Archives

Feb 15, 2019
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Billing Alert for Long-Term Care

The Office of Inspector General’s (OIG) studies can serve as a good alert system for long-term care facilities as well as the regulators who monitor them. We’ve compiled a list of relevant reports and recommendations published by the OIG in 2018 to help you prioritize your quality and compliance goals for this year.

Feb 08, 2019
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Billing Alert for Long-Term Care

Surgical dressings are limited to primary dressings, which are therapeutic or protective coverings applied directly to wounds or lesions that are on the skin or are caused by an opening to the skin, and to secondary dressings that are therapeutic or protective (i.e., are needed to secure the primary dressing).

Feb 01, 2019
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Billing Alert for Long-Term Care

After speaking with a few subject matter experts about the new tax laws, Billing Alert for Long-Term Care has the good, the bad, and the salvageable for 2019 tax reform. For some long-term care (LTC) facilities, these changes will have significant dollar impacts on 2018 tax returns, while other facilities will slip through the IRS’ narrow cracks mostly unaffected. Just as the care plan for each resident should be individualized to his or her care needs, each facility’s approach to taxes this year should be customized to its unique situation. Here are a few changes to keep in mind and discuss with your certified public accountant (CPA) before submitting this year’s tax return.

Jan 25, 2019
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Billing Alert for Long-Term Care

The assisted living and skilled care industry today is going through a rocky patch. A solid half of the skilled nursing facility (SNF) industry is struggling due to Medicare Advantage, softer demand, pervasive reliance on Medicaid for census, labor shortages, rising wage pressure, tight Medicare reimbursement, and new regulations, etc. While its struggles are not as pervasive as SNFs’, assisted living is facing challenges due to softer census, overcapacity, rising resident acuity, labor costs and shortages, and increasing regulatory scrutiny. The relative strength in the overall senior and postacute sector is home health and independent housing; however, while home health demand is good, regulatory overburden is still present, along with tight reimbursement and labor challenges. Independent housing’s market and sub-market rent side remain strong; however, many high-end providers are still struggling with census challenges and soft demand in certain markets.

Jan 18, 2019
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Billing Alert for Long-Term Care

The following Q&A comes from the Billers' Association for Long-Term Care talk forum, Biller's Talk.

Q: Is the facility required to give a Notice of Medicare Non-Coverage (NOMNC) to a benefit-exhausted resident?

A: An NOMNC is not required by CMS regulation to be issued in relation to benefit exhaust; however, it is not wrong or held against a facility to issue one at that time. Some organizations with multiple facilities require the NOMNC to be issued as a best practice and as part of their policy and procedures, even in the event that the Medicare Part A services are terminated due to benefit exhaust.

The regulations regarding NOMNCs can be found at CMS.gov in the Medicare Claims Processing Manual, Chapter 30, Section 260.

Jan 11, 2019
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Billing Alert for Long-Term Care

For HIPAA covered entities (CE) that maintain poor policies and procedures related to HIPAA compliance—those that are unfinished in draft form, not updated in years, and basically not followed to the letter—their lassitude has cost them dearly.

Just look at some of the settlements OCR has struck with CEs and business associates (BA) in the past five years. Many of those settlements include findings that organizations had poorly maintained policies and procedures. This has increased the settlement amounts and in turn led OCR to issue strict consent decrees requiring these entities to update and maintain their HIPAA-related policies and procedures.

Jan 04, 2019
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Billing Alert for Long-Term Care

When the Centers for Medicare & Medicaid Services’ (CMS) new Patient Driven Payment Model (PDPM) goes into effect October 1, 2019, providers will have a few new acronyms to add to their dictionary, as well as some old ones that will have increased importance to quality care and reimbursement. The following list and words of advice from experts will will help you prepare.

ARD—Assessment reference date

The assessment schedule under PDPM is more streamlined and simplified than the assessment schedule under RUG-IV. The assessment reference dates are listed in Table 1 for the different Medicare MDS assessment types.

Dec 27, 2018
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Billing Alert for Long-Term Care

The Certification and Survey Provider Enhancement Reports (CASPER) quality measures (QM) reports should be used to identify areas of opportunity for improving quality of care. State surveyors and facilities may access each of the reports online in the Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing system, where Minimum Data Set (MDS) data are normally transmitted. The site can be found at www.qtso.com/providers/cmsnet-submission-access. The reports are generated through the Centers for Medicare & Medicaid (CMS) CASPER reporting system. It is important for facilities to become familiar with CASPER QM reports, because surveyors review the data in these reports to assess the quality of the facility’s care to residents.

Dec 21, 2018
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Billing Alert for Long-Term Care

Q: A patient is discharged from the skilled nursing facility (SNF) on day 24 and sent home to receive home health services. The patient falls at home on day 28 and is admitted to the hospital due to a fractured hip. Does this count as a readmission under the SNF value-based purchasing (VBP) program?

A: Yes. It doesn’t matter where the patient was post-discharge. If the patient was within that 30-day window from the original hospital stay through the SNF discharge, any rehospitalization is fundamentally tagged to the SNF, and then the question becomes whether it was avoidable. In this case, a hip fracture would more than likely be determined avoidable.

Dec 14, 2018
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Billing Alert for Long-Term Care

Senior living (also referred to as assisted living) is a cash-reliant industry, often paid for by the residents themselves. In contrast to nursing homes or skilled nursing facilities, Medicare is not generally an option for senior living facilities because these companies do not address the skill level of nursing care facilities. Nevertheless, even though senior living care is technically less expensive than skilled nursing home care, it is far from being cheap. In 2016, the national average for assisted living was $3,628 per month. However, senior living care can vary considerably from approximately $3,000 to up to $8,000 each month. The variation in price is often reflective of geographic regions and the extent of offerings found in the senior living facility.

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