NYS DAL

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The DAL dated 11/21/19 from DOH regarding January 30, 2019 census data for case mix adjustment, July 1, 2019 rates.

PDPM Pitfalls

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Consider these common scenarios and how your team might better address these areas of potential missed opportunity: Section I: Check Box vs I8000 (ICD-10 code) Not coding diagnoses in the proper location can impact nursing, NTA and SLP components of PDPM For example, respiratory failure should be coded both in the check box I6300 (to...

Traditional Rehab Under a PDPM Lens!

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CMS has vehemently stated that providers are responsible for producing the same functional outcomes under PDPM as they did under the RUG payment model. Keeping that in mind, there is certainly opportunity to shift traditional restorative program structure while maintaining optimal functional and quality outcomes to avoid financial audits and quality payment penalties - an...

Staring Down the PDPM Barrel!

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So, now that you’ve mastered the ins and outs of PDPM, what’s next? You’ve learned the PDPM basics (i.e., changes to the MDS, Case Mix Components, determining the HIPPS code, etc.), but what comes next? Here’s a couple things to think about: Take a look at your current policies and procedures. The way to sustain...

SNF Quality Reporting Program: Non-compliance letters available

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CMS has provided notifications to facilities that were determined to be out of compliance with the quality reporting requirements for the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP), which may result in a 2% reduction that will affect their FY 2020 Annual Payment Update (APU). Non-compliance notifications have been sent to the Medicare Administrative...

Proposed Rule Requirements for Long-Term Care Facilities: Changes may be coming!

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Proposed Rule Requirements for Long-Term Care Facilities: Changes may be coming! On July 16, 2019, CMS announced a proposed rule, “Medicare & Medicaid Programs; Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency and Transparency” (CMS-3347-P) that could bring some welcomed updates to a number of Phase 1 & 2 items as well as...

Five Star Changes: What’s coming next month?

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Prepare yourselves! The stars will be realigning next month based on the announcement from CMS this week. Not only will survey results be reinstated (they have been on hold since last November) but there is sure to be more shifting based on changes made to the quality measures and staffing methodologies. The revised Five-Star Technical...

Rising to The Top Deficiency: Abuse Reporting and Investigations

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A common struggle SNF administrative teams have is conducting a thorough investigation to rule out abuse. Abuse and investigation citation frequency is steadily climbing above the infamous Infection Prevention & Control that has ranked number one across the nation since the start of our new survey process. If you are struggling in this area, start...

New QRP Detail Available in CASPER Reports!

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Earlier this month, CMS added the SNF QRP Provider Threshold Report to the QRP reports available in the QIES system.  Using this report, providers will have more detail and clarity to the status of the required data needed for meeting APU compliance.  If the SNF completes 100% of required data elements on at least 80%...

Bed Safety – Compliance & Reminders

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A holistic approach to safety in skilled nursing facilities includes an assessment of resident safety and functioning when in bed.  Residents in long term care are often compromised and frail so to ensure a safe environment, bed safety must be part of an initial and ongoing assessment process. While many hospitals still include use of...