Regulatory & Compliance
Casamba operates in a highly regulated industry. Keeping up to date with regulatory changes and challenges impacting post-acute care is imperative. Casamba’s Compliance Officer and Product Team work together to ensure our products make regulatory compliance efficient and effortless for our clients, both the clinicians delivering patient care and the corporate and management staff responsible for running the business.
Casamba is committed to honest, ethical and compliant business practices to ensure our continued status as a respectable and desirable employer and business partner. To that end, Casamba has established a Corporate Compliance Program, including a 24-hour Compliance Hotline. The Hotline allows our employees to report any concerns or issues in good faith anonymously and without fear of retribution.
Casamba Product Compliance Highlights
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Casamba products are designed to ensure compliance with regulatory requirements, both through built-in features as well as customizable options and settings. In addition, robust clinical libraries and comprehensive workflows ensure your documentation and billing stand up to medical record review or audits. Casamba proactively monitors upcoming regulatory changes across the health care industry and updates each product accordingly to help customers meet these ever-increasing demands.
Casamba Skilled includes compliance-focused features such as hard-coded and modifiable settings within the documentation and billing workflows, alerts and reports, and an integrated documentation auditing and monitoring tool. Clients can set required fields within the medical record documentation, disallow billing information to be saved without supporting documentation and apply payer-specific billing rules as appropriate. The product’s integrated audit tool can be customized to include specific items or questions based on client needs and allows documentation audits to be conducted fully within the application.
Reports and alerts for upcoming scheduled documentation, incomplete documentation, last treatment rendered by a therapist, and the documentation audit tool can be run on demand or on a scheduled basis to allow Skilled clients the ability to track compliance with regulations and company policies. The home page Dashboard gives transparency into items that need attention and provide direct links into the system to allow efficient edits and updates.
Casamba Skilled also contains an Appeals Management module which facilitates improved revenue cycle performance, maintains a centralized data repository of claims/records at various stages in the medical review and appeal process, manages filing schedules, and helps clients identify trends for education and training.
Casamba Home was developed to assist clinicians and office staff to maintain compliance with regulatory demands of both Home Health and Hospice. HomeMobile includes required fields, integrity check alerts, guided workflows, and built-in quality indicator (QI) rules that assist the clinician to complete documentation in a compliant manner. HomeOffice is embedded with customizable QI rules that prevent claims from passing through to billing with errors. These rules can be set up as hard stops or warnings to promote compliance in an effective and efficient manner.
Agencies have access to a variety of client-facing reports and in-application lists to monitor processes and alert users to potential issues or items needing attention, such as documentation yet to be signed, claims unable to be billed or processed, QI issues, etc. One of Casamba Home’s biggest strengths lies in the ability for an agency to personalize compliance and regulatory-related parameters to ensure clinicians document all required elements for accurate coding and billing.
Casamba Clinic ensures Medicare billing rules (i.e., 8-min rule, CCI/PTP edits, etc.) are automatically applied based on clinical documentation, which can be customized through client-defined required and recommended sentences. Therapy Plans of Care are automatically generated and tracked within the system, allowing clients to keep up with timely certification and recertification. Casamba Clinic provides users the ability to create documentation templates to ensure documentation and/or evaluation protocols are consistent enterprise-wide if desired. Casamba Clinic protects clinicians from documenting or billing outside of a given patient’s authorized health insurance, referral, or plan of care limitations.
Casamba Clinic incorporates many client-facing reports to ensure compliance with documentation and billing rules as required by payer, state, accreditation entity, or company policy. Reports can be generated to identify patients approaching or exceeding authorization parameters, inactive patients, patients with incomplete appointments or unsigned/open documentation, and unsigned or uncertified plans of care. Parameters can be adjusted to incorporate client-specific needs.
Casamba Revenue scrubs claims to ensure high first pass payment ratios and applies all levels of HIPAA compliance validation confirming all files are syntactically correct before transmission to the clearinghouse. In addition, our clearinghouse partner applies HIPAA and payer edits to claims up front, decreasing claim rejections and denials.
In the News
PDGM is coming in January 2020.
Learn the latest news about the new payment model for home health services under Medicare Part A as well as what it means for your business and your clients.
Getting ready for PDPM implementation?
CMS updated its educational and training resources. Click here to access.
Therapy Associations Release Joint Statement on Use of Students in Hospitals/Inpatient Rehab Facilities
The Centers for Medicare and Medicaid Services (CMS) hosted a Medicare Learning Network call on November 15, 2018, entitled Inpatient Rehabilitation Facility (IRF) Payment and Coverage Policies: FY 2019 Final Rule. During the question and answer portion of the call, a listener asked whether or not the minutes provided by a therapy student, under appropriate supervision, count toward the “3-hour rule” (the therapy intensity requirement in the IRF setting). Continue reading.
From RUG-IV to PDPM: Transitioning Payment in Skilled Nursing
It’s Official! The Patient-Driven Payment Model Begins October 1, 2019
The FY 2019 SNF PPS Final Rule definitively established the Patient-Driven Payment Model, or PDPM, as the new prospective payment system for Medicare Part A in the SNF on October 1, 2019. After considering the almost 300 comments received from stakeholders, CMS finalized PDPM with only a few modifications from what was proposed back in April 2018. Developed as a payment model that “derives payment classifications almost exclusively from verifiable resident characteristics,” PDPM separately identifies and adjusts five different case-mix components for the varied needs and characteristics of an individual resident’s care. These are then combined with a non-case mix component to form the full SNF PPS per diem rate for a given resident.
PTs, OTs and SLPs in Private Practice Confirmed as Eligible Providers in MIPS
As confirmed in the CY 2019 Medicare Physician Fee Schedule Final Rule released 11/1/2018, PTs, OTs, SLPs, clinical psychologists, dietitians, and audiologists have been added as eligible clinicians to participate in the Merit-based Incentive Payment System (MIPS) for the 2019 performance year (i.e., the 2021 payment year). Continue reading.
Section GG: What’s all the fuss about?
It all begins with the IMPACT Act of 2014…
The IMPACT Act requires the development of standardized patient assessment data that will enable:
- Quality care and improved outcomes
- Data Element uniformity
- Comparison of quality and data across PAC settings
- Improved discharge planning
- Exchangeability of data
- Coordinated care
And, this standardized data will be used to inform payment models. Continue reading.
CMS Releases Medicare Physician Fee Schedule Final Rule for 2019: Impact to Therapy Providers
On Thursday, November 1st, CMS released the 2019 Medicare Physician Fee Schedule Final Rule. This 2300+ page document proposes several items of significance for providers of outpatient therapy to Medicare Part B beneficiaries:
- New modifiers have been created to identify PT and OT services furnished “in whole or in part” by PTAs and OTAs to comply with requirements of the Bipartisan Budget Act of 2018. These modifiers will be required on claims with dates of service of 1/1/2020 or later.
- Functional Limitation Reporting will be discontinued for traditional Medicare Part B for services furnished on or after 1/1/2019.
- PTs, OTs, and SLPs, along with audiologists, clinical psychologists, and dietitians, will be eligible to participate in MIPS effective 1/1/2019.
CMS Releases 2019 Home Health Final Rule: Change is Coming…
The Home Health Final Rule for 2019, released on October 31, contains several significant proposals for home health providers including:
- Payment updates
- Changes to certification and recertification requirements
- Remote patient monitoring
- Home infusion benefits
- Modifications to the HH Quality Reporting and Value-based Purchasing Programs
- The introduction of a brand new payment system called the Patient-Driven Groupings Model to be implemented on January 1, 2020