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.
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.
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.
In preparing for the holiday festivities, it is essential for friends and family to understand that even if their loved ones are in a nursing home or skilled nursing facility (SNF), they can still partake in the holiday parties and goodie exchanges without putting their Medicare coverage at risk. Identifying the specific effects that a beneficiary’s leave of absence (LOA) can have on billing has long been hazy territory for SNFs, however, as they sometimes confuse Medicare’s consolidated billing (CB) requirements with internal definitions and policies they’ve developed for a beneficiary’s temporary exit from the facility.