PCA Compliance Report

NOTE: Effective April 1, 2014 Medical Assistance (MA) will only accept the revised CMS-1500 form (02-12) version

H.R. 1247/S.297, the Improving Veterans Access to Quality Care Act of 2015 (would allow NP’s full practice authority within the VHA system)

The first piece of legislation (one legislation I discussion 2 pieces of that) discuss is section 101 part of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), a bipartisan legislation signed into law on April 16, 2015. This law was created to replace the current law in that time Medicare reimbursement schedule with, the revolutionary idea of new program supposed directed focus on the quality, value and accountability of the national health care program. The CMS describe MACRA as a modern system new payment framework, supposed rewarded the national health care providers to obtain the better care instead of more service, looking for value over volume. The information’s observed in the interview provides consistent points

BH is a 62-year old African American Male who presents to Daybreak Clinic on September 2, 2015 for his routine follow-up exam for his hypertension, gout, and chronic back pain. His labs were collected Monday, August 31 and will be reviewed today. He reports that he has been out of his medications for a week due to needing a refill. He has a refill available that he reports he was unaware of. This will be his last visit to Daybreak due to his Social Security and Disability approvals. In addition to his medical needs today, he is requesting a letter of competency in order to be able to personally receive his Social Security check.

A practice change in a non-VA primary care practice led by a Nurse Practitioner (NP) that includes identifying eligible veterans and utilizing the referral process guidelines to peer support services. In the Veterans Choice Program, 2015 the authorization for all non-VA medical care for veterans who resides more than 40 miles from a VA health care clinic or is not able to obtain a medical appointment within 30 days is eligible to receive care from a non-VA entity. The consignment of all medical care appointments are over sought by Health Net, which authorizes all non-service, secured care. PCPs are highly fortified to communicate with veterans with a courtesy memorandum for their medical appointment. PCPs must adhere to the subsequent standards

This was placed to be presented at the Federal Register on July 7, 2016. It updates payment policies, payment rates, and other requirements for healthcare services provided under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2017. It is one of the several proposed rules that present a broader Administration

Would you please correct the patient sliding fee scale information that being entered incorrectly under the patient policies tab. I review the patient household family income ($22,432.41 for 3 family members) and the sliding fee scale level is B and under the patient policies tab the Sliding fee scale was selected as a Scale A and this is incorrect . You FWD message to the billing pool and PMG FWD back to the billing department b/c the information don't match. Please do the appropriate corrections and email me back so I can advise PMG.

The conference offers workshops that will clarify changes in the new Medicare policies as well as provide information detailing the supplemental insurance policies available to patients. This training offers a wonderful benefit to North Shore because when all care coordinators are educated about the new Medicare policies and can calculate the correct supplemental insurance plans for each patient, coordinators can recover treatment costs for the clinic. While the total cost to attend this conference is $18,000, this amount pales in comparison to the treatment costs that will be recovered due to the education of the clinic’s patient coordinators. Knowledge of the Medicare changes can help coordinators recover, for the clinic, up to or exceeding $50,000, per patient, in some cases. Therefore this one time cost will reap large returns down the

After many calls to Dr. Vanderjagt’s office, a prescription order was obtained and faxed to Hope Network. I have spoken with Hope Network and confirmed that they are able to accommodate the therapy recommended by the FCE. I have made many calls to Hope Network working on providing them the open claim letter and also the FCE. On 10/13/17 I scanned and faxed the FCE and open claim letter again and confirmed they received it.

CMS as to give more time for the Clinical groups and physicians to be ready for this payment systems it passed few rules to provide further flexibility for the above included groups to let them “pick their pace” and help them avoid penalties. Secondly, CMS shortened the reporting period to

Would you please resubmit the patient DOS 09122017 v#15852640. The patient guarantor just call me very upsed b/c he receive the EOB and he said that we are billing ot his insurance one E&M CODE that we are not suppost to be billed b/c that was a procedure order that the patient needs to get done outside and not at WFH. I review the office notes and the provider order a ECHO exam of heart(93307) but, the provider by mistake select this procedure as a billed procedure and PMG FWD to the payer. Would you please re-bill the service back to the payer with the billing correction ASAP so the patient can get done this procedure. I advise the guarantor that are we are going to make the necessary corrections ASAP. The guarantor understood and he said

The documentation submitted includes a recertification for home health care dated August 4, 2014, as billed. However, the plan of care

Before I submitted the monthly support monitoring planner calendar I went over all the questions and answered correctly based on the Russian translator. First I dated the calendar for the month of June. The participant was able to contact via phone. The participant do not concerns with a Medicaid services provision and also not need emergency backup provider. The participant’s do not have issues with non-medical services. Also, the participant’s do not significant changes in health status also life changes. The participant’s current plan of services does not need modification at the moment and also the participant’s devices present and visible in the home. Finally submitted the document for the DHMH evaluate.

Rasheeda was approved PTO on January 17, 2018, for son using FLMA. Marianne was aware of Rasheeda coming in late and Marianne felt that coverage was not needed. Rasheeda used four (4) PTO due to weather climate. Towards the end of the day, Rasheeda informed me that she would be leaving a little late; she needed

provided by the Centers for Medicare and Medicaid Services (CMS) for patients that are 55 and