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
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 Groupings 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.
Section GG in the Spotlight
October 1, 2018, marks the second time in two years where Skilled Nursing Facilities must prepare for changes to the MDS related to Section GG. Much like October of 2016, the emphasis continues to focus on the need for increased collaboration between nursing and therapy to ensure accurate coding related to the MDS. Continue reading.
CMS Releases Medicare Physician Fee Schedule Proposed Rule for 2019: Impact to Therapy Providers
On Thursday, July 12th, CMS released the 2019 Medicare Physician Fee Schedule Proposed Rule. This 1500+ page document proposes several items of significance for providers of outpatient therapy to Medicare Part B beneficiaries:
- New modifiers will be 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 services furnished on or after 1/1/2019.
- PTs and OTs, along with clinical social workers and clinical psychologists, will be eligible to participate in MIPS effective 1/1/2019.
CMS Releases 2019 Home Health Proposed Rule: Change is Coming…
The Home Health Proposed Rule for 2019, released on July 2nd, 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 proposed to be implemented on January 1, 2020