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.

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.

Electronic health records: Are they the right move for your facility?

January 13, 2017
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Billing Alert for Long-Term Care

Electronic health records (EHR) have slowly made their way into long-term care (LTC), with almost all facilities now using some form of electronic system to complete the MDS. There are several benefits to “going electronic,” a phrase that beats to the same tune as “going green.” Along with aiming to be more environmentally friendly, the benefits of using EHRs include:

  • Lowering the chances of medical errors, eliminating duplicate tests, and possibly improving overall quality of care*
  • Consistent information; Providers have the same up-to-date information about conditions, treatments, tests, and prescriptions*
  • Access to analytics, making it easier to see, track, and correct trends
  • The ability to roll up data for facility audits
  • Creating efficient data-mining tools

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.

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.

CMS is updating the Medicare drug spending dashboard

December 29, 2016
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The Bottom Line

As part of its effort to provide additional information on, and increase transparency with respect to the cost of prescription drugs, CMS is updating the Medicare Drug Spending Dashboard to include information for 2015. This online dashboard presents information for three categories of Medicare prescription drugs for both Part B and Part D: drugs with high spending on a per user basis, drugs with high spending for the program overall, and drugs with high unit cost increases in recent years

Proactive Denial Management

December 23, 2016
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Billing Alert for Long-Term Care

It was a rough way to start the fiscal year for a 99-bed nursing home operator in Oakland, California: a payback to their assigned Recovery Auditor of over $186,000 in Medicare payments they had earned three years ago for the provision of care to eligible patients. Why? The provider failed to properly review what services were being billed and failed to comply with certain details of billing Medicare for services. As a result, the planned remodel of their dining room and rehabilitation gym—both of which would have markedly improved patients’ quality of life—would have to wait several months for a round of capital funding.

Dementia Care Added to Medicare Advantage Value-Based Insurance Design Model

December 22, 2016
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Billing Alert for Long-Term Care

Experts say care for dementia patients may get a boost now that the condition is being added to The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation Medicare Advantage Value-Based Insurance Design (MA-VBID) model. I definitely see it as a positive,” says Renee Kinder, MS, CCC-SLP, RAC-CT, director of clinical education for Encore Rehabilitation Services in Louisville, Kentucky.

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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