A best practice is a technique or methodology that, through experience and research, has proven to reliably lead to a desired result. In any industry, best practices are developed over time. LTC billers must have a solid understanding of the fundamentals of claims processing as it relates to the Medicare regulations and the facility’s state Medicaid reimbursement system.
Quality care, surveyor training, and consistent enforcement are the three main themes in CMS’ 2016–2017 Nursing Home Action Plan released in May. The report focuses on five improvement areas that aim to strengthen the LTC industry’s focus on issues surrounding infection control and dementia care, while also improving the CMS survey process through additional surveyor training and enforcement tools.
Although hospital discharge planning is critical to determining the type of postacute care (PAC) that patients will receive, there is “no clear clinical guidance” for how to choose the most appropriate setting for them based on their conditions and cost-effectiveness, according to a Healthcare Cost and Utilization Project (H-CUP) Statistical Brief from the Agency for Healthcare Research and Quality.
On July 25, CMS released a proposed rule to create additional bundled payments/diagnosis-related group (DRG) focused episode payment models (EPM), tar- geted for July 1, 2017. The announcement/proposed rule is consistent with CMS’ and the Administration’s goal to migrate up to 50% of all traditional fee-for-service (FFS) payments to alternative models by 2018. As with the Comprehensive Care for Joint Replacement Model (CJR), which are bundled payments for hip and knee replacements, the comment period is relatively short.
It is “feasible” and “highly desirable” for Medicare fee-for-service to switch from a system that pays different rates for similar patients based on where they receive postacute care (PAC) to one that applies one uniform payment system to patients cared for in any of the four types of PAC facilities based on their characteristics, a report from the Medicare Payment Advisory Commission (MedPAC) concludes.