The Billers’ Association is seeking long-term care managers, revenue cycle enthusiasts, and billing professionals to join our growing ad-hoc list of experts interested in contributing to articles in our monthly publication, Billing Alert for Long-Term Care. This digital newsletter provides expansive regulatory coverage, including MDS changes, reimbursement issues, and expert advice and analysis to help improve job performance in all aspects of the revenue cycle management system.
In the Office of Inspector General's (OIG) FY17 Work Plan, the agency outlined its plans for 2017, stating its intended focus on nursing home complaints and care area management, such as falls and abuse/neglect issues, as well as a continued dedication to investigating Medicare fraud and abuse. As we've seen through numerous media outlets and updates on the latest settlements, the OIG followed through with its intentions.
The submission deadline for the Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP) and Long-Term Care Hospital (LTCH) QRP is approaching. IRF-PAI and LTCH CARE Data Set assessment data and data submitted to CMS via the Center for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) for April-June (Q2) of calendar year (CY) 2017 are due with this submission deadline.
All data must be submitted no later than 11:59 p.m. Pacific Standard Time on November 15, 2017.
The Skilled Nursing Facility (SNF) QRP deadline has been extended to May 15, 2018.
Since its initial inception as part of Section 6106 of the Affordable Care Act, the payroll-based journal (PBJ) requirement, which took effect July 1, 2017, has caused long-term care providers several growing pains as the CMS reporting mandate competes with facilities’ many other priorities. Prior to its implementation, in October 2015 CMS launched a voluntary phase of the PBJ reporting system, allowing providers to test their submission process. Few providers participated in the trial run, however, possibly because they were uncertain where their information would end up—or because they were hoping the government program would be postponed.
To receive optimal reimbursement for services, it’s essential to remove the confusion surrounding PPS scheduled and unscheduled assessments. Understand how to manage the process, including meetings to conduct, tools to implement, and ways to keep everything on track.
In a 90-minute webinar, expert Carol Maher, RN-BC, RAC-CT, helped attendees understand when and why a facility needs to perform PPS assessments and how to choose the assessment reference date (ARD) for each scheduled and unscheduled assessment to prevent payment loss. Here is an excerpt of the live Q&A that followed:
Under the IMPACT Act, SNFs are required to submit patient assessment data regarding a resident’s admission to and discharge from a Medicare Part A Assessment, effective as of October 1, 2016. Providers who fail to submit this required data (used for quality measures calculation) may face a 2%-point market basket rate reduction effective October 2018.
In preparing for the holiday festivities, it is essential that friends and family understand that while there are loved ones are in a nursing home, they can still partake in the holiday parties and goodie exchanges without putting their Medicare coverage at risk. According to Medicare law, nursing home residents may leave their facility for family events without losing their Medicare coverage for instances including: