Question about Probe review



We have a patient that total charges for claim was $1,797.89
During probe review it was found that we provided less PT visits than was
on the OASIS
RN put 12 PT visits and we actually did 6 visits so they took back $2640.69

Has anyone else ever experienced this?

Ann Stephen

«1

Comments

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    Ann

    Mediacre pays based on the HHRG not charges. The OASIS sets the payment on
    the initial RAP but is adjusted downward if fewer medicare Therapy visits
    were prformed

    James Plonsey
    President
    Medicare Training & Consulting


    In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time,
    annstephen@stephenshc.com writes:

    We have a patient that total charges for claim was $1,797.89
    During probe review it was found that we provided less PT visits than was
    on the OASIS
    RN put 12 PT visits and we actually did 6 visits so they took back $2640.69


    Has anyone else ever experienced this?


    Ann Stephen


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    Ann
     
    Mediacre pays based on the HHRG not charges. The OASIS sets the payme=
    nt on=20
    the initial RAP but is adjusted downward if fewer medicare Therapy visits=
    were=20
    prformed
     
    James Plonsey
    President
    Medicare Training & Consulting
     

    In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time,=20
    annstephen@stephenshc.com writes:

    We have a patient that total charges for claim was $1,797=
    .89=20
    During probe review it was found that we provided less PT visits th=
    an was=20
    on the OASIS
    RN put 12 PT visits and we actually did 6 visits so they took back=
    =20
    $2640.69


    Has anyone else ever experienced this?


    Ann Stephen


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  • Hello Ann.

    This is very common in ZPIC reviews.
    What I’ve been seeing lately is downcoding of therapy visits not deemed necessary when measured against the functional acuity of the patients as reported on the OASIS.
    This is where pre-rap/pre-claims utilization review can save you tons of money, and headaches.
    Let me know if you need audit tools for such.

    Michael McGowan
    michael@operacare.com
    www.operacare.com

    > On Aug 18, 2016, at 10:48 AM, PLONSEY@aol.com wrote
    >
    > Ann
    >
    > Mediacre pays based on the HHRG not charges. The OASIS sets the payment on the initial RAP but is adjusted downward if fewer medicare Therapy visits were prformed
    >
    > James Plonsey
    > President
    > Medicare Training & Consulting
    >
    > In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time, annstephen@stephenshc.com writes:
    > We have a patient that total charges for claim was $1,797.89
    > During probe review it was found that we provided less PT visits than was on the OASIS
    > RN put 12 PT visits and we actually did 6 visits so they took back $2640.69
    >
    > Has anyone else ever experienced this?
    >
    > Ann Stephen
    >
    > --
    > ******* Confidentiality Notice *******
    > This email, its electronic document attachments, and the
    > contents of its website linkages may contain confidential
    > health information. This information is intended solely
    > for use by the individual or entity to whom it is
    > addressed. If you have received this information in error,
    > please notify the sender immediately and arrange for the
    > prompt destruction of the material and any accompanying
    > attachments.
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to no mail. To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.

    Michael McGowan, MBA/HCA
    Senior Consultant/Expert Witness
    Medicare Appeals Development,LLC
    Direct 916-343-1164
    Michael@madappeals.com
    www.madappeals.com
    Time is valuable and creative thought is even more so. Don’t undervalue either.
    “Good planning and hard work lead to prosperity, but hasty shortcuts lead to poverty.”Proverbs 21:5 (NLT)
    This communication constitutes an electronic communication within the meaning of the Electronic Communications Privacy Act, 18 USC 2510, and its disclosure is strictly limited to the recipient intended by the sender of this message. This communication may contain confidential and privileged material for the sole use of the intended recipient and receipt by anyone other than the intended recipient does not constitute a loss of the confidential or privileged nature of the communications. Any review or distribution by others is strictly prohibited. If you are not the intended recipient please contact the sender by return electronic mail and delete all copies of this communication.
  • I would love to see your audit tools. Email to sharon@procaretn.com
    Thank you

    Sent from my iPhone

    On Aug 18, 2016, at 2:00 PM, michael McGowan wrote:

    Hello Ann.

    This is very common in ZPIC reviews.
    What I
  • I do need that tool.

    They took the whole payment +

    On Aug 18, 2016 1:00 PM, "michael McGowan" wrote:

    > Hello Ann.
    >
    > This is very common in ZPIC reviews.
    > What I’ve been seeing lately is downcoding of therapy visits not deemed
    > necessary when measured against the functional acuity of the patients as
    > reported on the OASIS.
    > This is where pre-rap/pre-claims utilization review can save you tons of
    > money, and headaches.
    > Let me know if you need audit tools for such.
    >
    > Michael McGowan
    > michael@operacare.com
    > www.operacare.com
    >
    > On Aug 18, 2016, at 10:48 AM, PLONSEY@aol.com wrote
    >
    > Ann
    >
    > Mediacre pays based on the HHRG not charges. The OASIS sets the payment on
    > the initial RAP but is adjusted downward if fewer medicare Therapy visits
    > were prformed
    >
    > James Plonsey
    > President
    > Medicare Training & Consulting
    >
    > In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time,
    > annstephen@stephenshc.com writes:
    >
    > We have a patient that total charges for claim was $1,797.89
    > During probe review it was found that we provided less PT visits than was
    > on the OASIS
    > RN put 12 PT visits and we actually did 6 visits so they took back $2640.69
    >
    > Has anyone else ever experienced this?
    >
    > Ann Stephen
    >
    > --
    > ******* Confidentiality Notice *******
    > This email, its electronic document attachments, and the
    > contents of its website linkages may contain confidential
    > health information. This information is intended solely
    > for use by the individual or entity to whom it is
    > addressed. If you have received this information in error,
    > please notify the sender immediately and arrange for the
    > prompt destruction of the material and any accompanying
    > attachments.
    >
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to no mail. To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    >
    > Michael McGowan, MBA/HCA
    > Senior Consultant/Expert Witness
    > Medicare Appeals Development,LLC
    > Direct 916-343-1164
    > Michael@madappeals.com
    > www.madappeals.com
    > Time is valuable and creative thought is even more so. Don’t undervalue
    > either.
    > “Good planning and hard work lead to prosperity, but hasty shortcuts lead
    > to poverty.”Proverbs 21:5 (NLT)
    > This communication constitutes an electronic communication within the
    > meaning of the Electronic Communications Privacy Act, 18 USC 2510, and its
    > disclosure is strictly limited to the recipient intended by the sender of
    > this message. This communication may contain confidential and privileged
    > material for the sole use of the intended recipient and receipt by anyone
    > other than the intended recipient does not constitute a loss of the
    > confidential or privileged nature of the communications. Any review or
    > distribution by others is strictly prohibited. If you are not the intended
    > recipient please contact the sender by return electronic mail and
    > delete all copies of this communication.
    >
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    >
  • I would be very interested in the tool too.

    Sent from my iPhone

    > On Aug 18, 2016, at 4:16 PM, Ann Stephen wrote:
    >
    > I do need that tool.
    >
    > They took the whole payment +
    >
    >
    >> On Aug 18, 2016 1:00 PM, "michael McGowan" wrote:
    >> Hello Ann.Â
    >>
    >> This is very common in ZPIC reviews.Â
    >> What I’ve been seeing lately is downcoding of therapy visits not deemed necessary when measured against the functional acuity of the patients as reported on the OASIS.Â
    >> This is where pre-rap/pre-claims utilization review can save you tons of money, and headaches.Â
    >> Let me know if you need audit tools for such.Â
    >>
    >> Michael McGowan
    >> michael@operacare.com
    >> www.operacare.com  Â
    >>
    >>> On Aug 18, 2016, at 10:48 AM, PLONSEY@aol.com wrote
    >>>
    >>> Ann
    >>> Â
    >>> Mediacre pays based on the HHRG not charges. The OASIS sets the payment on the initial RAP but is adjusted downward if fewer medicare Therapy visits were prformed
    >>> Â
    >>> James Plonsey
    >>> President
    >>> Medicare Training & Consulting
    >>> Â
    >>> In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time, annstephen@stephenshc.com writes:
    >>> We have a patient that total charges for claim was $1,797.89
    >>> During probe review it was found that we provided less PT visits than was on the OASIS
    >>> RN put 12 PT visits and we actually did 6 visits so they took back $2640.69
    >>>
    >>> Has anyone else ever experienced this?
    >>>
    >>> Ann Stephen
    >>>
    >>> --
    >>> ******* Confidentiality Notice *******
    >>> This email, its electronic document attachments, and the
    >>> contents of its website linkages may contain confidential
    >>> health information. This information is intended solely
    >>> for use by the individual or entity to whom it is
    >>> addressed. If you have received this information in error,
    >>> please notify the sender immediately and arrange for the
    >>> prompt destruction of the material and any accompanying
    >>> attachments.
    >>> ---
    >>> This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to no mail. To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >>> ---
    >>> This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >>
    >> Michael McGowan, MBA/HCA
    >> Senior Consultant/Expert Witness
    >> Medicare Appeals Development,LLC
    >> Direct 916-343-1164
    >> Michael@madappeals.com
    >> www.madappeals.com
    >> Time is valuable and creative thought is even more so. Don’t undervalue either.Â
    >> “Good planning and hard work lead to prosperity, but hasty shortcuts lead to poverty.”Proverbs 21:5 (NLT)
    >> This communication constitutes an electronic communication within the meaning of the Electronic Communications Privacy Act, 18 USC 2510, and its disclosure is strictly limited to the recipient intended by the sender of this message. This communication may contain confidential and privileged material for the sole use of the intended recipient and receipt by anyone other than the intended recipient does not constitute a loss of the confidential or privileged nature of the communications. Any review or distribution by others is strictly prohibited. If you are not the intended recipient please contact the sender by return electronic mail and delete all copies of this communication.
    >>
    >> ---
    >> This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.

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    I would be very interested in the tool too. 
    Sent from my iPhone
    On Aug 18, 2016, at 4:16 PM, Ann Stephen <annstephen@stephenshc.com> wrote:

    I do need that tool.

    They took the whole payment +

    On Aug 18, 2016 1:00 PM, "michael McGowan" <michaelmcgowan1@mac.com> wrote:
    Hello Ann. 
    This is very common in ZPIC reviews. What I’ve been seeing lately is downcoding of therapy visits not deemed necessary when measured against the functional acuity of the patients as reported on the OASIS. This is where pre-rap/pre-claims utilization review can save you tons of money, and headaches. Let me know if you need audit tools for such. 
    Michael McGowanmichael@operacare.comwww.operacare.com   
    On Aug 18, 2016, at 10:48 AM, PLONSEY@aol.com wrote





    Ann
     
    Mediacre pays based on the HHRG not charges. The OASIS sets the payment on
    the initial RAP but is adjusted downward if fewer medicare Therapy visits were
    prformed
     
    James Plonsey
    President
    Medicare Training & Consulting
     

    In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time,
    annstephen@stephenshc.com writes:

    We have a patient that total charges for claim was $1,797.89
    During probe review it was found that we provided less PT visits than was
    on the OASIS
    RN put 12 PT visits and we actually did 6 visits so they took back
    $2640.69


    Has anyone else ever experienced this?


    Ann Stephen


    --

    *******
    Confidentiality Notice *******
    This email, its electronic document
    attachments, and the
    contents of its website linkages may contain
    confidential
    health information. This information is intended solely
    for
    use by the individual or entity to whom it is
    addressed. If you have
    received this information in error,
    please notify the sender immediately
    and arrange for the
    prompt destruction of the material and any
    accompanying
    attachments.---
    This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to no mail. To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    ---
    This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    Michael McGowan, MBA/HCA
    Senior Consultant/Expert Witness
    Medicare Appeals Development,LLC
    Direct 916-343-1164
    Michael@madappeals.com
    www.madappeals.com
    Time is valuable and creative thought is even more so. Don’t undervalue either. “Good planning and hard work lead to prosperity, but hasty shortcuts lead to poverty.”Proverbs 21:5 (NLT)This communication constitutes an electronic communication within the meaning of the Electronic Communications Privacy Act, 18 USC 2510, and its disclosure is strictly limited to the recipient intended by the sender of this message.  This communication may contain confidential and privileged material for the sole use of the intended recipient and receipt by anyone other than the intended recipient does not constitute a loss of the confidential or privileged nature of the communications.  Any review or distribution by others is strictly prohibited. If you are not the intended recipient please contact the sender by return electronic mail and delete all copies of this communication.



