Connecting the dots between competency development and your bottom line

Mar 08, 2019
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Billing Alert for Long-Term Care

CMS regulations require that a facility assessment be completed annually to determine what resources are necessary to care for residents competently during both day-to-day operations and emergencies. These assessment findings can then be used to make decisions about direct care staff needs and capabilities needed to care for each resident. If current needs aren’t being met, nurse leadership may need to implement new competency development. This task doesn’t involve the billing department directly; however, billers, business office managers, and the finance department can support other departments through changes in the facility’s expenses that will help contribute to a healthier bottom line.

CMS to lift freeze on health inspection star ratings, assign one-star for no RN onsite

Mar 08, 2019
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The Bottom Line

CMS announced several updates to Nursing Home Compare (NHC) that will take place this April, including a removal of the freeze placed on health inspection star ratings instituted in February 2018. The freeze was placed to give all facilities a chance to be surveyed at least once under the new process. Beginning in April, consumers will be able to see the most up-to-date status of a facility’s compliance on NHC.

Updates to QIES won’t change the way providers submit data

Mar 01, 2019
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The Bottom Line

CMS announces that starting in March, the Quality Improvement and Evaluation System (QIES), Certification and Survey Provider Enhanced Reports (CASPER) and Automated Survey Processing Environment (ASPEN) will undergo a series of modernizing enhancements. The agency clarified that once updated, the new system, Internet Quality Improvement and Evaluation System (iQIES), will not change how providers currently submit data to CMS.

OIG highlights from 2018

Feb 15, 2019
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Billing Alert for Long-Term Care

The Office of Inspector General’s (OIG) studies can serve as a good alert system for long-term care facilities as well as the regulators who monitor them. We’ve compiled a list of relevant reports and recommendations published by the OIG in 2018 to help you prioritize your quality and compliance goals for this year.

CMS vows to stop hospitals from blocking nursing home requests for patient information

Feb 15, 2019
 | 
The Bottom Line

The Centers for Medicare & Medicaid Services (CMS) released several proposals in a blog post dated February 8, 2019, to help increase interoperability between hospitals and LTC facilities and remove silos that prevent SNFs and nursing homes from getting the information they need to care for patients. The agency is accepting comments on the requests for information and proposed rule until early April (exact date to be announced).

Featured member resource: Admission Audit

Feb 15, 2019
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The Bottom Line

These audits occur generally five days after an admission (not too early/not too late). The goal is to capture the completion of assessments, care plans, accuracy in medication reconciliation, and orders from the hospital. Depending on the findings, an opportunity for correction via late-entry documentation can occur to help ensure a clean claim. Download the Admission Audit.

The real impacts of poor quality, inadequate compliance, and weak risk management

Jan 25, 2019
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Billing Alert for Long-Term Care

The assisted living and skilled care industry today is going through a rocky patch. A solid half of the skilled nursing facility (SNF) industry is struggling due to Medicare Advantage, softer demand, pervasive reliance on Medicaid for census, labor shortages, rising wage pressure, tight Medicare reimbursement, and new regulations, etc. While its struggles are not as pervasive as SNFs’, assisted living is facing challenges due to softer census, overcapacity, rising resident acuity, labor costs and shortages, and increasing regulatory scrutiny. The relative strength in the overall senior and postacute sector is home health and independent housing; however, while home health demand is good, regulatory overburden is still present, along with tight reimbursement and labor challenges. Independent housing’s market and sub-market rent side remain strong; however, many high-end providers are still struggling with census challenges and soft demand in certain markets.

States now required to conduct at least 50% of off-hour surveys on weekends for facilities with potential staffing issues

Jan 25, 2019
 | 
The Bottom Line

A list of facilities with potential staffing issues is being provided to CMS regional offices and state survey agencies to support survey activities for evaluating sufficient staffing, according to a memo released by CMS back in November, 2018. The memo states that “while CMS is encouraged by facilities’ efforts to improve staffing,” payroll based journal (PBJ) data has raised a few concerns, prompting them to inform state survey agencies of facilities with potential staffing issues. These issues include facilities with significantly low nurse staffing levels on weekends and facilities with several days in a quarter without an RN onsite.

Chief compliance officer job description, competencies, and performance evaluation

Jan 18, 2019
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The Bottom Line

By now, most organizations have identified a compliance officer, set up a reporting hotline for staff to report concerns, and done some training with staff on the elements of their facility’s specific compliance and ethics plan to meet the November 28, 2019 implementation deadline.

Having a trusted and responsible person that reports directly to the governing board is imperative to the success of a compliance and ethics program. The compliance officer is responsible for overseeing all aspects of the implementation of the program and reporting its progress on a regular basis to senior management. This individual is also primarily responsible for evaluating the program’s needs and tailoring the tools required of a compliance and ethics program to best meet those in a timely manner. Download our Chief Compliance Officer Job Description, Competencies, and Performance Evaluation to help this role measure his or her success.

Implementing an efficient preadmission screening process to determine potential revenue under PDPM

Jan 04, 2019
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The Bottom Line

Most hospitals like for facilities to respond to referrals within 15 minutes, and that can be a very ambitious goal. It usually includes running insurance, speaking with the director of nursing, or calling the pharmacy to get an idea of drug costs. Facilities are used to relying on their admissions coordinator to conduct many of these tasks, but under the Patient Driven Payment Model (PDPM), providers will have to involve more team members in the preadmission screening process.

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