Performing a thorough preadmission screening on each resident will help ensure that the facility can afford to meet that individual’s care needs under PDPM. Use this preadmission screening flowsheetcreated by HCPro’s regulatory specialist and boot camp instructor, Stefanie Corbett, DHA, as a checklist to improve your process.
During her speech at the National Association of Accountable Care Organizations Spring 2019 Conference, CMS Administrator Seema Verma referred to the Stark Law as an outdated regulation that “addressed real issues regarding the potential for financial incentives to inappropriately influence how physicians make decisions” when it was enacted 30 years ago, but that serves little purpose under a value-based system.
Staffing data from Jan 1 through March 31 must be submitted no later than 45 days from the end of the quarter. The final submission deadline for this quarter is May 15, 2019. On a SNF open door forum held earlier this week, officials instructed facilities to review their monthly provider preview reports in their CASPER folder for feedback on their most recent submission.
Q. Should therapy treatment practices change under the Patient-Driven Payment Model (PDPM)?
A. Even though therapy minutes are no longer relevant to the provision and payment for therapy, CMS has assumed that most therapy will continue to be provided one-on-one. SNFs with contract providers need to take great care to ensure that the contractor does not automatically ramp up inpatient therapy on a group and concurrent basis to the 25% threshold!
Unless the facility has experienced a significant change in overall case mix from when under resource utilization groups (RUG) to PDPM (fewer therapy-qualified residents), there would be no logical clinical reason to change treatment practices.
One of the most important staff members in the facility is the person who informs the family that they owe money, making the business office the most important stop during the admissions process. Download this white paperto ensure your staff understand best practices for providing customer service to residents and family members, especially when discussing complicated financial matter by
Beginning this April, the Department of Health and Human Services (HHS) will randomly select nine HIPAA-covered entities for compliance reviews. The possible selections can include any health plan for clearinghouses that are covered by HIPAA and is not isolated to just those that work with Medicare and Medicaid.
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.
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 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.
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.