Pointers

  • In elderly Trazodone is the safer first line medicine for sleep.
  • Opioid conversion: calculate total daily dose of current med, use equivalent chart, convert to morphine then to new med, pay attention to route, reduce 25-50% for cross tolerance. Reduce 50% in elderly / renal failure.
  • Dosing: OxyContin: approved q 12, some used it q 8 hrs. MS CONTIN: q 8 hrs, q 12 hrs. METHADONE: q 6, 8 or 12 hrs. DURAGESIC: approved q 72 hrs but some uses q48 hrs.
  • Once study state is achieved increase baseline med by: 25% for mild, 50% for moderate, 75-100 % for severe relentless pain.
  • Steady state: Morphine / OxyContin in 2-3 days; Methadone in 5 days
  • Overpayment to medicare must report / return payment within 60 days.
  • OIG : Office of Inspector General maintains a list of excluded individuals / entities.
  • oig.hhs.gov/fraud/fugitives/index.asp
  • In 1998 medicare paid 2.2 billion dollars to hospice
  • In 2009 : medicare paid 12.1 billion dollars to hospice
  • MAC: Medicare Administrator Contractor: process claims, pre/post pay reviews, issues ADRs, handle claim appeals, collect over / improper payment, enroll medicare providers, educating billing processes
  • medicare edits: focus on long length of stay>180 ->730- >999 days; GIP > 7 days; hospice patients in long term facilities; Dx : Debility, Alzheimer”s; COPD; patients denied previously.
  • RAC : Recovery auditor (RA): medicare bounty hunter: identify /collect improper payment.
  • ZPICs: Zone Program Integrity Contractors: detect, prevent & deter medicare fraud.
  • Oral certification if written can not be obtained within 2 days (anybody has any comments on this)
  • Written certification should be in the chart before billing
  • Certification / recertification can be obtained within 15 days prior to effective date