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    ---
    This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
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  • Yes, a tool would be very helpful!

    From: Rebeca N. Grillo [mailto:phsrg@aol.com]
    Sent: Thursday, August 18, 2016 3:23 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: Re: [myhomehealth-l] Question about Probe review

    I would be very interested in the tool too.

    Sent from my iPhone

    On Aug 18, 2016, at 4:16 PM, Ann Stephen wrote:

    I do need that tool.

    They took the whole payment +

    On Aug 18, 2016 1:00 PM, "michael McGowan" wrote:
    Hello Ann.Â

    This is very common in ZPIC reviews.Â
    What I’ve been seeing lately is downcoding of therapy visits not deemed necessary when measured against the functional acuity of the patients as reported on the OASIS.Â
    This is where pre-rap/pre-claims utilization review can save you tons of money, and headaches.Â
    Let me know if you need audit tools for such.Â

    Michael McGowan
    michael@operacare.com
    www.operacare.com  Â

    On Aug 18, 2016, at 10:48 AM, PLONSEY@aol.com wrote

    Ann
    Â
    Mediacre pays based on the HHRG not charges. The OASIS sets the payment on the initial RAP but is adjusted downward if fewer medicare Therapy visits were prformed
    Â
    James Plonsey
    President
    Medicare Training & Consulting
    Â
    In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time, annstephen@stephenshc.com writes:
    We have a patient that total charges for claim was $1,797.89
    During probe review it was found that we provided less PT visits than was on the OASIS
    RN put 12 PT visits and we actually did 6 visits so they took back $2640.69

    Has anyone else ever experienced this?

    Ann Stephen

    --
    ******* Confidentiality Notice *******
    This email, its electronic document attachments, and the
    contents of its website linkages may contain confidential
    health information. This information is intended solely
    for use by the individual or entity to whom it is
    addressed. If you have received this information in error,
    please notify the sender immediately and arrange for the
    prompt destruction of the material and any accompanying
    attachments.

    ---

    This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to no mail. To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.

    ---

    This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.

    Michael McGowan, MBA/HCA
    Senior Consultant/Expert Witness
    Medicare Appeals Development,LLC
    Direct 916-343-1164
    Michael@madappeals.com
    www.madappeals.com
    Time is valuable and creative thought is even more so. Don’t undervalue either.Â
    “Good planning and hard work lead to prosperity, but hasty shortcuts lead to poverty.”Proverbs 21:5 (NLT)
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    ________________________________

    "Important Warning: This message is intended for the use of the entity or person to whom it is addressed and may contain information that is privileged and confidential. If you are not the intended recipient and received this email in error, you are hereby notified that any disclosure, copying, or distribution of this information is strictly prohibited. This disclosure is governed by applicable law. Please notify the sender by email at the address shown.Thank you for your compliance."
  • Please include me when sending sharing the tool.

    Thank you

    Alberta Jewkes, RN
    Home Health Administrator, WV Division


    On Aug 18, 2016, at 4:31 PM, Lopez, Lisa D wrote:

    Yes, a tool would be very helpful!

    From: Rebeca N. Grillo [mailto:phsrg@aol.com]
    Sent: Thursday, August 18, 2016 3:23 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: Re: [myhomehealth-l] Question about Probe review

    I would be very interested in the tool too.

    Sent from my iPhone

    On Aug 18, 2016, at 4:16 PM, Ann Stephen wrote:

    I do need that tool.

    They took the whole payment +

    On Aug 18, 2016 1:00 PM, "michael McGowan" wrote:
    Hello Ann.
  • Please include me when sharing the tool.



    Thanks,

    Courtney Fleming

    Regulatory Affairs Director



    From: Jewkes, Alberta [mailto:Alberta.Jewkes@ahss.org]
    Sent: Thursday, August 18, 2016 3:52 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: Re: [myhomehealth-l] Question about Probe review



    Please include me when sending sharing the tool.



    Thank you

    Alberta Jewkes, RN

    Home Health Administrator, WV Division




    On Aug 18, 2016, at 4:31 PM, Lopez, Lisa D wrote:

    Yes, a tool would be very helpful!



    From: Rebeca N. Grillo [mailto:phsrg@aol.com]
    Sent: Thursday, August 18, 2016 3:23 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: Re: [myhomehealth-l] Question about Probe review



    I would be very interested in the tool too.


    Sent from my iPhone


    On Aug 18, 2016, at 4:16 PM, Ann Stephen wrote:

    I do need that tool.

    They took the whole payment +



    On Aug 18, 2016 1:00 PM, "michael McGowan" wrote:

    Hello Ann.Â



    This is very common in ZPIC reviews.Â

    What I’ve been seeing lately is downcoding of therapy visits not deemed necessary when measured against the functional acuity of the patients as reported on the OASIS.Â

    This is where pre-rap/pre-claims utilization review can save you tons of money, and headaches.Â

    Let me know if you need audit tools for such.Â



    Michael McGowan

    michael@operacare.com

    www.operacare.com  Â



    On Aug 18, 2016, at 10:48 AM, PLONSEY@aol.com wrote



    Ann

    Â

    Mediacre pays based on the HHRG not charges. The OASIS sets the payment on the initial RAP but is adjusted downward if fewer medicare Therapy visits were prformed

    Â

    James Plonsey

    President

    Medicare Training & Consulting

    Â

    In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time, annstephen@stephenshc.com writes:

    We have a patient that total charges for claim was $1,797.89

    During probe review it was found that we provided less PT visits than was on the OASIS

    RN put 12 PT visits and we actually did 6 visits so they took back $2640.69



    Has anyone else ever experienced this?



    Ann Stephen




    --

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    Michael McGowan, MBA/HCA
    Senior Consultant/Expert Witness
    Medicare Appeals Development,LLC
    Direct 916-343-1164
    Michael@madappeals.com
    www.madappeals.com
    Time is valuable and creative thought is even more so. Don’t undervalue either.Â

    “Good planning and hard work lead to prosperity, but hasty shortcuts lead to poverty.”Proverbs 21:5 (NLT)

    This communication constitutes an electronic communication within the meaning of the Electronic Communications Privacy Act, 18 USC 2510, and its disclosure is strictly limited to the recipient intended by the sender of this message. This communication may contain confidential and privileged material for the sole use of the intended recipient and receipt by anyone other than the intended recipient does not constitute a loss of the confidential or privileged nature of the communications. Any review or distribution by others is strictly prohibited. If you are not the intended recipient please contact the sender by return electronic mail and delete all copies of this communication.



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    _____


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  • Please include me as well

    Thank you!!

    Sent from my iPhone

    > On Aug 18, 2016, at 5:10 PM, Courtney Fleming wrote:
    >
    > Please include me when sharing the tool.
    >
    > Thanks,
    > Courtney Fleming
    > Regulatory Affairs Director
    >
    > From: Jewkes, Alberta [mailto:Alberta.Jewkes@ahss.org]
    > Sent: Thursday, August 18, 2016 3:52 PM
    > To: Multiple recipients of list MYHOMEHEALTH-L
    > Subject: Re: [myhomehealth-l] Question about Probe review
    >
    > Please include me when sending sharing the tool.
    >
    > Thank you
    >
    > Alberta Jewkes, RN
    > Home Health Administrator, WV Division
    >
    >
    > On Aug 18, 2016, at 4:31 PM, Lopez, Lisa D wrote:
    >
    > Yes, a tool would be very helpful!
    >
    > From: Rebeca N. Grillo [mailto:phsrg@aol.com]
    > Sent: Thursday, August 18, 2016 3:23 PM
    > To: Multiple recipients of list MYHOMEHEALTH-L
    > Subject: Re: [myhomehealth-l] Question about Probe review
    >
    > I would be very interested in the tool too.
    >
    > Sent from my iPhone
    >
    > On Aug 18, 2016, at 4:16 PM, Ann Stephen wrote:
    >
    > I do need that tool.
    >
    > They took the whole payment +
    >
    >
    > On Aug 18, 2016 1:00 PM, "michael McGowan" wrote:
    > Hello Ann.Â
    >
    > This is very common in ZPIC reviews.Â
    > What I’ve been seeing lately is downcoding of therapy visits not deemed necessary when measured against the functional acuity of the patients as reported on the OASIS.Â
    > This is where pre-rap/pre-claims utilization review can save you tons of money, and headaches.Â
    > Let me know if you need audit tools for such.Â
    >
    > Michael McGowan
    > michael@operacare.com
    > www.operacare.com  Â
    >
    > On Aug 18, 2016, at 10:48 AM, PLONSEY@aol.com wrote
    >
    > Ann
    > Â
    > Mediacre pays based on the HHRG not charges. The OASIS sets the payment on the initial RAP but is adjusted downward if fewer medicare Therapy visits were prformed
    > Â
    > James Plonsey
    > President
    > Medicare Training & Consulting
    > Â
    > In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time, annstephen@stephenshc.com writes:
    > We have a patient that total charges for claim was $1,797.89
    > During probe review it was found that we provided less PT visits than was on the OASIS
    > RN put 12 PT visits and we actually did 6 visits so they took back $2640.69
    >
    > Has anyone else ever experienced this?
    >
    > Ann Stephen
    >
    > --
    > ******* Confidentiality Notice *******
    > This email, its electronic document attachments, and the
    > contents of its website linkages may contain confidential
    > health information. This information is intended solely
    > for use by the individual or entity to whom it is
    > addressed. If you have received this information in error,
    > please notify the sender immediately and arrange for the
    > prompt destruction of the material and any accompanying
    > attachments.
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to no mail. To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    > Michael McGowan, MBA/HCA
    > Senior Consultant/Expert Witness
    > Medicare Appeals Development,LLC
    > Direct 916-343-1164
    > Michael@madappeals.com
    > www.madappeals.com
    > Time is valuable and creative thought is even more so. Don’t undervalue either.Â
    > “Good planning and hard work lead to prosperity, but hasty shortcuts lead to poverty.”Proverbs 21:5 (NLT)
    > This communication constitutes an electronic communication within the meaning of the Electronic Communications Privacy Act, 18 USC 2510, and its disclosure is strictly limited to the recipient intended by the sender of this message. This communication may contain confidential and privileged material for the sole use of the intended recipient and receipt by anyone other than the intended recipient does not constitute a loss of the confidential or privileged nature of the communications. Any review or distribution by others is strictly prohibited. If you are not the intended recipient please contact the sender by return electronic mail and delete all copies of this communication.
    >
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    > ---
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    > ---
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    >
    >
    > "Important Warning: This message is intended for the use of the entity or person to whom it is addressed and may contain information that is privileged and confidential. If you are not the intended recipient and received this email in error, you are hereby notified that any disclosure, copying, or distribution of this information is strictly prohibited. This disclosure is governed by applicable law. Please notify the sender by email at the address shown.Thank you for your compliance."
    > ---
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    > ---
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    > ---
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    --Apple-Mail-E2E40592-EBB3-4037-ABE2-2B0E4FA1D935
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    Please include me as well
    Thank you!!

    Sent from my iPhone
    On Aug 18, 2016, at 5:10 PM, Courtney Fleming <cfleming@mehha.com> wrote:

    Please include me when sharing the tool.

     

    Thanks,

    Courtney Fleming

    Regulatory Affairs Director

     

    From: Jewkes, Alberta [mailto:Alberta.Jewkes@ahss.org]
    Sent: Thursday, August 18, 2016 3:52 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: Re: [myhomehealth-l] Question about Probe review

     

    Please include me when sending sharing the tool. 

     

    Thank you

    Alberta Jewkes, RN

    Home Health Administrator, WV Division

     


    On Aug 18, 2016, at 4:31 PM, Lopez, Lisa D <LDLopez@chc.net> wrote:

    Yes, a tool would be very helpful!

     

    From: Rebeca N. Grillo [mailto:phsrg@aol.com]
    Sent: Thursday, August 18, 2016 3:23 PM
    To: Multiple recipients of list MYHOMEHEALTH-L <myhomehealth-l@list.myhomehealth.com>
    Subject: Re: [myhomehealth-l] Question about Probe review

     

    I would be very interested in the tool too. 


