Just when you thought the water was safe . . .
July 1, 1997 2 minutes read
Just when you thought the water was safe . . .
Da dum, da dum, here’s more of ORT
Coming soon to a state near you a bigger, better Operation Restore Trust, along with an added action feature called the Wedge program. If this were a movie, Bruce Willis would star, but since it’s not, you may want to read on.
The initial ORT demonstration project focused on five states, which include more than a third of all Medicare and Medicaid beneficiaries: California, Florida, New York, Texas and Illinois. ORT brought together teams to target efforts on three high-growth program areas of Medicare and Medicaid: home health agencies, nursing homes, and durable medical equipment suppliers.
Running concurrently with ORT will be the Wedge initiative in the following 14 states, some of which are already ORT target states: Connecticut, Florida, Massachusetts, Minnesota, Illinois, Indiana, Louisiana, Ohio, Oklahoma, Tennessee, Texas, Utah, Virginia, and Wyoming.
To date, the ORT probes have taken two forms:
(1) The California model, where surveyors review home health compliance with the Conditions of Participation and then act to decertify providers they say are out of compliance;
(2) The Texas/Tennessee model, where surveys review 15 claims for a two-month period and demand repayment based on projection of the denial percentage to the universe of claims. A provider refusing this "consent settlement" then faces review of 100 claims from a 12-month period and repayment demands based on projection of the denial rate to the whole year.
Experts say the expanded ORT program will be based on the California experience, while the Wedge initiative will follow the Texas/Tennessee model.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content