| Earlier this week CMS announced that the National Partnership to Improve Dementia Care, first established in 2012 with a mission to enhance the use of non-pharmacological approaches and person-centered dementia care practices, met its goal of reducing the national prevalence of antipsychotic use in long-stay nursing home residents by 30% (decreasing from 23.9% to 15.7%) by the end of 2016. Building on this success, CMS set a new goal for nursing homes with high rates of use to reduce antipsychotic prevalence by 15% by the end of 2019. Nursing homes with low rates of antipsychotic use are encouraged to maintain their efforts. The act of swallowing, for those who do not have difficulty with it, can feel like second nature. But when this ability starts to diminish—a common symptom of aging—affected individuals are forced into a world where things that are necessary to survive, such as food and water, pose potentially life-threatening challenges. Studies show that approximately 53%–74% of long-term care facility residents have dysphagia. In the final rule entitled “Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY2018, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, Survey Team Composition, and Correction of the Performance Period for the NHSN HCP Influenza Vaccination Immunization Reporting Measure in the ESRD QIP for PY 2020” published on August 4, there were a number of technical errors that are identified and corrected in section IV., Correction of Errors. The corrections are effective October 1, 2017. CMS has posted the annual release of the Skilled Nursing Facility Public Use File (Skilled Nursing Facility PUF) with data for 2015. The Skilled Nursing Facility PUF presents summarized information on services provided to Medicare beneficiaries by skilled nursing facilities. It contains information on utilization, payment (Medicare payment and Medicare standardized payment), submitted charges, and beneficiary demographic and chronic condition indicators organized by CMS Certification Number (6-digit provider identification number), Resource Utilization Group (RUG), and state of service. The National Center for Assisted Living’s (NCAL) regulatory review of assisted living facilities (ALF) for 2017 proved that “states are demonstrating their effectiveness in regulating assisted living communities,” NCAL Executive Director Scott Tittle said in a recent NCAL blog post. CMS is hosting an open door forum 2 p.m. to 3 p.m. EST Oct. 10 to discuss modifications and proposed changes to how CMS calculates the quality of care star ratings for home health agencies. The changes include removing the influenza measure. | A new Hospice Compare fact sheet is now available in the downloads section of the Hospice Quality Public Reporting webpage. New in the October issue of PPS Alert for Long-Term Care: The essential role of MDS 3.0 in RCS-1 Currently, Medicare pays for services provided by skilled nursing facilities (SNF) under the Medicare Part A SNF PPS benefit on a per diem basis using the RUG-IV grouper. The most significant driver of this reimbursement model is the amount of therapy (days and minutes) provided to a Medicare resident, regardless of outcomes achieved. Survey: Education and Training Tools Infection control: Preparing your facility’s infection preventionist Long-term care facilities traditionally lack the specialized infection control training more commonly found in hospitals, with infection control violations making up one of the most common survey deficiencies. Even though facilities are not required to have a trained infection preventionist until November 2019, providers must start preparing this role now in order to meet the expanding requirements being rolled out between now and Phase 3, including the requirement that all facilities have an antibiotic stewardship program in place by November 28, 2017. Quality: Five-star ratings and performance improvement As quality and value take a front row seat in the reimbursement world, more emphasis will need to be placed on monitoring and improving your facility’s standings. The best way to achieve this is by monitoring for trends and changes to the five-star rating reports. Billing: Reduce your facility’s audit risk Facilities can reduce their audit risk and the potential for nonpayment by ensuring claims are complete and accurate. In order to do this, administrators need to identify risk areas and analyze providers’ information so that billers can review their own data before submission and ensure compliance. Customer service: Managing risk through person-centered care According to a recent report published by the OIG, nursing home complaints increased from 47,279 complaints in 2011 to 62,790 complaints in 2015. More than half of the complaints were related to quality of care, treatment, or neglect. It’s essential that facilities understand the components of an effective customer service program, realize the importance of risk management, and master several methods of reducing the potential for litigation. | | | Product Spotlight Skilled Nursing Facility Billing Boot Camp provides hands-on, how-to education focusing on billing for Medicare Part A and B, the ins and outs of consolidated billing, accurately completing the UB-04. Plus, guidance on understanding the SNF coverage criteria and a breakdown of the different beneficiary notices. Attendees will be able to return to their facility with the tools they need to understand the latest billing and reimbursement regulations, plus how to navigate the many billing processes to ensure their SNF is receiving appropriate reimbursement for services provided. Billers Association Members (BAM) save 10% off the registration fee! |
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