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July 2008 Table of Contents

Compliance Resources
(as referenced in the newsletters)

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Complex Medicare reporting requirements... increased Medicaid billing scrutiny... OIG audits... whistleblower provisions. Even the best run organizations are finding it difficult to keep up with the oversight onslaught.

Compliance Watch helps you keep up with regulatory changes and best practices in corporate compliance. Compliance Watch is an e-newsletter (for paid subscribers only) published quarterly by the National Council and edited by Mary Thornton, BSRN, MBA.

This insightful newsletter includes analysis of government audits, rules development, enforcement and oversight activities, and articles by experts who share successes in reducing audit and investigatory risk while maintaining high clinical standards.

Subscribe now through our web Store to receive three issues in 2008
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July 2008 Table of Contents

Case Management
There are significant changes in how case management is delivered and reimbursed by Medicaid. You will likely need to make changes in the way your case managers practice and document …

Medical Necessity
Understanding medical necessity can help clinicians build the "golden thread" of documentation for state and federal auditors. 11 basic tests can help to establish medical necessity ...

And more

• Group Therapy
• Quality vs. Compliance
• Medicaid PERM Audits
• State False Claims Act
• New Jersey Office of Medicaid Inspector General
• OIG Orange Book 2008
• Ask the Expert (Q&A from Mary Thornton)

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Compliance Resources

• Medicaid coverage for rehabilitative services: CMS Proposed Rule
• Case management and targeted case management definitions in the Deficit Reduction Act 2006: CMS Interim Final Rule
  
• Case management Q&A from the National Association of State Medicaid Directors
• Estimated cost savings to Medicare if improper Part B services were reduced: OIG Recommendations
• Medicare payments for Part B mental health services: CMS provider education article