"Hospices Should Improve Their Election Statements [NOE] and Certifications of Terminal Illness [CTI]," the Office of Inspector General (OIG) entitled its September 15, 2016 report.
CMS indicated in the FY 2017 Hospice Final Rule, the OIG reported that “Hospices commonly billed for GIP when the beneficiary did not have uncontrolled pain or unmanaged symptoms."
Of course, this could be a documentation problem. But even if it is, billing is not allowed for any hospice level of care without supporting clinical documentation in the clinical record.
Then, the OIG looked at the NOEs and CTIs for those same claims and found them inadequate as well.
The hospice industry must wake up to the fact that ever-increasing scrutiny will not, as one hospice professional hoped, "blow over" so that we can all go back to "touchy-feely" hospice care without accurate, thorough documentation to support payment for hospice's medically necessary services. Once the OIG and CMS find problems within a program, the issue never drops from their sights.
Get used to it.
The OIG published 4 recommendations for CMS concerning hospice NOEs and CTIs:
- Develop and disseminate model text for election statements.
- Instruct surveyors to strengthen their review of election statements and certifications of terminal illness.
- Educate hospices about election statements and certifications of terminal illness.
- Provide guidance to hospices regarding the effects on beneficiaries when they revoke their election and when they are discharged from hospice care.
CMS agreed with the first 3 three OIG recommendations and neither concurred nor rejected #4.
Here's a copy of the OIG's report of its study:
WHY WE DID THIS STUDY
Medicare hospice care is intended to help terminally ill beneficiaries continue life with minimal disruptions and to support beneficiaries' families and other caregivers. Two key requirements of the Medicare hospice benefit are for the beneficiary to sign an election statement and for a physician to certify the beneficiary as terminally ill. Together, the election statement and certification of terminal illness provide critical safeguards to ensure that the beneficiary understands the hospice benefit and that the physician is involved in determining whether the beneficiary is appropriate for hospice care. However, previous OIG work has raised concerns that some election statements used by hospices are misleading and that physicians are sometimes not involved in care planning and may rarely see beneficiaries. Also, OIG has investigated numerous cases in which hospices submitted fraudulent claims for patients who were not appropriate for hospice care. This report assesses both hospice election statements and certifications of terminal illness.
HOW WE DID THIS STUDY
We based this study on a review of hospice election statements and certifications of terminal illness from a stratified random sample of hospice general inpatient (GIP) stays in 2012. Although the election statements and certifications of terminal illness were collected for a previous OIG study that focused on GIP, these documents are for the hospice benefit as a whole and are not specific to any one level of care.
WHAT WE FOUND
We found that hospice election statements lacked required information or had other vulnerabilities in more than one-third of GIP stays. Notably, they did not always mention-as required-that the beneficiary was waiving coverage of certain Medicare services by electing hospice care or that hospice care is palliative rather than curative. Further, in 14 percent of GIP stays, the physician did not meet requirements-such as composing a narrative-when certifying, and appeared to have limited involvement in determining that the beneficiary was appropriate for hospice care.
WHAT WE RECOMMEND
The findings in this report make clear that hospices should improve their election statements and ensure that physicians meet requirements when certifying beneficiaries for hospice care. We recommend that CMS (1) develop and disseminate model text for election statements, (2) instruct surveyors to strengthen their review of election statements and certifications of terminal illness, (3) educate hospices about election statements and certifications of terminal illness, and (4) provide guidance to hospices regarding the effects on beneficiaries when they revoke their election and when they are discharged from hospice care. CMS agreed with three of our recommendations and neither concurred nor nonconcurred with our fourth recommendation.
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Amann Umrah Umrah the actual most important and as a result fundamental component Islam
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6 Noble Virtues of just the right Wife
How being a good Housewife?Who is an excellent wife? How coordinator,being good wife? indications of Qualities of an ideal life partner? primary virtues she should have?
Wifely virtues are reviewed in Tulasi Ramayana (Sri Ramacharitamanasa) Aranya Kanda verse 4 as advice provided for Sita by Sage Atri’s wife Ansuya. as per the verse, ‘Devotion of body chemistry, dialog and mind to her lord’s (husband’s) Feet is the only real duty, almost holy vow and penance of a woman’. The 6 Noble Virtues a housewife must have are summed up in the verses (at Neetisaram or Neeti Saara or Niti Shastra) with our understanding of below.
Being a Good House WifeNeeti Saara is a common collection of morals written by Telugu Poet Baddena aka Bhadra Bhupala who lived during the 13th century. Since this was written by an Indian keeping in mind the Hindu culture, It outlines the qualities an Indian bride should have.
concept of ‘Karyeshu Dasi, Karaneshu Manthri; Bhojeshu Mata, Shayaneshu Rambha, Roopeshu lakshmi, Kshamayeshu Dharitri, Shat dharmayukta, Kuladharma Pathni’.
