Kelly Simonelli, Author at LW Consulting, Inc.

Breaking the Cycle: Why Mental Health Medication Non-Adherence Is Everyone’s Problem

Kelly Simonelli — Thu, 18 Dec 2025 14:16:51 +0000

When we talk about medication non-adherence in mental health, it’s easy to focus only on the patient—missed doses, relapse, or crisis episodes. But the reality is much bigger. Non-adherence is a system-wide issue that ripples across emergency departments (EDs), skilled nursing facilities (SNFs), hospitals, and community providers. Recent research shows that nearly half of patients with psychiatric conditions do not take their medications as prescribed (Zewdu et al., 2025). That isn’t just a personal setback,…

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Choosing the Right Independent Review Organization

Kelly Simonelli — Mon, 08 Dec 2025 16:19:16 +0000

If you are negotiating a Corporate Integrity Agreement (CIA) on behalf of a client, you may need the services of an Independent Review Organization (IRO) to manage the ensuing work and make sure that you make the right business choices. All IROs are not created equally. So, what do you need to know to select the IRO best suited to the situation? But what exactly is an IRO, and why is it so important? LW…

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Voluntary Medicare Extrapolated Overpayments: Legal and Compliance Considerations in 2025

Kelly Simonelli — Wed, 03 Dec 2025 20:17:04 +0000

The regulatory landscape for Medicare overpayments is evolving rapidly, and the risks for healthcare providers are growing — especially when it comes to repayments and potential liability under the False Claims Act (FCA). Our latest whitepaper, “Voluntary Medicare Extrapolated Overpayments: Legal and Compliance Considerations in 2025”, sheds light on what healthcare attorneys can do to guide their clients. Key Takeaways Why This Matters Providers across the continuum are under significant pressure—regulatory, legal, and operational. If…

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2025 TPE Audits and the Importance of Internal Auditing in Therapy Practices

Kelly Simonelli — Tue, 11 Nov 2025 21:42:54 +0000

The Centers for Medicare & Medicaid Services’ (CMS) 2025 Targeted Probe and Educate (TPE) audits continue to reveal the same issues—missing medical necessity details and incomplete plans of care. These gaps put therapy practices at risk of denials and penalties. Therefore, internal auditing is essential to ensure compliance and audit readiness. As payers and regulators increase scrutiny, documentation and billing are no longer just administrative tasks; they are crucial to reimbursement and long-term sustainability. Internal…

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Psychedelic Treatments, Telehealth, and Compliance: What Providers Need to Know

Kelly Simonelli — Mon, 03 Nov 2025 16:48:08 +0000

Health providers are facing a period of rapid change. From the rise of psychedelic-assisted therapies to evolving telehealth policies and heightened regulatory scrutiny, organizations must balance innovation with compliance. Proper documentation, coding, and audit preparedness are no longer optional; they are essential for protecting patients, practices, and reimbursement. This article summarizes key takeaways from LW Consulting’s Senior Consultant, Christine Pilarski’s recent workshop on Coding, Billing, Payment, Audit, and Enforcement at the ASKP3 2025 Mastering the…

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Why Clinical Laboratories Can’t Afford to Ignore the 2025 OIG iCPG

Kelly Simonelli — Mon, 27 Oct 2025 12:30:00 +0000

The Office of Inspector General (OIG) is set to release new General Compliance Program Guidance (iCPG) for clinical laboratories in 2025—and it’s a game changer. For more than 25 years, labs have operated under the same compliance framework. But with the rise of genetic testing, electronic order sets, and complex payer rules, the OIG is updating its expectations. The new iCPG will strengthen oversight, expand data monitoring requirements, and tie laboratory stewardship directly to compliance…

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What Organizations Should Expect Regarding TPE Audits for Medicare Part A

Kelly Simonelli — Fri, 24 Oct 2025 16:09:28 +0000

The Centers for Medicare & Medicaid Services (CMS) launched the SNF 5-Claim Probe and Educate (SPE) in 2023 in response to a 15.1% improper payment rate under the Patient-Driven Payment Model (PDPM), identified in 2022 (2023). The probe was meant to audit five PDPM claims per skilled nursing facility (SNF) and offer education based on the findings. At the time of the roll out, CMS projected that providers with error rates under 20% could request…

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Navigating Uncertainty: Key Takeaways from LeadingAge Rhode Island’s 2025 Aging Services Policy Conference

Kelly Simonelli — Thu, 23 Oct 2025 13:58:37 +0000

LW Consulting, Inc. (LWCI) had the pleasure of attending this year’s LeadingAge Rhode Island Aging Services Policy Conference, which underscored one resounding theme: UNCERTAINTY. As new federal policies unfold, providers across the aging services continuum are preparing for significant shifts—many of which remain undefined. From sweeping federal budget reforms to evolving state-level requirements, the road ahead demands vigilance, flexibility, and collaboration. Federal Policy UpdatesA major topic of discussion was H.R. 1, the “One Big Beautiful…

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LW Consulting, Inc Announces New Partnership with Dr. Andrew Fletcher of Eutologic Consulting

Kelly Simonelli — Wed, 22 Oct 2025 16:10:36 +0000

Harrisburg, PA —October, 2025—LW Consulting, Inc. (LWCI) a nationally recognized leader in healthcare and business consulting, is excited to announce their new partnership with Dr. Andrew Fletcher of Eutologic Consulting. Eutologic Consulting was established in 2022 by Dr. Andrew Fletcher, MD, MBA, CPE, CHCQM, FCAP. Dr. Andrew Fletcher is an anatomic and clinical pathologist with 25 years of experience. He specializes in laboratory strategic consulting, operations management, and clinical transformation, with his main focus being…

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Understanding the Importance of Medicare Cost Report Accuracy

Kelly Simonelli — Tue, 14 Oct 2025 12:30:00 +0000

Medicare cost reports are the backbone of hospital, skilled nursing facility, home health agencies, and Federally Qualified Health Center (FQHC) reimbursements—yet errors can slip through, leading to costly corrections. Audit results released in August 2025 by the Health and Human Services Office of Inspector General (HHS-OIG) uncovered exactly that: cost reports settled by Novitas Solutions, Inc. via their desk review process were later reopened due to “obvious errors,” resulting in nearly $9.4 million in corrective…

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