    Sent from my iPhone


    On Aug 18, 2016, at 4:16 PM, Ann Stephen <annstephen@stephenshc.com> wrote:

    I do need that tool.

    They took the whole payment +

     

    On Aug 18, 2016 1:00 PM, "michael McGowan" <michaelmcgowan1@mac.com> wrote:

    Hello Ann. 

     

    This is very common in ZPIC reviews. 

    What I’ve been seeing lately is downcoding of therapy visits not deemed necessary when measured against the functional acuity of the patients as reported on the OASIS. 

    This is where pre-rap/pre-claims utilization review can save you tons of money, and headaches. 

    Let me know if you need audit tools for such. 

     

    Michael McGowan

    michael@operacare.com

    www.operacare.com  Â 

     

    On Aug 18, 2016, at 10:48 AM, PLONSEY@aol.com wrote

     

    Ann

     

    Mediacre pays based on the HHRG not charges. The OASIS sets the payment on the initial RAP but is adjusted downward if fewer medicare Therapy visits were prformed

     

    James Plonsey

    President

    Medicare Training & Consulting

     

    In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time, annstephen@stephenshc.com writes:

    We have a patient that total charges for claim was $1,797.89

    During probe review it was found that we provided less PT visits than was on the OASIS

    RN put 12 PT visits and we actually did 6 visits so they took back $2640.69

     

    Has anyone else ever experienced this?

     

    Ann Stephen

     

    --

    ******* Confidentiality Notice *******
    This email, its electronic document attachments, and the
    contents of its website linkages may contain confidential
    health information. This information is intended solely
    for use by the individual or entity to whom it is
    addressed. If you have received this information in error,
    please notify the sender immediately and arrange for the
    prompt destruction of the material and any accompanying
    attachments.

    ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to no mail.  To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.”  To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.

     

    Michael McGowan, MBA/HCA
    Senior Consultant/Expert Witness
    Medicare Appeals Development,LLC
    Direct 916-343-1164
    Michael@madappeals.com
    www.madappeals.com
    Time is valuable and creative thought is even more so. Don’t undervalue either. 

    “Good planning and hard work lead to prosperity, but hasty shortcuts lead to poverty.”Proverbs 21:5 (NLT)

    This communication constitutes an electronic communication within the meaning of the Electronic Communications Privacy Act, 18 USC 2510, and its disclosure is strictly limited to the recipient intended by the sender of this message.  This communication may contain confidential and privileged material for the sole use of the intended recipient and receipt by anyone other than the intended recipient does not constitute a loss of the confidential or privileged nature of the communications.  Any review or distribution by others is strictly prohibited. If you are not the intended recipient please contact the sender by return electronic mail and delete all copies of this communication.

     

    ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.”  To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.”  To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to �no mail.�  To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.

     


    "Important Warning: This message is intended for the use of the entity or person to whom it is addressed and may contain information that is privileged and confidential. If you are not the intended recipient and received this email in error, you are hereby notified that any disclosure, copying, or distribution of this information is strictly prohibited. This disclosure is governed by applicable law. Please notify the sender by email at the address shown.Thank you for your compliance."

    ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to �no mail.�  To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.”  To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
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    This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    --Apple-Mail-E2E40592-EBB3-4037-ABE2-2B0E4FA1D935--
  • please include me

    On Thu, Aug 18, 2016 at 12:59 PM, michael McGowan
    wrote:

    > Hello Ann.
    >
    > This is very common in ZPIC reviews.
    > What I’ve been seeing lately is downcoding of therapy visits not deemed
    > necessary when measured against the functional acuity of the patients as
    > reported on the OASIS.
    > This is where pre-rap/pre-claims utilization review can save you tons of
    > money, and headaches.
    > Let me know if you need audit tools for such.
    >
    > Michael McGowan
    > michael@operacare.com
    > www.operacare.com
    >
    > On Aug 18, 2016, at 10:48 AM, PLONSEY@aol.com wrote
    >
    > Ann
    >
    > Mediacre pays based on the HHRG not charges. The OASIS sets the payment on
    > the initial RAP but is adjusted downward if fewer medicare Therapy visits
    > were prformed
    >
    > James Plonsey
    > President
    > Medicare Training & Consulting
    >
    > In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time,
    > annstephen@stephenshc.com writes:
    >
    > We have a patient that total charges for claim was $1,797.89
    > During probe review it was found that we provided less PT visits than was
    > on the OASIS
    > RN put 12 PT visits and we actually did 6 visits so they took back $2640.69
    >
    > Has anyone else ever experienced this?
    >
    > Ann Stephen
    >
    > --
    > ******* Confidentiality Notice *******
    > This email, its electronic document attachments, and the
    > contents of its website linkages may contain confidential
    > health information. This information is intended solely
    > for use by the individual or entity to whom it is
    > addressed. If you have received this information in error,
    > please notify the sender immediately and arrange for the
    > prompt destruction of the material and any accompanying
    > attachments.
    >
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to no mail. To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    >
    > Michael McGowan, MBA/HCA
    > Senior Consultant/Expert Witness
    > Medicare Appeals Development,LLC
    > Direct 916-343-1164
    > Michael@madappeals.com
    > www.madappeals.com
    > Time is valuable and creative thought is even more so. Don’t undervalue
    > either.
    > “Good planning and hard work lead to prosperity, but hasty shortcuts lead
    > to poverty.”Proverbs 21:5 (NLT)
    > This communication constitutes an electronic communication within the
    > meaning of the Electronic Communications Privacy Act, 18 USC 2510, and its
    > disclosure is strictly limited to the recipient intended by the sender of
    > this message. This communication may contain confidential and privileged
    > material for the sole use of the intended recipient and receipt by anyone
    > other than the intended recipient does not constitute a loss of the
    > confidential or privileged nature of the communications. Any review or
    > distribution by others is strictly prohibited. If you are not the intended
    > recipient please contact the sender by return electronic mail and
    > delete all copies of this communication.
    >
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    >


    --
    Best Regards,

    Shawn Chacko
    Abounding Home Health Care, Inc.
    972.365.7433
  • Please include me when sending sharing the tool. Thanks!Rohit Gaandhi/CEOExperts in Home Health Management 

    Rohit Gandhi's Outlook for iOS

    _____________________________
    From: Jewkes, Alberta
    Sent: Friday, August 19, 2016 2:22 AM
    Subject: Re: [myhomehealth-l] Question about Probe review
    To: Multiple recipients of list MYHOMEHEALTH-L


    Please include me when sending sharing the tool. 
    Thank you

    Alberta Jewkes, RNHome Health Administrator, WV Division

    On Aug 18, 2016, at 4:31 PM, Lopez, Lisa D wrote:



    Yes, a tool would be very helpful!

     

    From: Rebeca N. Grillo [mailto:phsrg@aol.com]
    Sent: Thursday, August 18, 2016 3:23 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: Re: [myhomehealth-l] Question about Probe review

     

    I would be very interested in the tool too. 


    Sent from my iPhone


    On Aug 18, 2016, at 4:16 PM, Ann Stephen wrote:

    I do need that tool.

    They took the whole payment +

     

    On Aug 18, 2016 1:00 PM, "michael McGowan" wrote:

    Hello Ann. 

     

    This is very common in ZPIC reviews. 

    What I’ve been seeing lately is downcoding of therapy visits not deemed necessary when measured against the functional acuity of the patients as reported on the OASIS. 

    This is where pre-rap/pre-claims utilization review can save you tons of money, and headaches. 

    Let me know if you need audit tools for such. 

     

    Michael McGowan

    michael@operacare.com

    www.operacare.com   

     

    On Aug 18, 2016, at 10:48 AM, PLONSEY@aol.com wrote

     

    Ann

     

    Mediacre pays based on the HHRG not charges. The OASIS sets the payment on the initial RAP but is adjusted downward if fewer medicare Therapy visits were prformed

     

    James Plonsey

    President

    Medicare Training & Consulting

     

    In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time,annstephen@stephenshc.com writes:

    We have a patient that total charges for claim was $1,797.89

    During probe review it was found that we provided less PT visits than was on the OASIS

    RN put 12 PT visits and we actually did 6 visits so they took back $2640.69

     

    Has anyone else ever experienced this?

     

    Ann Stephen


     

    --

    ******* Confidentiality Notice *******
    This email, its electronic document attachments, and the
    contents of its website linkages may contain confidential
    health information. This information is intended solely
    for use by the individual or entity to whom it is
    addressed. If you have received this information in error,
    please notify the sender immediately and arrange for the
    prompt destruction of the material and any accompanying
    attachments.---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to no mail.  To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.”  To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.

     

    Michael McGowan, MBA/HCA
    Senior Consultant/Expert Witness
    Medicare Appeals Development,LLC
    Direct 916-343-1164
    Michael@madappeals.com
    www.madappeals.com
    Time is valuable and creative thought is even more so. Don’t undervalue either. 

    “Good planning and hard work lead to prosperity, but hasty shortcuts lead to poverty.”Proverbs 21:5 (NLT)

    This communication constitutes an electronic communication within the meaning of the Electronic Communications Privacy Act, 18 USC 2510, and its disclosure is strictly limited to the recipient intended by the sender of this message.  This communication may contain confidential and privileged material for the sole use of the intended recipient and receipt by anyone other than the intended recipient does not constitute a loss of the confidential or privileged nature of the communications.  Any review or distribution by others is strictly prohibited. If you are not the intended recipient please contact the sender by return electronic mail and delete all copies of this communication.

     ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.”  To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.”  To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to �no mail.�  To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.

    "Important Warning: This message is intended for the use of the entity or person to whom it is addressed and may contain information that is privileged and confidential. If you are not the intended recipient and received this email in error, you are hereby notified that any disclosure, copying, or distribution of this information is strictly prohibited. This disclosure is governed by applicable law. Please notify the sender by email at the address shown.Thank you for your compliance."
    ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to �no mail.� To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
  • Please include me when sending the tool.

