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By: Christa Roberts, PT, MPT, RAC-CT and Eleisha Wilkes RN, RAC-CT

The details of proposed rule LSA #18-251 were published on October 4, 2018 by the Indiana Family and Social Services Administration, and introduces plans to revamp the Medicaid program integrity requirements. LSA #18-251 is extensive and impacts the bulk of business facets for Indiana Medicaid providers, including claims filing time limits, medical record retention, provider enrollment, sanctions, audits, and provider appeals.

LSA #18-251 consolidates existing rules, clarifies requirements and adds new program integrity requirements affecting Medicaid providers. Some of the more significant changes are as follows:

  • Currently, providers have up to one year from the date of service to submit an original claim; however, under the proposed rule, providers would have to submit claims for payment within 180 days of the date of service or the claim would be denied (effective January 1, 2019).
  • Providers will be subject to a medical record retention for financial records period of 3 years following submission to Indiana Medicaid (there is currently no record retention policy).
  • The proposed rule consolidates and adds new provider enrollment requirements.
  • Medicaid payment suspension procedures authorized by Federal law are outlined.
  • A new section is added regarding provider exclusions and readmissions (specifically, the rule lists various offenses that could result in an exclusion and sets a duration of up to 3 years for such exclusion).
  • A new section describes prepayment review processes and procedures (previously only available in agency manuals).
  • The proposed rule revises existing Medicaid overpayment provisions to align with changes in Indiana law (adds a 3-year look back period for audits initiated after July 2, 2019, though may be extended to 7 years under certain circumstances).
  • Administrative appeals procedures are consolidated and changed to align with Indiana law.

LSA #18-251 is open for public comment until the public hearing, which is preliminarily scheduled for October 26, 2018. A copy of the proposed rule can be reviewed at: www.in.gov/legislative/iac/20181003-IR-405180251PRA.xml.pdf

 


 

Speak with your doctor to find out how therapy could benefit you!

Indiana hospitals are racking up millions of dollars in penalties for having too many patients return for care within a month of discharge.

Sixty-six Hoosier hospitals—including 17 in central Indiana—will see their Medicare payments docked next year by a total of about $12 million as a result of having patients readmitted within 30 days. That’s up from $9 million in penalties three years ago.

The federal government says readmissions are often unnecessary and cost taxpayers tens of billions of dollars a year for treatments that should have been caught the first time around, or were not followed up adequately.

So for the seventh consecutive year, it is using the pressure of lower reimbursements to get hospitals to improve their numbers.

Hospitals, for their part, say they are working with patients every way they can think of to keep readmissions at a minimum.

Many are sending patients home with a thick, detailed packet of discharge instructions and a month’s worth of medications. Hospitals send nurses and aides to discharged patients’ homes to see how they are doing. In some cases, patients are given vouchers for cabs or van shuttles to get to their primary care physicians for follow-up visits.

Still, the penalties keep climbing.

“It’s getting more difficult,” said Brian Tabor, president of the Indiana Hospital Association. “Hospitals have picked a lot of the low-hanging fruit in terms of strategies. And so the work gets harder and harder.”

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Hospitals are going to be looking to post-acute providers now more than ever to step-up their game. This spring, HTS launched THRIVE a turn-key system to promote successful care transitions following a post-acute stay. Our proprietary clinical programs are just another way that we move our clients forward as leaders of rehabilitation in the markets they serve. Contact us today to learn how partnering with HTS can help improve outcomes and reduce readmissions.

 


October is National Physical Therapy Month!
National Physical Therapy Month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapy may be necessary for those recovering after an illness, a fall, injury, surgery or chronic condition. Physical therapists work hard to help patients retain and regain their quality of life.

 


Speak with your doctor to find out how therapy could benefit you!

Difficulty maintaining balance are extremely pressing problems that could impact one’s safety and well-being at any age, potentially signaling the presence of a health problem. The people who are able to maintain good balance around the clock, in any given set of circumstances- whether they are standing still or moving-can control the position of their body with ease. A healthy sense of balance enables individuals to get up from their chairs in a matter of a few seconds or bend over without falling, walk on any type of surface without staggering, or climb the stairs safely. Read more

Therapy to Restore Speech Lost to Aphasia

Did you know that strokes are the fifth most common cause of disability in the U.S? Strokes can be caused by a plethora of factors, including vascular malformations, trauma, and elevated blood pressure. A stroke can impact one’s overall health and quality of life in a number of ways, by triggering multiple communication problems.  One such problem is Aphasia, a language disorder affecting the stroke sufferers’ ability to communicate, which requires speech therapy to help the sufferer learn to communicate again. People that suffer from Aphasia typically have symptoms associated with damage to the left side of their brain. The person may have difficulty finding or pronouncing words, forming sentences, misunderstanding what others say, difficulty spelling and writing sentences, and problems with counting or reading the time on a clock. Read more

Caring for aging parents requires special care and finding the best methods to overcome the stress, sadness, and anxiety that the child-parent role reversal inevitably brings along is usually a priority for caring children. Caring for an aging parent is no easy task. As a matter of fact, this job is of the most challenging family milestones, considering its wide array of complications, including emotional aspects, underlying family problems, elevated costs and lack of time. Nonetheless, when family members learn to collaborate as a solid team to protect the best interest of an aging family member, they become more able to improve the lives of their loved ones and avoid divergences that could cause even more stress and emotional trauma. Read more

Apart from being one of the most-loved months of spring, May is also known as Better Hearing and Speech Month (BHSM). Every May, BHSM offers both health care providers and the general community the chance to raise awareness about a wide range of communication disorders and support the efforts of the American Speech-Language-Hearing Association (ASHA) in enhancing access to life-altering treatment and speech therapy options. Read more