Medicare Plus Blue℠ Preferred Provider Organization and PFFS plans
The Centers for Medicare and Medicaid Services requires annual training to detect, prevent, and correct fraud, waste and abuse. All providers and their employees, contractors, governing bodies and downstream entities who partner with Medicare Advantage organizations and prescription drug plans are required to take the training. New hires need to complete the training within 90 days of being hired and then annually.
Documentation of Skilled Versus Unskilled Care for Medicare Beneficiaries: Speech
Medicare guidelines state that all services must be medically necessary and be provided at a level of complexity and sophistication that requires a speech-language pathologist to perform the tasks. They further stipulate that the interventions provided “require the expertise, knowledge, clinical judgment, decision making and abilities of a therapist that assistants, qualified personnel, caretakers or the patient cannot provide independently” (Medicare Benefit Policy Manual, Chapter 15, Section 220.3B [PDF]).