    Thank you

    Tiju Thomas
    Administrator
    Living Hope Home Healthcare

    Sent from my iPhone

    > On Aug 18, 2016, at 7:40 PM, Rohit Gandhi wrote:
    >
    > Please include me when sending sharing the tool.
    > Thanks!
    > Rohit Gaandhi/CEO
    > Experts in Home Health Management
    >
    > Rohit Gandhi's Outlook for iOS
    >
    > _____________________________
    > From: Jewkes, Alberta
    > Sent: Friday, August 19, 2016 2:22 AM
    > Subject: Re: [myhomehealth-l] Question about Probe review
    > To: Multiple recipients of list MYHOMEHEALTH-L
    >
    >
    > Please include me when sending sharing the tool.
    >
    > Thank you
    >
    > Alberta Jewkes, RN
    > Home Health Administrator, WV Division
    >
    >
    > On Aug 18, 2016, at 4:31 PM, Lopez, Lisa D wrote:
    >
    > Yes, a tool would be very helpful!
    >
    > From: Rebeca N. Grillo [mailto:phsrg@aol.com]
    > Sent: Thursday, August 18, 2016 3:23 PM
    > To: Multiple recipients of list MYHOMEHEALTH-L
    > Subject: Re: [myhomehealth-l] Question about Probe review
    >
    > I would be very interested in the tool too.
    >
    > Sent from my iPhone
    >
    > On Aug 18, 2016, at 4:16 PM, Ann Stephen wrote:
    >
    > I do need that tool.
    >
    > They took the whole payment +
    >
    >
    > On Aug 18, 2016 1:00 PM, "michael McGowan" wrote:
    > Hello Ann.Â
    >
    > This is very common in ZPIC reviews.Â
    > What I’ve been seeing lately is downcoding of therapy visits not deemed necessary when measured against the functional acuity of the patients as reported on the OASIS.Â
    > This is where pre-rap/pre-claims utilization review can save you tons of money, and headaches.Â
    > Let me know if you need audit tools for such.Â
    >
    > Michael McGowan
    > michael@operacare.com
    > www.operacare.com  Â
    >
    > On Aug 18, 2016, at 10:48 AM, PLONSEY@aol.com wrote
    >
    > Ann
    > Â
    > Mediacre pays based on the HHRG not charges. The OASIS sets the payment on the initial RAP but is adjusted downward if fewer medicare Therapy visits were prformed
    > Â
    > James Plonsey
    > President
    > Medicare Training & Consulting
    > Â
    > In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time,annstephen@stephenshc.com writes:
    > We have a patient that total charges for claim was $1,797.89
    > During probe review it was found that we provided less PT visits than was on the OASIS
    > RN put 12 PT visits and we actually did 6 visits so they took back $2640.69
    >
    > Has anyone else ever experienced this?
    >
    > Ann Stephen
    >
    > --
    > ******* Confidentiality Notice *******
    > This email, its electronic document attachments, and the
    > contents of its website linkages may contain confidential
    > health information. This information is intended solely
    > for use by the individual or entity to whom it is
    > addressed. If you have received this information in error,
    > please notify the sender immediately and arrange for the
    > prompt destruction of the material and any accompanying
    > attachments.
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to no mail. To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    > Michael McGowan, MBA/HCA
    > Senior Consultant/Expert Witness
    > Medicare Appeals Development,LLC
    > Direct 916-343-1164
    > Michael@madappeals.com
    > www.madappeals.com
    > Time is valuable and creative thought is even more so. Don’t undervalue either.Â
    > “Good planning and hard work lead to prosperity, but hasty shortcuts lead to poverty.”Proverbs 21:5 (NLT)
    > This communication constitutes an electronic communication within the meaning of the Electronic Communications Privacy Act, 18 USC 2510, and its disclosure is strictly limited to the recipient intended by the sender of this message. This communication may contain confidential and privileged material for the sole use of the intended recipient and receipt by anyone other than the intended recipient does not constitute a loss of the confidential or privileged nature of the communications. Any review or distribution by others is strictly prohibited. If you are not the intended recipient please contact the sender by return electronic mail and delete all copies of this communication.
    >
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to �no mail.� To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    >
    > "Important Warning: This message is intended for the use of the entity or person to whom it is addressed and may contain information that is privileged and confidential. If you are not the intended recipient and received this email in error, you are hereby notified that any disclosure, copying, or distribution of this information is strictly prohibited. This disclosure is governed by applicable law. Please notify the sender by email at the address shown.Thank you for your compliance."
    > ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to �no mail.� To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    > ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    >
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.

    --Apple-Mail-3847BB76-2201-47CA-B65E-EBB0301A2BEA
    Content-Type: text/html;
    charset=utf-8
    Content-Transfer-Encoding: quoted-printable

    Please include me when sending the tool.
    Thank you
    Tiju ThomasAdministratorLiving Hope Home Healthcare
    Sent from my iPhone
    On Aug 18, 2016, at 7:40 PM, Rohit Gandhi <gggrohit@gmail.com> wrote:

    Please include me when sending sharing the tool. Thanks!Rohit Gaandhi/CEOExperts in Home Health Management 

    Rohit Gandhi's Outlook for iOS

    _____________________________
    From: Jewkes, Alberta <alberta.jewkes@ahss.org>
    Sent: Friday, August 19, 2016 2:22 AM
    Subject: Re: [myhomehealth-l] Question about Probe review
    To: Multiple recipients of list MYHOMEHEALTH-L <myhomehealth-l@list.myhomehealth.com>


    Please include me when sending sharing the tool. 
    Thank you

    Alberta Jewkes, RNHome Health Administrator, WV Division

    On Aug 18, 2016, at 4:31 PM, Lopez, Lisa D <LDLopez@chc.net> wrote:

    Yes, a tool would be very helpful!

     

    From: Rebeca N. Grillo [mailto:phsrg@aol.com]
    Sent: Thursday, August 18, 2016 3:23 PM
    To: Multiple recipients of list MYHOMEHEALTH-L <myhomehealth-l@list.myhomehealth.com>
    Subject: Re: [myhomehealth-l] Question about Probe review

     

    I would be very interested in the tool too. 


    Sent from my iPhone


    On Aug 18, 2016, at 4:16 PM, Ann Stephen <annstephen@stephenshc.com> wrote:

    I do need that tool.

    They took the whole payment +

     

    On Aug 18, 2016 1:00 PM, "michael McGowan" <michaelmcgowan1@mac.com> wrote:

    Hello Ann. 

     

    This is very common in ZPIC reviews. 

    What I’ve been seeing lately is downcoding of therapy visits not deemed necessary when measured against the functional acuity of the patients as reported on the OASIS. 

    This is where pre-rap/pre-claims utilization review can save you tons of money, and headaches. 

    Let me know if you need audit tools for such. 

     

    Michael McGowan

    michael@operacare.com

    www.operacare.com  Â 

     

    On Aug 18, 2016, at 10:48 AM, PLONSEY@aol.com wrote

     

    Ann

     

    Mediacre pays based on the HHRG not charges. The OASIS sets the payment on the initial RAP but is adjusted downward if fewer medicare Therapy visits were prformed

     

    James Plonsey

    President

    Medicare Training & Consulting

     

    In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time,annstephen@stephenshc.com writes:

    We have a patient that total charges for claim was $1,797.89

    During probe review it was found that we provided less PT visits than was on the OASIS

    RN put 12 PT visits and we actually did 6 visits so they took back $2640.69

     

    Has anyone else ever experienced this?

     

    Ann Stephen

     

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    Michael McGowan, MBA/HCA
    Senior Consultant/Expert Witness
    Medicare Appeals Development,LLC
    Direct 916-343-1164
    Michael@madappeals.com
    www.madappeals.com
    Time is valuable and creative thought is even more so. Don’t undervalue either. 

    “Good planning and hard work lead to prosperity, but hasty shortcuts lead to poverty.”Proverbs 21:5 (NLT)

    This communication constitutes an electronic communication within the meaning of the Electronic Communications Privacy Act, 18 USC 2510, and its disclosure is strictly limited to the recipient intended by the sender of this message.  This communication may contain confidential and privileged material for the sole use of the intended recipient and receipt by anyone other than the intended recipient does not constitute a loss of the confidential or privileged nature of the communications.  Any review or distribution by others is strictly prohibited. If you are not the intended recipient please contact the sender by return electronic mail and delete all copies of this communication.

     

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    --Apple-Mail-3847BB76-2201-47CA-B65E-EBB0301A2BEA--
  • Also include me when sending out the tool. Thank You!!

    From: Tiju Thomas [mailto:edittiju@yahoo.com]
    Sent: Thursday, August 18, 2016 9:35 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: [EXTERNAL] Re: [myhomehealth-l] Question about Probe review

    Please include me when sending the tool.

    Thank you

    Tiju Thomas
    Administrator
    Living Hope Home Healthcare

    Sent from my iPhone

    On Aug 18, 2016, at 7:40 PM, Rohit Gandhi wrote:
    Please include me when sending sharing the tool.
    Thanks!
    Rohit Gaandhi/CEO
    Experts in Home Health Management
    Rohit Gandhi's Outlook for iOS

    _____________________________
    From: Jewkes, Alberta
    Sent: Friday, August 19, 2016 2:22 AM
    Subject: Re: [myhomehealth-l] Question about Probe review
    To: Multiple recipients of list MYHOMEHEALTH-L



    Please include me when sending sharing the tool.

    Thank you

    Alberta Jewkes, RN
    Home Health Administrator, WV Division


    On Aug 18, 2016, at 4:31 PM, Lopez, Lisa D wrote:
    Yes, a tool would be very helpful!

    From: Rebeca N. Grillo [mailto:phsrg@aol.com]
    Sent: Thursday, August 18, 2016 3:23 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: Re: [myhomehealth-l] Question about Probe review

    I would be very interested in the tool too.

    Sent from my iPhone

    On Aug 18, 2016, at 4:16 PM, Ann Stephen wrote:

    I do need that tool.

    They took the whole payment +

    On Aug 18, 2016 1:00 PM, "michael McGowan" wrote:
    Hello Ann.Â

    This is very common in ZPIC reviews.Â
    What I’ve been seeing lately is downcoding of therapy visits not deemed necessary when measured against the functional acuity of the patients as reported on the OASIS.Â
    This is where pre-rap/pre-claims utilization review can save you tons of money, and headaches.Â
    Let me know if you need audit tools for such.Â

    Michael McGowan
    michael@operacare.com
    www.operacare.com  Â

    On Aug 18, 2016, at 10:48 AM, PLONSEY@aol.com wrote

    Ann
    Â
    Mediacre pays based on the HHRG not charges. The OASIS sets the payment on the initial RAP but is adjusted downward if fewer medicare Therapy visits were prformed
    Â
    James Plonsey
    President
    Medicare Training & Consulting
    Â
    In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time,annstephen@stephenshc.com writes:
    We have a patient that total charges for claim was $1,797.89
    During probe review it was found that we provided less PT visits than was on the OASIS
    RN put 12 PT visits and we actually did 6 visits so they took back $2640.69

    Has anyone else ever experienced this?

    Ann Stephen

    --
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    contents of its website linkages may contain confidential
    health information. This information is intended solely
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    prompt destruction of the material and any accompanying
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    Michael McGowan, MBA/HCA
    Senior Consultant/Expert Witness
    Medicare Appeals Development,LLC
    Direct 916-343-1164
    Michael@madappeals.com
    www.madappeals.com
    Time is valuable and creative thought is even more so. Don’t undervalue either.Â
    “Good planning and hard work lead to prosperity, but hasty shortcuts lead to poverty.”Proverbs 21:5 (NLT)
    This communication constitutes an electronic communication within the meaning of the Electronic Communications Privacy Act, 18 USC 2510, and its disclosure is strictly limited to the recipient intended by the sender of this message. This communication may contain confidential and privileged material for the sole use of the intended recipient and receipt by anyone other than the intended recipient does not constitute a loss of the confidential or privileged nature of the communications. Any review or distribution by others is strictly prohibited. If you are not the intended recipient please contact the sender by return electronic mail and delete all copies of this communication.


    ---

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    ---

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    ________________________________

    "Important Warning: This message is intended for the use of the entity or person to whom it is addressed and may contain information that is privileged and confidential. If you are not the intended recipient and received this email in error, you are hereby notified that any disclosure, copying, or distribution of this information is strictly prohibited. This disclosure is governed by applicable law. Please notify the sender by email at the address shown.Thank you for your compliance."

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    ---

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  • Please send me a copy of the tool.
    Thank you in advance
    Sandy

    Sent from my iPhone

    On Aug 18, 2016, at 3:31 PM, Lopez, Lisa D wrote:

    Yes, a tool would be very helpful!

    From: Rebeca N. Grillo [mailto:phsrg@aol.com]
    Sent: Thursday, August 18, 2016 3:23 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: Re: [myhomehealth-l] Question about Probe review

    I would be very interested in the tool too.

    Sent from my iPhone

    On Aug 18, 2016, at 4:16 PM, Ann Stephen wrote:

    I do need that tool.

    They took the whole payment +

    On Aug 18, 2016 1:00 PM, "michael McGowan" wrote:
    Hello Ann.
  • I would like a copy of the tool. cladyman@hcuinc.com

    Thank you.
    Celeste

    From: Sandra Moore [mailto:smoore@sfmc.net]
    Sent: Friday, August 19, 2016 8:14 AM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: Re: [myhomehealth-l] Question about Probe review

    Please send me a copy of the tool.
    Thank you in advance
    Sandy

    Sent from my iPhone

    On Aug 18, 2016, at 3:31 PM, Lopez, Lisa D wrote:
    Yes, a tool would be very helpful!

    From: Rebeca N. Grillo [mailto:phsrg@aol.com]
    Sent: Thursday, August 18, 2016 3:23 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: Re: [myhomehealth-l] Question about Probe review

    I would be very interested in the tool too.

    Sent from my iPhone

    On Aug 18, 2016, at 4:16 PM, Ann Stephen wrote:

    I do need that tool.

