Key points with the new CMS Five-Star ratings this week!

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The updated July 2020 Five-Star Ratings were posted on CASPER this week. These will be posted for public viewing on Nursing Home Compare (NHC) on or around July 29, 2020. On June 25th, CMS released memorandum QSO 20-34-NH describing the updates to the staffing and quality measures. We have been fielding a multitude of questions...

The Program for Evaluating Payment Patterns Electronic Report, aka PEPPER is back!

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CMS announced recently that the Program for Evaluating Payment Patterns Electronic Report, aka PEPPER, will be available on July 29, 2020 for SNF providers. The July 2020 SNF PEPPER will include Q4FY19 legacy RUG-IV data: Therapy and Non-Therapy RUGs with High ADL, Change of Therapy, Ultrahigh Therapy RUGS, 20- and 90-day episodes of care. New...

THE RACS ARE BACK!

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Just when you thought it was safe THE RACS ARE BACK!!!! On March 30th, CMS suspended most Medicare Fee-For-Service (FFS) medical reviews because of the COVID-19 pandemic. In a recent COVID-19 Provider Burden Relief  FAQs, CMS stated that regardless of the status of the public health emergency, pre-payment and post payment medical reviews will resume...

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...