diagnosis to qualify for the FCNA program.
True
Agencies have a deadline of 10 days to submit a PAR request. What if we don't have the signed Plan of Care (POC) or order?
HHAs are required to ensure their required documentation is obtained in a timely manner. Appropriately documented verbal orders are accepted; however, orders must be counter-signed by the ordering physician or allowed practitioner before billing can occur.
1,1 = $82.90
2 = $49.52
How should you dispose of PHI?
shredder