    They took the whole payment +

    On Aug 18, 2016 1:00 PM, "michael McGowan" wrote:
    Hello Ann.Â

    This is very common in ZPIC reviews.Â
    What I’ve been seeing lately is downcoding of therapy visits not deemed necessary when measured against the functional acuity of the patients as reported on the OASIS.Â
    This is where pre-rap/pre-claims utilization review can save you tons of money, and headaches.Â
    Let me know if you need audit tools for such.Â

    Michael McGowan
    michael@operacare.com
    www.operacare.com  Â

    On Aug 18, 2016, at 10:48 AM, PLONSEY@aol.com wrote

    Ann
    Â
    Mediacre pays based on the HHRG not charges. The OASIS sets the payment on the initial RAP but is adjusted downward if fewer medicare Therapy visits were prformed
    Â
    James Plonsey
    President
    Medicare Training & Consulting
    Â
    In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time, annstephen@stephenshc.com writes:
    We have a patient that total charges for claim was $1,797.89
    During probe review it was found that we provided less PT visits than was on the OASIS
    RN put 12 PT visits and we actually did 6 visits so they took back $2640.69

    Has anyone else ever experienced this?

    Ann Stephen

    --
    ******* Confidentiality Notice *******
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    contents of its website linkages may contain confidential
    health information. This information is intended solely
    for use by the individual or entity to whom it is
    addressed. If you have received this information in error,
    please notify the sender immediately and arrange for the
    prompt destruction of the material and any accompanying
    attachments.

    ---

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    ---

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    Michael McGowan, MBA/HCA
    Senior Consultant/Expert Witness
    Medicare Appeals Development,LLC
    Direct 916-343-1164
    Michael@madappeals.com
    www.madappeals.com
    Time is valuable and creative thought is even more so. Don’t undervalue either.Â
    “Good planning and hard work lead to prosperity, but hasty shortcuts lead to poverty.”Proverbs 21:5 (NLT)
    This communication constitutes an electronic communication within the meaning of the Electronic Communications Privacy Act, 18 USC 2510, and its disclosure is strictly limited to the recipient intended by the sender of this message. This communication may contain confidential and privileged material for the sole use of the intended recipient and receipt by anyone other than the intended recipient does not constitute a loss of the confidential or privileged nature of the communications. Any review or distribution by others is strictly prohibited. If you are not the intended recipient please contact the sender by return electronic mail and delete all copies of this communication.


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    ---

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    ---

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    ________________________________

    "Important Warning: This message is intended for the use of the entity or person to whom it is addressed and may contain information that is privileged and confidential. If you are not the intended recipient and received this email in error, you are hereby notified that any disclosure, copying, or distribution of this information is strictly prohibited. This disclosure is governed by applicable law. Please notify the sender by email at the address shown.Thank you for your compliance."

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  • Hi

    Can you please include me when you send the tool?

    Thank you
    On Aug 18, 2016 8:00 AM, "michael McGowan" wrote:

    > Hello Ann.
    >
    > This is very common in ZPIC reviews.
    > What I’ve been seeing lately is downcoding of therapy visits not deemed
    > necessary when measured against the functional acuity of the patients as
    > reported on the OASIS.
    > This is where pre-rap/pre-claims utilization review can save you tons of
    > money, and headaches.
    > Let me know if you need audit tools for such.
    >
    > Michael McGowan
    > michael@operacare.com
    > www.operacare.com
    >
    > On Aug 18, 2016, at 10:48 AM, PLONSEY@aol.com wrote
    >
    > Ann
    >
    > Mediacre pays based on the HHRG not charges. The OASIS sets the payment on
    > the initial RAP but is adjusted downward if fewer medicare Therapy visits
    > were prformed
    >
    > James Plonsey
    > President
    > Medicare Training & Consulting
    >
    > In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time,
    > annstephen@stephenshc.com writes:
    >
    > We have a patient that total charges for claim was $1,797.89
    > During probe review it was found that we provided less PT visits than was
    > on the OASIS
    > RN put 12 PT visits and we actually did 6 visits so they took back $2640.69
    >
    > Has anyone else ever experienced this?
    >
    > Ann Stephen
    >
    > --
    > ******* Confidentiality Notice *******
    > This email, its electronic document attachments, and the
    > contents of its website linkages may contain confidential
    > health information. This information is intended solely
    > for use by the individual or entity to whom it is
    > addressed. If you have received this information in error,
    > please notify the sender immediately and arrange for the
    > prompt destruction of the material and any accompanying
    > attachments.
    >
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to no mail. To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    >
    > Michael McGowan, MBA/HCA
    > Senior Consultant/Expert Witness
    > Medicare Appeals Development,LLC
    > Direct 916-343-1164
    > Michael@madappeals.com
    > www.madappeals.com
    > Time is valuable and creative thought is even more so. Don’t undervalue
    > either.
    > “Good planning and hard work lead to prosperity, but hasty shortcuts lead
    > to poverty.”Proverbs 21:5 (NLT)
    > This communication constitutes an electronic communication within the
    > meaning of the Electronic Communications Privacy Act, 18 USC 2510, and its
    > disclosure is strictly limited to the recipient intended by the sender of
    > this message. This communication may contain confidential and privileged
    > material for the sole use of the intended recipient and receipt by anyone
    > other than the intended recipient does not constitute a loss of the
    > confidential or privileged nature of the communications. Any review or
    > distribution by others is strictly prohibited. If you are not the intended
    > recipient please contact the sender by return electronic mail and
    > delete all copies of this communication.
    >
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    >
  • Please include me when sharing the tool as well.

    Thank you,
    Alexander K.
    HealthFlex Home Health Services

    Sent from my iPhone

    > On Aug 19, 2016, at 4:54 AM, Hilverding, Vickie wrote:
    >
    > Also include me when sending out the tool. Thank You!!
    >
    > From: Tiju Thomas [mailto:edittiju@yahoo.com]
    > Sent: Thursday, August 18, 2016 9:35 PM
    > To: Multiple recipients of list MYHOMEHEALTH-L
    > Subject: [EXTERNAL] Re: [myhomehealth-l] Question about Probe review
    >
    > Please include me when sending the tool.
    >
    > Thank you
    >
    > Tiju Thomas
    > Administrator
    > Living Hope Home Healthcare
    >
    > Sent from my iPhone
    >
    > On Aug 18, 2016, at 7:40 PM, Rohit Gandhi wrote:
    >
    > Please include me when sending sharing the tool.
    > Thanks!
    > Rohit Gaandhi/CEO
    > Experts in Home Health Management
    >
    > Rohit Gandhi's Outlook for iOS
    >
    > _____________________________
    > From: Jewkes, Alberta
    > Sent: Friday, August 19, 2016 2:22 AM
    > Subject: Re: [myhomehealth-l] Question about Probe review
    > To: Multiple recipients of list MYHOMEHEALTH-L
    >
    >
    >
    > Please include me when sending sharing the tool.
    >
    > Thank you
    >
    > Alberta Jewkes, RN
    > Home Health Administrator, WV Division
    >
    >
    > On Aug 18, 2016, at 4:31 PM, Lopez, Lisa D wrote:
    >
    > Yes, a tool would be very helpful!
    >
    > From: Rebeca N. Grillo [mailto:phsrg@aol.com]
    > Sent: Thursday, August 18, 2016 3:23 PM
    > To: Multiple recipients of list MYHOMEHEALTH-L
    > Subject: Re: [myhomehealth-l] Question about Probe review
    >
    > I would be very interested in the tool too.
    >
    > Sent from my iPhone
    >
    > On Aug 18, 2016, at 4:16 PM, Ann Stephen wrote:
    >
    > I do need that tool.
    >
    > They took the whole payment +
    >
    >
    > On Aug 18, 2016 1:00 PM, "michael McGowan" wrote:
    > Hello Ann.Â
    >
    > This is very common in ZPIC reviews.Â
    > What I’ve been seeing lately is downcoding of therapy visits not deemed necessary when measured against the functional acuity of the patients as reported on the OASIS.Â
    > This is where pre-rap/pre-claims utilization review can save you tons of money, and headaches.Â
    > Let me know if you need audit tools for such.Â
    >
    > Michael McGowan
    > michael@operacare.com
    > www.operacare.com  Â
    >
    > On Aug 18, 2016, at 10:48 AM, PLONSEY@aol.com wrote
    >
    > Ann
    > Â
    > Mediacre pays based on the HHRG not charges. The OASIS sets the payment on the initial RAP but is adjusted downward if fewer medicare Therapy visits were prformed
    > Â
    > James Plonsey
    > President
    > Medicare Training & Consulting
    > Â
    > In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time,annstephen@stephenshc.com writes:
    > We have a patient that total charges for claim was $1,797.89
    > During probe review it was found that we provided less PT visits than was on the OASIS
    > RN put 12 PT visits and we actually did 6 visits so they took back $2640.69
    >
    > Has anyone else ever experienced this?
    >
    > Ann Stephen
    >
    > --
    > ******* Confidentiality Notice *******
    > This email, its electronic document attachments, and the
    > contents of its website linkages may contain confidential
    > health information. This information is intended solely
    > for use by the individual or entity to whom it is
    > addressed. If you have received this information in error,
    > please notify the sender immediately and arrange for the
    > prompt destruction of the material and any accompanying
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    > ---
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    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to â€Å“no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    > Michael McGowan, MBA/HCA
    > Senior Consultant/Expert Witness
    > Medicare Appeals Development,LLC
    > Direct 916-343-1164
    > Michael@madappeals.com
    > www.madappeals.com
    > Time is valuable and creative thought is even more so. Don’t undervalue either.Â
    > â€Å“Good planning and hard work lead to prosperity, but hasty shortcuts lead to poverty.”Proverbs 21:5 (NLT)
    > This communication constitutes an electronic communication within the meaning of the Electronic Communications Privacy Act, 18 USC 2510, and its disclosure is strictly limited to the recipient intended by the sender of this message. This communication may contain confidential and privileged material for the sole use of the intended recipient and receipt by anyone other than the intended recipient does not constitute a loss of the confidential or privileged nature of the communications. Any review or distribution by others is strictly prohibited. If you are not the intended recipient please contact the sender by return electronic mail and delete all copies of this communication.
    >
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to â€Å“no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to �no mail.� To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    >
    > "Important Warning: This message is intended for the use of the entity or person to whom it is addressed and may contain information that is privileged and confidential. If you are not the intended recipient and received this email in error, you are hereby notified that any disclosure, copying, or distribution of this information is strictly prohibited. This disclosure is governed by applicable law. Please notify the sender by email at the address shown.Thank you for your compliance."
    > ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to �no mail.� To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    > ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    >
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to no mail. To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.

    --Apple-Mail-02343F8F-57EA-42E7-B84A-DB47CF11CBEA
    Content-Type: text/html;
    charset=utf-8
    Content-Transfer-Encoding: quoted-printable

    Please include me when sharing the tool as well.
    Thank you,Alexander K.HealthFlex Home Health Services

    Sent from my iPhone
    On Aug 19, 2016, at 4:54 AM, Hilverding, Vickie <Vickie.Hilverding@gentiva.com> wrote:

    Also include me when sending out the tool. Thank You!!

     

    From: Tiju Thomas [mailto:edittiju@yahoo.com]
    Sent: Thursday, August 18, 2016 9:35 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: [EXTERNAL] Re: [myhomehealth-l] Question about Probe review

     

    Please include me when sending the tool.

     

    Thank you

     

    Tiju Thomas

    Administrator

    Living Hope Home Healthcare


    Sent from my iPhone


    On Aug 18, 2016, at 7:40 PM, Rohit Gandhi <gggrohit@gmail.com> wrote:

    Please include me when sending sharing the tool. 

    Thanks!

    Rohit Gaandhi/CEO

    Experts in Home Health Management 

    Rohit Gandhi's Outlook for iOS

     

    _____________________________
    From: Jewkes, Alberta <alberta.jewkes@ahss.org>
    Sent: Friday, August 19, 2016 2:22 AM
    Subject: Re: [myhomehealth-l] Question about Probe review
    To: Multiple recipients of list MYHOMEHEALTH-L <myhomehealth-l@list.myhomehealth.com>



    Please include me when sending sharing the tool. 

     

    Thank you

    Alberta Jewkes, RN

    Home Health Administrator, WV Division

     


    On Aug 18, 2016, at 4:31 PM, Lopez, Lisa D <LDLopez@chc.net> wrote:

    Yes, a tool would be very helpful!