1) Karyeshu Dasi: Works perhaps a servant
2) Karaneshu Mantri : says like a minister
3) Bhojeshu Mata: Feeds like a mother
4) Shayaneshu Ramba : Pleases in bed enjoy the heavenly beauty Rambha
5) Roopeshu Lakshmi : picturesque like Goddess Lakshmi
6) Kshmayeshu Dharitri : Having endurance like Earth
7) Shat dharma yuktah: Woman that this six virtues
8) Kula dharma Patni : beneficial housewife (A married woman who is not employed outside the home)
allows, A good housewife have to
Be like a servant in doing the chores entrance
Give keen advice like a minister to her husband
Serve food to the husband as adoringly as a mother feeds her son
Like a courtesan in the bed room
glorious like Maha Lakshmi and
Have the forbearance of mother earth
As per the very last line of the shloka, A woman want all the above said qualities to be an ideal house wife. It also means that the absence of meet chinese girls even one quality makes a woman a failure as a good wife. Anyone experiencing these verses on Patni dharma (benefits of wife) Would know to be from a man. This age old understanding of how the wife should be has entered the mind set of even modern men and woman because of such a shloka. Correct me should i be wrong. Is there a similar verse picturing the qualities of an ideal husband? I hesitation! around the, The Hindu Dharma also has references about husband and wife relationship as ‘saha dharma chariNam’ which means sharing of dharma equally. It is also said that the outcomes or fruits of the chores would be shared equally. depending on Manu, ‘where women are privileged, The Gods are proud; Where they could be recycled honored, All work evolves into fruitless’.
in such a 21st Century, The role of a wife has completely changed from what persisted in the 1950s. The Modern Woman comes across as a strong, Independent and powerful individual who manages both home and office. Still her contribution and role in one’s life and family is often taken for granted. Her efforts are neither recognised nor appreciated. due to the typical Indian male mindset. however the qualities outlined in Neetisaaram are for that of a housewife (A wife who stay home), It is seen that most Indian Males expect their wives to fulfill the role even if she is a working woman. I know a couple who works in a Bank. Both the husband and wife go to the Bank together and come back together. But the wife does all the work before going to bank and does all the work after coming back from work also with no help from husband at all because according to him running the household is her obligations. keeping track of free, modern, Educated and earning a woman is, Most Indian men see the household chores as an obligation of a woman.
In this modern age, How far this six desirable properties or traits of an ideal wife are possible? it’s no surprise that, Woman like me find most of these verses Male chauvinistic and patronizing. I find the expectation of perfection (Goddess Lakshmi in Beauty and Rambha asleep) From female degrading. Do these traits apply regarding in this 21st century? A marriage is supposed to be an equal partnership between the couple. Having said this I also agree that woman should thrive in achieving this 6 fold role to have a happy and successful marriage. I am a firm believer of ‘Treat your Husband exactly the same you want yourself to be treated’. What you give is what you get in return. Give absolutely adore, Respect and care to your companion and you are sure to get it back from him. Even Niti Saara has an equivalent verse, ‘Do not do unto others what one couldn’t like others to do unto oneself’.
Tips for Composing a rewarding BDSM Dating Profile
When entering the world of online dating services, It s important to create a stylish profile after all, Your profile is what sells you as a person that someone want to go out with. When you re in face of a giant box to put text in, It can be hard determine what to say. what / things you share? What scenario keep to yourself? Is it weird to tell in which I love cheese? every one of these questions can run through your head and make creating a profile daunting. almost all of the the case on BDSM dating sites, Where people would like to try things that could be considered as taboo. subsequently, If you re any BDSM profile online, here’s a few tips to help it be successful and welcoming. Avoid Weird Usernames When working with a niche dating sits like BDSM sites, People are often tempted to put their best activity or interest into their username. this, truth that common, Might be effecting your profile s success. If your username mentions something about sex, you might be putting people off of talking to you. As a rule, If your username is a bed that’s capable of making people blush, Don t make use of. Be Honest It s common for people to lie about issues age or location on social networking sites, And restricted to,consist of dating sites. If you re purchasing long term relationship on a BDSM website, Remember to be honest about who are you are and what you’re looking for out of the website. Don t trick people into messaging you of the opinion that you want something else or that you re 5 years younger or older. Only List A Few Kinks or Fetishes On BDSM online, It s tempting to want to list every fetish and appeal to your intelligence have. Here s top tips, reality: wear t. While it s okay to list some of your kinks, Listing too many can put people off as you possibly can too much to read, And leaves nothing for you and your possible date to share later on. should you like you have too many, Pick 3 to briefly mention and then move on to a different one topic. Have A Good shape Photo On any dating site, The profile photo godatenow.com you use ’s important. It gives people something to base a first outcome off of, And shows your identity. whne selecting a profile photo, Use one that shows that you smiling and is well lit. as well, Avoid using group photos as your profile photo as this can confuse potential dates and can make people bypass your profile altogether. Creating a BDSM profile isn t much unique of creating a standard dating profile is. The major difference comes in in the interests family of the BDSM profile, so where, In an average profile you wouldn t usually list fetishes but in BDSM profiles, It s acceptable and pushed. to be successful with your profile, Remember your manners and be respectful to poor people of ghana you speak to.