SNFRM as the first measure for the Skilled Nursing Facility Value Based Purchasing

February 10, 2017
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The Bottom Line

In the Fiscal Year (FY) 2016 SNF Prospective Payment System (PPS) final rule, CMS adopted the SNFRM as the first measure for the Skilled Nursing Facility Value Based Purchasing (SNF VBP) Program. The measure is defined as the risk-standardized rate of all-cause, unplanned hospital readmissions of Medicare beneficiaries within 30 days of discharge from their prior hospitalization. Hospital readmissions are identified through Medicare hospital claims (not SNF claims) so no readmission data is collected from SNFs and there are no additional reporting requirements for the measure.

DMEPOS Competitive Bidding Round 2019 Announced

February 3, 2017
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The Bottom Line

On January 31, 2017, the Centers for Medicare & Medicaid Services (CMS) announced plans to consolidate all rounds and areas included in the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program into a single round of competition – Round 2019.  After the current Round 1 2017, Round 2 Recompete, and National Mail-Order competitions conclude on December 31, 2018, Round 2019 contracts will become effective on January 1, 2019 through December 31, 2021.  Round 2019 will include 141 competitive bidding areas (CBAs) and have a total of 11 product categories.

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.

Dental, hearing, and vision services added under Medicare coverage

January 18, 2017
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The Bottom Line

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 is expected to improve beneficiaries’ quality of life, decrease healthcare costs by creating healthier seniors, and is expected to reduce depression and social isolation.

HIPAA, what can you share?

January 13, 2017
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The Bottom Line

Those of us who work in the healthcare industry are pretty familiar with HIPAA; however, on occasion there is still confusion about what can and cannot be shared with others. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was established in an effort to protect the privacy of individually identifiable health information. Although it’s been around for many years, many of us are still confused by all the rules and regulations.

2017 Resolutions: What to prioritize in the ever-evolving postacute landscape

January 6, 2017
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The Bottom Line

With a new year upon us and (perhaps) the most amount of free-flowing health policy changes happening or about to happen in decades, it seems appropriate to create some simple resolutions for the year ahead. Similar to the personal resolutions most people make (get healthy, lose weight, clean closets, etc.), the following are about improvements in the business and operating environments. 

A year of ambiguity alleviated by OIG’s familiar plans

January 6, 2017
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Billing Alert for Long-Term Care

In the months leading to the New Year, much was left to be desired for long-term healthcare providers: Namely, answers. Beginning with anticipation over how CMS’ revision overhaul of Conditions of Participation (CoP) for Medicare will play out during Phase 1 (and 2, and 3) of the new survey process, and ending with scattered talk among the Trump administration of “repeal and replace” of ACA, providers have been anticipating the last straw.

ACO and Bundling Q&A with Maureen McCarthy, BS, RN, RAC-MT

December 29, 2016
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Billing Alert for Long-Term Care

Q: What are the domain weights for the new QMs?

A: Those quality measures are worth 50 percent—so they’re worth 10, 20, 30, 40 or 50 percent of the weight of that specific quality measure domain. Let’s look at the re-hospitalization number. For your re-hospitalization component, you could be getting 10, 20, 30, 40 or 50 points and that is the same for all five of the new measures, including re-hospitalization measure, the emergency room use, the successful discharge to the community, the improvement in function for the short stay and the decline in function for the long stay.  Pull your most recent five-star report and you’ll be able to see (the third column from the left on those reports) that data and would be able to make a determination as to which area you wanted to make improvements in your quality before it starts to negatively affect your organization.

CMS launches three new policies, continuing the shift to value-based care

December 22, 2016
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The Bottom Line

The Centers for Medicare & Medicaid Services launched three new policies on December 20, 2016, 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. These 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. 

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