     

    From: Rebeca N. Grillo [mailto:phsrg@aol.com]
    Sent: Thursday, August 18, 2016 3:23 PM
    To: Multiple recipients of list MYHOMEHEALTH-L <myhomehealth-l@list.myhomehealth.com>
    Subject: Re: [myhomehealth-l] Question about Probe review

     

    I would be very interested in the tool too. 


    Sent from my iPhone


    On Aug 18, 2016, at 4:16 PM, Ann Stephen <annstephen@stephenshc.com> wrote:

    I do need that tool.

    They took the whole payment +

     

    On Aug 18, 2016 1:00 PM, "michael McGowan" <michaelmcgowan1@mac.com> wrote:

    Hello Ann. 

     

    This is very common in ZPIC reviews. 

    What I’ve been seeing lately is downcoding of therapy visits not deemed necessary when measured against the functional acuity of the patients as reported on the OASIS. 

    This is where pre-rap/pre-claims utilization review can save you tons of money, and headaches. 

    Let me know if you need audit tools for such. 

     

    Michael McGowan

    michael@operacare.com

    www.operacare.com  Ã‚ 

     

    On Aug 18, 2016, at 10:48 AM, PLONSEY@aol.com wrote

     

    Ann

     

    Mediacre pays based on the HHRG not charges. The OASIS sets the payment on the initial RAP but is adjusted downward if fewer medicare Therapy visits were prformed

     

    James Plonsey

    President

    Medicare Training & Consulting

     

    In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time,annstephen@stephenshc.com writes:

    We have a patient that total charges for claim was $1,797.89

    During probe review it was found that we provided less PT visits than was on the OASIS

    RN put 12 PT visits and we actually did 6 visits so they took back $2640.69

     

    Has anyone else ever experienced this?

     

    Ann Stephen

     

    --

    ******* Confidentiality Notice *******
    This email, its electronic document attachments, and the
    contents of its website linkages may contain confidential
    health information. This information is intended solely
    for use by the individual or entity to whom it is
    addressed. If you have received this information in error,
    please notify the sender immediately and arrange for the
    prompt destruction of the material and any accompanying
    attachments.

    ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to no mail.  To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to â€Å“no mail.”  To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.

     

    Michael McGowan, MBA/HCA
    Senior Consultant/Expert Witness
    Medicare Appeals Development,LLC
    Direct 916-343-1164
    Michael@madappeals.com
    www.madappeals.com
    Time is valuable and creative thought is even more so. Don’t undervalue either. 

    â€Å“Good planning and hard work lead to prosperity, but hasty shortcuts lead to poverty.”Proverbs 21:5 (NLT)

    This communication constitutes an electronic communication within the meaning of the Electronic Communications Privacy Act, 18 USC 2510, and its disclosure is strictly limited to the recipient intended by the sender of this message.  This communication may contain confidential and privileged material for the sole use of the intended recipient and receipt by anyone other than the intended recipient does not constitute a loss of the confidential or privileged nature of the communications.  Any review or distribution by others is strictly prohibited. If you are not the intended recipient please contact the sender by return electronic mail and delete all copies of this communication.

     

    ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to â€Å“no mail.”  To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.”  To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to �no mail.�  To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.

     


    "Important Warning: This message is intended for the use of the entity or person to whom it is addressed and may contain information that is privileged and confidential. If you are not the intended recipient and received this email in error, you are hereby notified that any disclosure, copying, or distribution of this information is strictly prohibited. This disclosure is governed by applicable law. Please notify the sender by email at the address shown.Thank you for your compliance."

    ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to �no mail.�  To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.”  To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.

     

    ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.”  To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    ---This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to no mail.  To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    ---
    This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.

    --Apple-Mail-02343F8F-57EA-42E7-B84A-DB47CF11CBEA--
  • I would appreciate a copy of the tool as well.
    Thank you

    From: michael McGowan [mailto:michaelmcgowan1@mac.com]
    Sent: Thursday, August 18, 2016 12:59 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: Re: [myhomehealth-l] Question about Probe review

    Hello Ann.

    This is very common in ZPIC reviews.
    What I’ve been seeing lately is downcoding of therapy visits not deemed necessary when measured against the functional acuity of the patients as reported on the OASIS.
    This is where pre-rap/pre-claims utilization review can save you tons of money, and headaches.
    Let me know if you need audit tools for such.

    Michael McGowan
    michael@operacare.com
    www.operacare.com

    On Aug 18, 2016, at 10:48 AM, PLONSEY@aol.com wrote

    Ann

    Mediacre pays based on the HHRG not charges. The OASIS sets the payment on the initial RAP but is adjusted downward if fewer medicare Therapy visits were prformed

    James Plonsey
    President
    Medicare Training & Consulting

    In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time, annstephen@stephenshc.com writes:
    We have a patient that total charges for claim was $1,797.89
    During probe review it was found that we provided less PT visits than was on the OASIS
    RN put 12 PT visits and we actually did 6 visits so they took back $2640.69

    Has anyone else ever experienced this?

    Ann Stephen

    --
    ******* Confidentiality Notice *******
    This email, its electronic document attachments, and the
    contents of its website linkages may contain confidential
    health information. This information is intended solely
    for use by the individual or entity to whom it is
    addressed. If you have received this information in error,
    please notify the sender immediately and arrange for the
    prompt destruction of the material and any accompanying
    attachments.

    ---

    This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to no mail. To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.

    ---

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    Michael McGowan, MBA/HCA
    Senior Consultant/Expert Witness
    Medicare Appeals Development,LLC
    Direct 916-343-1164
    Michael@madappeals.com
    www.madappeals.com
    Time is valuable and creative thought is even more so. Don’t undervalue either.
    “Good planning and hard work lead to prosperity, but hasty shortcuts lead to poverty.”Proverbs 21:5 (NLT)
    This communication constitutes an electronic communication within the meaning of the Electronic Communications Privacy Act, 18 USC 2510, and its disclosure is strictly limited to the recipient intended by the sender of this message. This communication may contain confidential and privileged material for the sole use of the intended recipient and receipt by anyone other than the intended recipient does not constitute a loss of the confidential or privileged nature of the communications. Any review or distribution by others is strictly prohibited. If you are not the intended recipient please contact the sender by return electronic mail and delete all copies of this communication.


    ---

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    ________________________________
    CONFIDENTIALITY NOTICE: This e-mail and any files transmitted with it are confidential and are intended solely for the use of the individual or entity to whom they are addressed. This communication may contain material protected by federal privacy rules. If you are not the intended recipient or the person responsible for delivering this e-mail to the intended recipient, be advised that you have received this e-mail in error and that any use, dissemination, forwarding, printing, or copying of this e-mail is strictly prohibited. If you have received this e-mail in error, please immediately notify MRHC’s Privacy Officer by telephone at (918) 421-8658. You will be reimbursed for reasonable costs incurred in notifying us.
  • Please include me as well.



    Lisa Ann Socha, PT, MBA

    Compliance Officer

    585 Southlake Blvd, Suite B

    Richmond, VA 23236

    (804) 897-9056

    Fax: (804) 897-1099





    The information contained in this email transmission is privileged, confidential and may be protected by law. The information contained in this email is intended only for the use by the individual or entity named above. Should this email contain personal health information, the authorized recipient of the information is prohibited from disclosing any personal health information that is protected by law to any other party. If you have received this email in error, please notify the sender immediately and destroy the information. Thank you.



    From: Courtney Fleming [mailto:cfleming@mehha.com]
    Sent: Thursday, August 18, 2016 5:10 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: RE: [myhomehealth-l] Question about Probe review



    Please include me when sharing the tool.



    Thanks,

    Courtney Fleming

    Regulatory Affairs Director



    From: Jewkes, Alberta [mailto:Alberta.Jewkes@ahss.org]
    Sent: Thursday, August 18, 2016 3:52 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: Re: [myhomehealth-l] Question about Probe review



    Please include me when sending sharing the tool.



    Thank you

    Alberta Jewkes, RN

    Home Health Administrator, WV Division




    On Aug 18, 2016, at 4:31 PM, Lopez, Lisa D wrote:

    Yes, a tool would be very helpful!



    From: Rebeca N. Grillo [mailto:phsrg@aol.com]
    Sent: Thursday, August 18, 2016 3:23 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: Re: [myhomehealth-l] Question about Probe review



    I would be very interested in the tool too.


    Sent from my iPhone


    On Aug 18, 2016, at 4:16 PM, Ann Stephen wrote:

    I do need that tool.

    They took the whole payment +



    On Aug 18, 2016 1:00 PM, "michael McGowan" wrote:

    Hello Ann.Â



    This is very common in ZPIC reviews.Â

    What I’ve been seeing lately is downcoding of therapy visits not deemed necessary when measured against the functional acuity of the patients as reported on the OASIS.Â

    This is where pre-rap/pre-claims utilization review can save you tons of money, and headaches.Â

    Let me know if you need audit tools for such.Â



    Michael McGowan

    michael@operacare.com

    www.operacare.com  Â



    On Aug 18, 2016, at 10:48 AM, PLONSEY@aol.com wrote



    Ann

    Â

    Mediacre pays based on the HHRG not charges. The OASIS sets the payment on the initial RAP but is adjusted downward if fewer medicare Therapy visits were prformed

    Â

    James Plonsey

    President

    Medicare Training & Consulting

    Â

    In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time, annstephen@stephenshc.com writes:

    We have a patient that total charges for claim was $1,797.89

    During probe review it was found that we provided less PT visits than was on the OASIS

    RN put 12 PT visits and we actually did 6 visits so they took back $2640.69



    Has anyone else ever experienced this?



    Ann Stephen




    --

    ******* Confidentiality Notice *******
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    ---
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    Michael McGowan, MBA/HCA
    Senior Consultant/Expert Witness
    Medicare Appeals Development,LLC
    Direct 916-343-1164
    Michael@madappeals.com
    www.madappeals.com
    Time is valuable and creative thought is even more so. Don’t undervalue either.Â

    “Good planning and hard work lead to prosperity, but hasty shortcuts lead to poverty.”Proverbs 21:5 (NLT)

    This communication constitutes an electronic communication within the meaning of the Electronic Communications Privacy Act, 18 USC 2510, and its disclosure is strictly limited to the recipient intended by the sender of this message. This communication may contain confidential and privileged material for the sole use of the intended recipient and receipt by anyone other than the intended recipient does not constitute a loss of the confidential or privileged nature of the communications. Any review or distribution by others is strictly prohibited. If you are not the intended recipient please contact the sender by return electronic mail and delete all copies of this communication.



    ---
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    ---
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    ---
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    _____


    "Important Warning: This message is intended for the use of the entity or person to whom it is addressed and may contain information that is privileged and confidential. If you are not the intended recipient and received this email in error, you are hereby notified that any disclosure, copying, or distribution of this information is strictly prohibited. This disclosure is governed by applicable law. Please notify the sender by email at the address shown.Thank you for your compliance."

    ---
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    ---
    This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    ---
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  • Please include me as well.


