Hospital Readmission Rates: Progressive Reductions

April 7, 2017
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Billing Alert for Long-Term Care

With prodding from federal officials and an industrywide shift toward delivering services based on value rather than volume, healthcare providers are making progress on reducing hospital readmission rates, federal statistics show. From 2007 to 2011, the all-cause 30-day hospital readmission rate for Medicare fee-for-service beneficiaries held steady at about 19% to 19.5%, according to the Centers for Medicare & Medicaid Services. But those rates fell to 18.5% in 2012 and 17.5% in 2013, CMS reports.

 

SNF merger and acquisitions: The provider number trap

March 24, 2017
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Billing Alert for Long-Term Care

Over my career, I have done a fair amount of merger and acquisition (M&A) work, including:

  • Continuing care retirement communities (CCRC)
  • Skilled nursing facilities (SNF)
  • Home health agencies (HHA)
  • Physician practices
  • Hospices

While each deal has many nuances and issues, none can be as confusing to navigate as the federal payer issues—specifically, the provider number. For SNFs, HHAs, and hospices, an acquisition that is not properly vetted and structured can have severe repercussions post-closing, if provider liabilities existed pre-close and were unknown and/or unknowable. Even the best due diligence cannot ferret out certain provider number–related liabilities.

The Medicare provider number is the unique reference number assigned to a participating provider. When initially originating as a provider, the organization must apply for provider status, await accreditation (for SNFs, this is done via a state survey; for HHAs and hospices, it is via private accreditation), and then get ultimate approval by Medicare/HHS. As long as the provider that has obtained the number remains in good standing with CMS—meaning it hasn’t had its provider status/agreement revoked—the provider may participate in, and bill, Medicare and Medicaid (as applicable).

Transforming Health Care Delivery through the CMS Innovation Center: Better Care, Healthier People, and Smarter Spending

March 10, 2017
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The Bottom Line

CMS has made great progress in recent years on reforming our system into one that delivers better quality of care for patients and pays for care in a smarter way, including investing more in prevention and primary care.

The reimbursement role of the MDS 3.0

March 10, 2017
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Billing Alert for Long-Term Care

Although the main purpose of the MDS is to assist the clinical team to provide accurate, resident-centered care, the MDS has evolved to become the basis for Medicare and Medicaid state case-mix payments. The MDS is used as a data collection tool to classify Medicare residents into resource utilization groups (RUG). The RUG scores as reported in MDS items Z0100 or Z0150 are then used to bill Medicare or Medicaid.

Eight ways to improve the transition process between hospitals and SNFs

March 3, 2017
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Billing Alert for Long-Term Care

There are few times during a SNF stay that a resident is more vulnerable than those first several days. Often, a bad transition process only serves to exacerbate those vulnerabilities, leading to complications or rehospitalization.

In fact, a  study published in the Journal of Post-Acute and Long Term Care shows that poor coordination between hospitals and postacute care providers can have devastating consequences for residents, particularly those with higher acuity.

Exciting updates: More content, tools, and news at your fingertips!

March 3, 2017
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The Bottom Line

The challenges billing professionals tackle each day don’t wait for solutions and neither should you. That’s why The Billers’ Association for Long-Term Care is transitioning to a one-level membership to allow all members access to a lively discussion board, analysis of regulatory compliance issues, weekly news of the changes that are happening in the billing world, as well as whitepapers, and more. The Billers’ Association is a single source for all your billing, regulatory, and compliance news, tools, and best practice strategies.

The IMPACT Act in 2017- last chance to register for CMS event

February 22, 2017
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The Bottom Line

Thursday, February 23 from 1:30 to 3 pm ET

To register or for more information, click here.

The Improving Medicare Post-Acute Care Transformation of 2014 (IMPACT Act) requires the reporting of standardized patient assessment data by Post-Acute Care (PAC) providers, including skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, and long-term care hospitals.  During this call, CMS experts discuss goals, requirements, progress to date, and key milestones for 2017. A question and answer session follows the presentation.

CMS Issues Proposed Rule to Increase Patients’ Health Insurance Choices for 2018

February 16, 2017
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The Bottom Line

On February 15, 2017, The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for 2018, which proposes new reforms that are critical to stabilizing the individual and small group health insurance markets to help protect patients. This proposed rule would make changes to special enrollment periods, the annual open enrollment period, guaranteed availability, network adequacy rules, essential community providers, and actuarial value requirements; and announces upcoming changes to the qualified health plan certification timeline.

Advancing care coordination through episode payment models final rule

February 10, 2017
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Billing Alert for Long-Term Care

In late December, 2016, the Centers for Medicare & Medicaid Services (CMS) finalized new Innovation Center models that continue the Administration’s progress to shift Medicare payments from rewarding quantity to rewarding quality by creating strong incentives for hospitals to deliver better care to patients at a lower cost.

Bill introduced to add dental, hearing, and vision services under Medicare coverage

February 3, 2017
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Billing Alert for Long-Term Care

On January 12, 2017, lawmakers introduced a bill that lifts restrictions which previously prohibited Medicare from covering basic healthcare necessities such as eyeglasses, hearing aids, and dental care. The Seniors Have Eyes, Ears and Teeth Act (H.R. 508) is anticipated to improve beneficiaries’ quality of life, while decreasing healthcare costs by creating healthier seniors.

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