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Resident w/Care giver

Understanding CMS Latest Five Star Quality Rating Methodology

With the recent July 2024 refresh to Care Compare, CMS has changed the staffing case mix adjustment to a model based on the PDPM, essentially using the nursing case mix groups to adjust for acuity. Other important changes include: The gap period used in defining termed staff has increased from 60 days to 90 days…
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fall risk bracelet

Survey Readiness…More Important Than Ever!

Published: April 9, 2024 April 2024 Update: CMS Survey Process Notice: Testing Risk-Based Survey Approach By modifying some surveys based on compliance and quality history, CMS will be able to devote more time and resources to nursing homes with lower quality whose residents are at higher risk of harm. This effort to prioritize resources for…
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compliance policies

CMS Seeks Greater Enforcement Power in Proposed SNF PPS Rule FY 2025

Published April 5, 2024 With the changes proposed by CMS for FY 2025, a SNF survey finding of noncompliance will become more burdensome. In this new rule, issued on March 28, 2024, the Centers for Medicare & Medicaid Services (CMS) proposed several revisions to policies and payment rates used under the Skilled Nursing Facility (SNF)…
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ppe

CDC: Enhanced Barrier Precautions in Nursing Homes

Published April 3, 2024 On March 20, 2024, the CDC released a memorandum updating the Enhanced Barrier Precautions in Nursing Homes. In summary, the memo stated: CMS is issuing new guidance for State Survey Agencies and long term care (LTC) facilities on the use of enhanced barrier precautions (EBP) to align with nationally accepted standards.…
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Resident w/Care giver

Quality Measures Update!

Published March 6, 2024
October 2023 brought the long-term care industry many changes, specifically with the release of MDS 1.18.11. One of the most impactful changes has been the removal of Section G and updates to Section GG. The update to the MDS resulted in updates needing to be made to the Quality Measures (QMs). The following QMs were updated/replaced due to the change from Section G to Section GG:

Coretactics 5-Claim Probe Experts Assist Before, During & After Your 5-Claim Audit!

Published February 23, 2024
CMS has authorization to revoke Medicare billing privileges under certain conditions. Regulation 42 CFR §424.535(a)(8)(ii) states CMS has the authority to revoke a currently enrolled provider or supplier’s Medicare billing privileges if CMS determines that the provider or supplier has a pattern or practice of submitting claims that fail to meet Medicare requirements.

Medicaid Compliance Certification Requirement Changes

Published February 13, 2024
Annual Certification Statement for Provider Billing Medicaid – A provider adopting and maintaining an effective compliance program will now attest to this as part of their annual “Certification Statement for Provider Billing Medicaid.” This Form must be completed and returned to NYSDOH by the enrollment anniversary date.

Amy E. Lee Receives ACHCA’s 2023 Education Award!

Published February 7, 2024
Amy E. Lee, President & CEO of Coretactics, was awarded Educator of the Year at the American College of Health Care Administrators 2023 national awards ceremony during and annual Convocation.