    On Fri, Aug 19, 2016 at 2:16 PM, Lisa Socha
    wrote:

    > Please include me as well.
    >
    >
    >
    > *Lisa Ann Socha, PT, MBA*
    >
    > *Compliance Officer*
    >
    > *585 Southlake Blvd, Suite B*
    >
    > *Richmond, VA 23236*
    >
    > *(804) 897-9056 *
    >
    > *Fax: (804) 897-1099 *
    >
    >
    >
    >
    >
    > *The information contained in this email transmission is privileged,
    > confidential and may be protected by law. The information contained in this
    > email is intended only for the use by the individual or entity named above.
    > Should this email contain personal health information, the authorized
    > recipient of the information is prohibited from disclosing any personal
    > health information that is protected by law to any other party. If you
    > have received this email in error, please notify the sender immediately and
    > destroy the information. Thank you.*
    >
    >
    >
    > *From:* Courtney Fleming [mailto:cfleming@mehha.com]
    > *Sent:* Thursday, August 18, 2016 5:10 PM
    > *To:* Multiple recipients of list MYHOMEHEALTH-L
    > *Subject:* RE: [myhomehealth-l] Question about Probe review
    >
    >
    >
    > Please include me when sharing the tool.
    >
    >
    >
    > Thanks,
    >
    > Courtney Fleming
    >
    > Regulatory Affairs Director
    >
    >
    >
    > *From:* Jewkes, Alberta [mailto:Alberta.Jewkes@ahss.org
    > ]
    > *Sent:* Thursday, August 18, 2016 3:52 PM
    > *To:* Multiple recipients of list MYHOMEHEALTH-L
    > *Subject:* Re: [myhomehealth-l] Question about Probe review
    >
    >
    >
    > Please include me when sending sharing the tool.
    >
    >
    >
    > Thank you
    >
    > Alberta Jewkes, RN
    >
    > Home Health Administrator, WV Division
    >
    >
    >
    >
    > On Aug 18, 2016, at 4:31 PM, Lopez, Lisa D wrote:
    >
    > Yes, a tool would be very helpful!
    >
    >
    >
    > *From:* Rebeca N. Grillo [mailto:phsrg@aol.com ]
    > *Sent:* Thursday, August 18, 2016 3:23 PM
    > *To:* Multiple recipients of list MYHOMEHEALTH-L myhomehealth.com>
    > *Subject:* Re: [myhomehealth-l] Question about Probe review
    >
    >
    >
    > I would be very interested in the tool too.
    >
    >
    > Sent from my iPhone
    >
    >
    > On Aug 18, 2016, at 4:16 PM, Ann Stephen
    > wrote:
    >
    > I do need that tool.
    >
    > They took the whole payment +
    >
    >
    >
    > On Aug 18, 2016 1:00 PM, "michael McGowan"
    > wrote:
    >
    > Hello Ann.Â
    >
    >
    >
    > This is very common in ZPIC reviews.Â
    >
    > What I’ve been seeing lately is downcoding of therapy visits not deemed
    > necessary when measured against the functional acuity of the patients as
    > reported on the OASIS.Â
    >
    > This is where pre-rap/pre-claims utilization review can save you tons of
    > money, and headaches.Â
    >
    > Let me know if you need audit tools for such.Â
    >
    >
    >
    > Michael McGowan
    >
    > michael@operacare.com
    >
    > www.operacare.com  Â
    >
    >
    >
    > On Aug 18, 2016, at 10:48 AM, PLONSEY@aol.com wrote
    >
    >
    >
    > Ann
    >
    > Â
    >
    > Mediacre pays based on the HHRG not charges. The OASIS sets the payment on
    > the initial RAP but is adjusted downward if fewer medicare Therapy visits
    > were prformed
    >
    > Â
    >
    > James Plonsey
    >
    > President
    >
    > Medicare Training & Consulting
    >
    > Â
    >
    > In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time,
    > annstephen@stephenshc.com writes:
    >
    > We have a patient that total charges for claim was $1,797.89
    >
    > During probe review it was found that we provided less PT visits than was
    > on the OASIS
    >
    > RN put 12 PT visits and we actually did 6 visits so they took back $2640.69
    >
    >
    >
    > Has anyone else ever experienced this?
    >
    >
    >
    > Ann Stephen
    >
    >
    >
    > --
    >
    > ******* Confidentiality Notice *******
    > This email, its electronic document attachments, and the
    > contents of its website linkages may contain confidential
    > health information. This information is intended solely
    > for use by the individual or entity to whom it is
    > addressed. If you have received this information in error,
    > please notify the sender immediately and arrange for the
    > prompt destruction of the material and any accompanying
    > attachments.
    >
    > ---
    >
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to no mail. To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    > ---
    >
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.†To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    >
    >
    > Michael McGowan, MBA/HCA
    > Senior Consultant/Expert Witness
    > Medicare Appeals Development,LLC
    > Direct 916-343-1164
    > Michael@madappeals.com
    > www.madappeals.com
    > Time is valuable and creative thought is even more so.
    > Don’t undervalue either.Â
    >
    > “Good planning and hard work lead to prosperity, but hasty
    > shortcuts lead to poverty.†Proverbs 21:5 (NLT)
    >
    > This communication constitutes an electronic communication within the
    > meaning of the Electronic Communications Privacy Act, 18 USC 2510,
    > and its disclosure is strictly limited to the recipient intended by the
    > sender of this message. This communication may contain confidential
    > and privileged material for the sole use of the intended recipient and
    > receipt by anyone other than the intended recipient does not constitute
    > a loss of the confidential or privileged nature of the communications.Â
    > Any review or distribution by others is strictly prohibited. If you are
    > not the intended recipient please contact the sender by
    > return electronic mail and delete all copies of this communication.
    >
    >
    >
    > ---
    >
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.†To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    > ---
    >
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    > ---
    >
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to �no mail.� To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    >
    > ------------------------------
    >
    >
    > "Important Warning: This message is intended for the use of the entity or
    > person to whom it is addressed and may contain information that is
    > privileged and confidential. If you are not the intended recipient and
    > received this email in error, you are hereby notified that any disclosure,
    > copying, or distribution of this information is strictly prohibited. This
    > disclosure is governed by applicable law. Please notify the sender by email
    > at the address shown.Thank you for your compliance."
    >
    > ---
    >
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to �no mail.� To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    > ---
    >
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    > ---
    >
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to no mail. To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    > ---
    > This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
    >
    >


    --
    Tammy Kerby RN, WCC, HCS-D, HCS-O
    C 641.856.9093



    CONFIDENTIALITY NOTICE: This transmission,including any attachments to
    it, may contain confidential information or protected health information
    subject to privacy regulations such as the Health Insurance Portability
    and Accountability Act of 1996 (HIPAA). This transmission is intended only
    for the use of the recipient(s) named above. If you are not the intended
    recipient or a person responsible for delivering it to the intended
    recipient, you are hereby notified that any disclosure, copying,
    distribution, or use of any of the information contained in this
    transmission is STRICTLY PROHIBITED. If you have received this
    transmission in error, please immediately notify me by reply e-mail, and
    destroy the original transmission in its entirety without saving it in any
    manner.
  • Please send me a copy of the tool as well.

    Email: bahsa78@gmail.com

    Thank you

    On Fri, Aug 19, 2016 at 3:21 PM, Tammy Kerby wrote:

    > Please include me as well.
    >
    >
    > On Fri, Aug 19, 2016 at 2:16 PM, Lisa Socha
    > wrote:
    >
    >> Please include me as well.
    >>
    >>
    >>
    >> *Lisa Ann Socha, PT, MBA*
    >>
    >> *Compliance Officer*
    >>
    >> *585 Southlake Blvd, Suite B*
    >>
    >> *Richmond, VA 23236*
    >>
    >> *(804) 897-9056 *
    >>
    >> *Fax: (804) 897-1099 *
    >>
    >>
    >>
    >>
    >>
    >> *The information contained in this email transmission is privileged,
    >> confidential and may be protected by law. The information contained in this
    >> email is intended only for the use by the individual or entity named above.
    >> Should this email contain personal health information, the authorized
    >> recipient of the information is prohibited from disclosing any personal
    >> health information that is protected by law to any other party. If you
    >> have received this email in error, please notify the sender immediately and
    >> destroy the information. Thank you.*
    >>
    >>
    >>
    >> *From:* Courtney Fleming [mailto:cfleming@mehha.com]
    >> *Sent:* Thursday, August 18, 2016 5:10 PM
    >> *To:* Multiple recipients of list MYHOMEHEALTH-L
    >> *Subject:* RE: [myhomehealth-l] Question about Probe review
    >>
    >>
    >>
    >> Please include me when sharing the tool.
    >>
    >>
    >>
    >> Thanks,
    >>
    >> Courtney Fleming
    >>
    >> Regulatory Affairs Director
    >>
    >>
    >>
    >> *From:* Jewkes, Alberta [mailto:Alberta.Jewkes@ahss.org
    >> ]
    >> *Sent:* Thursday, August 18, 2016 3:52 PM
    >> *To:* Multiple recipients of list MYHOMEHEALTH-L
    >> *Subject:* Re: [myhomehealth-l] Question about Probe review
    >>
    >>
    >>
    >> Please include me when sending sharing the tool.
    >>
    >>
    >>
    >> Thank you
    >>
    >> Alberta Jewkes, RN
    >>
    >> Home Health Administrator, WV Division
    >>
    >>
    >>
    >>
    >> On Aug 18, 2016, at 4:31 PM, Lopez, Lisa D wrote:
    >>
    >> Yes, a tool would be very helpful!
    >>
    >>
    >>
    >> *From:* Rebeca N. Grillo [mailto:phsrg@aol.com ]
    >> *Sent:* Thursday, August 18, 2016 3:23 PM
    >> *To:* Multiple recipients of list MYHOMEHEALTH-L <
    >> myhomehealth-l@list.myhomehealth.com>
    >> *Subject:* Re: [myhomehealth-l] Question about Probe review
    >>
    >>
    >>
    >> I would be very interested in the tool too.
    >>
    >>
    >> Sent from my iPhone
    >>
    >>
    >> On Aug 18, 2016, at 4:16 PM, Ann Stephen
    >> wrote:
    >>
    >> I do need that tool.
    >>
    >> They took the whole payment +
    >>
    >>
    >>
    >> On Aug 18, 2016 1:00 PM, "michael McGowan"
    >> wrote:
    >>
    >> Hello Ann.Â
    >>
    >>
    >>
    >> This is very common in ZPIC reviews.Â
    >>
    >> What I’ve been seeing lately is downcoding of therapy visits not deemed
    >> necessary when measured against the functional acuity of the patients as
    >> reported on the OASIS.Â
    >>
    >> This is where pre-rap/pre-claims utilization review can save you tons of
    >> money, and headaches.Â
    >>
    >> Let me know if you need audit tools for such.Â
    >>
    >>
    >>
    >> Michael McGowan
    >>
    >> michael@operacare.com
    >>
    >> www.operacare.com  Â
    >>
    >>
    >>
    >> On Aug 18, 2016, at 10:48 AM, PLONSEY@aol.com wrote
    >>
    >>
    >>
    >> Ann
    >>
    >> Â
    >>
    >> Mediacre pays based on the HHRG not charges. The OASIS sets the payment
    >> on the initial RAP but is adjusted downward if fewer medicare Therapy
    >> visits were prformed
    >>
    >> Â
    >>
    >> James Plonsey
    >>
    >> President
    >>
    >> Medicare Training & Consulting
    >>
    >> Â
    >>
    >> In a message dated 8/18/2016 11:33:24 A.M. Central Daylight Time,
    >> annstephen@stephenshc.com writes:
    >>
    >> We have a patient that total charges for claim was $1,797.89
    >>
    >> During probe review it was found that we provided less PT visits than was
    >> on the OASIS
    >>
    >> RN put 12 PT visits and we actually did 6 visits so they took back
    >> $2640.69
    >>
    >>
    >>
    >> Has anyone else ever experienced this?
    >>
    >>
    >>
    >> Ann Stephen
    >>
    >>
    >>
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    >>
    >>
    >>
    >> Michael McGowan, MBA/HCA
    >> Senior Consultant/Expert Witness
    >> Medicare Appeals Development,LLC
    >> Direct 916-343-1164
    >> Michael@madappeals.com
    >> www.madappeals.com
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    >> Any review or distribution by others is strictly prohibited. If you are
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    >> return electronic mail and delete all copies of this communication.
    >>
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    >
    >
    > --
    > Tammy Kerby RN, WCC, HCS-D, HCS-O
    > C 641.856.9093
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  • Sometimes even your billing will downcode in review. I have seen systems where the minutes logged in the visit = units billed, and upon focused review, 15 30 minute visits gets downcoded to 7 or 8 visits because of the short length of the 15. Where 480 minutes over 10 visits used to be the predictor of high acuity of therapy, the expectation lies that 4 unit therapy visits would be the norm in home health and the 2 unit visits over 14 times down coded to 7 visits. As Michael stated, poor documentation that doesn't show necessity, skill, or documentation to standards of CoP can all down grade a visit. Or visits deemed non billable for no orders to support or improper supervision. So not only a matter of RAP vs reality of how many, but so many other factors can down grade your therapy counts. Even a whole chart with MUE can negate all therapy visits before they occur. Only proper OASIS scrutiny in real time at SOC to plan for necessity and efficient treatment followed up by rock solid documentation can help you get the payment you think you are going to get. With the new pre auth claim review, and RAC ad ZPIC and all the other audit teams out there, it is best to be sure what you are doing and why and make sure it all follows through. Michael's tool is the only tool I have seen that automates some of these first steps to let you see your chart from a macro and micro and agency macro view simultaneously in seconds where it can take an entire QA team to do this in hours. Welcome to the new world of home care where our bank accounts now have large exit doors. Hopefully in the new world of value based, bundled, merit based type models we as a whole industry can step up to the plate and show our worth and not worry about these audits anymore!
  • I would love to see the pre-RAP/pre-claim audit reviews you have referred to, and compare them to what we currently use!

