While all of our hopes are rising for a fresh start to 2021, the star ratings on Care Compare may be bringing new challenges to a number of SNF providers. Last week, CMS announced that they will resume calculating the Quality Measure and Survey components of the Five Star rating system, much of which has...
With the rise in COVID cases nationally, endless regulatory changes, reimbursement cuts and soaring costs, it would be wise for skilled nursing leadership to regroup with their operational, clinical and reimbursement teams to review the facilities infection control and 1135 waiver application practices. Coretactics has put together some reference material and web links to help...
CMS will not be moving their laser focus away from your ability to comply with infection control regulatory guidance any time soon. In a QSO Letter issued June 1, 2020, CMS informed providers they would be receiving enhanced enforcement actions for infection control deficiencies. These actions include heavy civil monetary penalties, issuance of directed plans...
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...
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...
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...
The DAL dated 11/21/19 from DOH regarding January 30, 2019 census data for case mix adjustment, July 1, 2019 rates.
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...
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...
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...