    Thanks!
    ssibig@generationsolutions.net
  • Is anyone else still getting the 5 Probe and Educate ADRs?

    On Mon, Aug 29, 2016 at 11:47 AM, Stephanie Sibig <
    ssibig@generationsolutions.net> wrote:

    > I would love to see the pre-RAP/pre-claim audit reviews you have referred
    > to, and compare them to what we currently use!
    >
    > Thanks!
    > ssibig@generationsolutions.net
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    >
  • I have all 5 requested for and sent back, but the problem I am having is that I have NOT received the letters we are supposed to get. I can see the replies as far as accepted or denied in the FISS system, but we were all supposed to get letters to instruct us on what next step to take. Has anybody received letters yet?

    From: Mike P [mailto:premierhhcbilling@gmail.com]
    Sent: Monday, August 29, 2016 12:18 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: Re: [myhomehealth-l] Question about Probe review

    Is anyone else still getting the 5 Probe and Educate ADRs?

    On Mon, Aug 29, 2016 at 11:47 AM, Stephanie Sibig wrote:
    I would love to see the pre-RAP/pre-claim audit reviews you have referred to, and compare them to what we currently use!

    Thanks!
    ssibig@generationsolutions.net
    ---
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    ---

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  • We sent in our responses to probe and educate on 5/20/16. We did not get out letter until 8/1/16. I am still waiting on a response to set up our “education call”.

    Melody Ford RN BSN CRNI
    Director of Clinical Services, Owner
    ABF Home Health Services, LLC
    198 S. Main Suite 1
    Mount Clemens, MI 48043
    P: 586-477-1402
    F: 586-477-1413
    www.abfhomehealth.com

    [logo 2]
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    From: Cathy Lovell [mailto:CLovell@SidneyRMC.com]
    Sent: Monday, August 29, 2016 2:21 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: RE: [myhomehealth-l] Question about Probe review

    I have all 5 requested for and sent back, but the problem I am having is that I have NOT received the letters we are supposed to get. I can see the replies as far as accepted or denied in the FISS system, but we were all supposed to get letters to instruct us on what next step to take. Has anybody received letters yet?

    From: Mike P [mailto:premierhhcbilling@gmail.com]
    Sent: Monday, August 29, 2016 12:18 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: Re: [myhomehealth-l] Question about Probe review

    Is anyone else still getting the 5 Probe and Educate ADRs?

    On Mon, Aug 29, 2016 at 11:47 AM, Stephanie Sibig wrote:
    I would love to see the pre-RAP/pre-claim audit reviews you have referred to, and compare them to what we currently use!

    Thanks!
    ssibig@generationsolutions.net
    ---
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    ---

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    ---

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  • Melody,
    Are you with CGS?

    From: Melody Ford [mailto:mford@abfhomehealth.com]
    Sent: Monday, August 29, 2016 12:28 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: RE: [myhomehealth-l] Question about Probe review

    We sent in our responses to probe and educate on 5/20/16. We did not get out letter until 8/1/16. I am still waiting on a response to set up our “education call”.

    Melody Ford RN BSN CRNI
    Director of Clinical Services, Owner
    ABF Home Health Services, LLC
    198 S. Main Suite 1
    Mount Clemens, MI 48043
    P: 586-477-1402
    F: 586-477-1413
    www.abfhomehealth.com

    [logo 2]
    Confidentiality Notice: The information in this email, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and legally privileged information. If you are not the intended recipient, any disclosure, copying, distribution or use of the contents of this information in any manner is strictly prohibited and may be unlawful. If you receive this message in error, or are not the named recipient(s), please notify the sender by reply email, delete this email from your computer, and destroy copies of the form immediately.


    From: Cathy Lovell [mailto:CLovell@SidneyRMC.com]
    Sent: Monday, August 29, 2016 2:21 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: RE: [myhomehealth-l] Question about Probe review

    I have all 5 requested for and sent back, but the problem I am having is that I have NOT received the letters we are supposed to get. I can see the replies as far as accepted or denied in the FISS system, but we were all supposed to get letters to instruct us on what next step to take. Has anybody received letters yet?

    From: Mike P [mailto:premierhhcbilling@gmail.com]
    Sent: Monday, August 29, 2016 12:18 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: Re: [myhomehealth-l] Question about Probe review

    Is anyone else still getting the 5 Probe and Educate ADRs?

    On Mon, Aug 29, 2016 at 11:47 AM, Stephanie Sibig wrote:
    I would love to see the pre-RAP/pre-claim audit reviews you have referred to, and compare them to what we currently use!

    Thanks!
    ssibig@generationsolutions.net
    ---
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    ---

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  • No NGS

    Melody Ford RN BSN CRNI
    Director of Clinical Services, Owner
    ABF Home Health Services, LLC
    198 S. Main Suite 1
    Mount Clemens, MI 48043
    P: 586-477-1402
    F: 586-477-1413
    www.abfhomehealth.com

    [logo 2]
    Confidentiality Notice: The information in this email, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and legally privileged information. If you are not the intended recipient, any disclosure, copying, distribution or use of the contents of this information in any manner is strictly prohibited and may be unlawful. If you receive this message in error, or are not the named recipient(s), please notify the sender by reply email, delete this email from your computer, and destroy copies of the form immediately.


    From: Cathy Lovell [mailto:CLovell@SidneyRMC.com]
    Sent: Monday, August 29, 2016 2:34 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: RE: [myhomehealth-l] Question about Probe review

    Melody,
    Are you with CGS?

    From: Melody Ford [mailto:mford@abfhomehealth.com]
    Sent: Monday, August 29, 2016 12:28 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: RE: [myhomehealth-l] Question about Probe review

    We sent in our responses to probe and educate on 5/20/16. We did not get out letter until 8/1/16. I am still waiting on a response to set up our “education call”.

    Melody Ford RN BSN CRNI
    Director of Clinical Services, Owner
    ABF Home Health Services, LLC
    198 S. Main Suite 1
    Mount Clemens, MI 48043
    P: 586-477-1402
    F: 586-477-1413
    www.abfhomehealth.com

    [logo 2]
    Confidentiality Notice: The information in this email, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and legally privileged information. If you are not the intended recipient, any disclosure, copying, distribution or use of the contents of this information in any manner is strictly prohibited and may be unlawful. If you receive this message in error, or are not the named recipient(s), please notify the sender by reply email, delete this email from your computer, and destroy copies of the form immediately.


    From: Cathy Lovell [mailto:CLovell@SidneyRMC.com]
    Sent: Monday, August 29, 2016 2:21 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: RE: [myhomehealth-l] Question about Probe review

    I have all 5 requested for and sent back, but the problem I am having is that I have NOT received the letters we are supposed to get. I can see the replies as far as accepted or denied in the FISS system, but we were all supposed to get letters to instruct us on what next step to take. Has anybody received letters yet?

    From: Mike P [mailto:premierhhcbilling@gmail.com]
    Sent: Monday, August 29, 2016 12:18 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: Re: [myhomehealth-l] Question about Probe review

    Is anyone else still getting the 5 Probe and Educate ADRs?

    On Mon, Aug 29, 2016 at 11:47 AM, Stephanie Sibig wrote:
    I would love to see the pre-RAP/pre-claim audit reviews you have referred to, and compare them to what we currently use!

    Thanks!
    ssibig@generationsolutions.net
    ---
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  • We received our 5 Probe and Educate this spring, sent back the information late May/Early June and just last week received our letter. We did notice earlier in August that we received payment on those charts without denial. Hope this helps.

    Sharon



    From: Cathy Lovell [mailto:CLovell@SidneyRMC.com]
    Sent: Monday, August 29, 2016 2:21 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: RE: [myhomehealth-l] Question about Probe review



    I have all 5 requested for and sent back, but the problem I am having is that I have NOT received the letters we are supposed to get. I can see the replies as far as accepted or denied in the FISS system, but we were all supposed to get letters to instruct us on what next step to take. Has anybody received letters yet?



    From: Mike P [mailto:premierhhcbilling@gmail.com]
    Sent: Monday, August 29, 2016 12:18 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: Re: [myhomehealth-l] Question about Probe review



    Is anyone else still getting the 5 Probe and Educate ADRs?



    On Mon, Aug 29, 2016 at 11:47 AM, Stephanie Sibig wrote:

    I would love to see the pre-RAP/pre-claim audit reviews you have referred to, and compare them to what we currently use!

    Thanks!
    ssibig@generationsolutions.net
    ---
    This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.



    ---
    This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to �no mail.� To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.


    Confidentiality Notice | This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential or proprietary information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, immediately contact the sender by reply e-mail and destroy all copies of the original message. ­­

    ---
    This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to no mail. To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.




    CONFIDENTIALITY NOTICE: This message, including any attachments,
    is for the sole use of the intended recipient(s) and may contain confidential
    and privileged information. Any unauthorized review, use, disclosure or
    distribution is prohibited. If you are not the intended recipient, please
    contact the sender by reply e-mail and destroy all copies of the original
    message.
  • Are you with CGS?

    From: Sharon Muhlenkamp [mailto:sjmuhlenkamp@mercer-health.com]
    Sent: Monday, August 29, 2016 12:38 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: RE: [myhomehealth-l] Question about Probe review

    We received our 5 Probe and Educate this spring, sent back the information late May/Early June and just last week received our letter. We did notice earlier in August that we received payment on those charts without denial. Hope this helps.
    Sharon

    From: Cathy Lovell [mailto:CLovell@SidneyRMC.com]
    Sent: Monday, August 29, 2016 2:21 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: RE: [myhomehealth-l] Question about Probe review

    I have all 5 requested for and sent back, but the problem I am having is that I have NOT received the letters we are supposed to get. I can see the replies as far as accepted or denied in the FISS system, but we were all supposed to get letters to instruct us on what next step to take. Has anybody received letters yet?

    From: Mike P [mailto:premierhhcbilling@gmail.com]
    Sent: Monday, August 29, 2016 12:18 PM
    To: Multiple recipients of list MYHOMEHEALTH-L
    Subject: Re: [myhomehealth-l] Question about Probe review

    Is anyone else still getting the 5 Probe and Educate ADRs?

    On Mon, Aug 29, 2016 at 11:47 AM, Stephanie Sibig wrote:
    I would love to see the pre-RAP/pre-claim audit reviews you have referred to, and compare them to what we currently use!

    Thanks!
    ssibig@generationsolutions.net
    ---
    This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to “no mail.” To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.


    ---

    This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to �no mail.� To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.

    Confidentiality Notice | This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential or proprietary information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, immediately contact the sender by reply e-mail and destroy all copies of the original message. ­­

    ---

    This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to no mail. To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.







    CONFIDENTIALITY NOTICE: This message, including any attachments,

    is for the sole use of the intended recipient(s) and may contain confidential

    and privileged information. Any unauthorized review, use, disclosure or

    distribution is prohibited. If you are not the intended recipient, please

    contact the sender by reply e-mail and destroy all copies of the original

    message.



    ---

    This list is an exclusive service of DecisionHealth (http://www.decisionhealth.com), publisher of Home Health Line. To access the web interface, go to http://www.decisionhealth.com/myhomehealth-l and enter your e-mail address. Click on the My Account tab and then the Advanced tab to set or change your password. Click on the Essentials tab and Membership Type to set the way you want to access list messages. To read messages on the web interface only, set Membership Type to �no mail.� To see the archive of past messages, click on the Messages tab and the Show More button. To view the chat forum, click on the Conference tab. To unsubscribe, click on the My Forums tab.
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