The Government Accountability Office (GAO) recently released a report titled “Electronic Health Records: HHS Needs to Improve Planning and Evaluation of Its Efforts to Increase Information Exchange in Post-Acute Care Settings,” stating that the Department of Health and Human Services (HHS) lacks a comprehensive plan to meet its goal in increasing the proportion of post-acute care providers electronically exchanging health information.

Understand special SNF billing cases to avoid claims rejections

Often times, claim rejections and negative outcomes from billing compliance audits are results of ineffective or nonexhaustive billing processes within the skilled nursing facility (SNF). The below information will help providers lay the foundation for a comprehensive billing system that safeguards against these pitfalls by highlighting one special consolidated billing (CB) case involving services that don’t fall squarely into included or excluded categories whose navigation could otherwise throw a wrench in workflows: Categorical service exclusions.

Copays didn’t deter study subjects in home health

A Brown University study, published in JAMA Internal Medicine, shows that patients might not be deterred from receiving home health care by copays.

Other Post-Acute News

*New in the May issue of PPS Alert for Long-Term Care* How to identify and document significant change in status assessments: Reducing hospitalizations

Determining when a significant change in status assessment (SCSA) is necessary and completing the assessment can be a difficult process, but one that facilities must master to provide appropriate care to all residents and avoid survey deficiencies.

SNF consolidated billing rule will seek public comment in July: Brush up on the five major categories here

A thorough understanding of how consolidated billing works will help billing and administrative staff determine which residents are subject to consolidated billing when there is a leave of absence, pay the correct vendor invoices, communicate efficiently with other vendors and physicians, and determine the Medicare allowable amount for services provided by outside vendors.

Put Your QAPI Plan Into Action, Prepare for CoPs, Achieve 5-Star Rating

CMS has granted home health agencies six additional months to prepare the Conditions of Participation—so don’t waste any more time. Implementing the CoPs is a huge time and cost burden so the sooner agencies begin to put policies and procedures into place, the better off they’ll be on Jan. 13, 2018.

Successful PPS scheduling: Receive optimal reimbursement while reducing default and provider-liable days

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.

Long-Term Care Billing A to Z

Long-term care billing departments are known by various names, but they all face the challenge of understanding and complying with Medicare’s many billing requirements for accurate reimbursement.

Product Spotlight

Medicare Boot Camp®—Long-Term Care Version

HCPro's Medicare Boot Camp®—Long-Term Care Version covers the latest Medicare rules and regulations so that you can help your facility provide quality resident care, document successfully, bill appropriately for services, and prevent payment denials. Medicare Boot Camp—Long-Term Care Version follows a Medicare patient from preadmission through discharge, addressing the function of each department, and uncovering the pitfalls along the way.

Upcoming CMS Events

Thursday, May 11, 9:30 am - 4:30pm ET - Medicare Advantage and Prescription Drug Plan Audit & Enforcement Conference & Webcast

Wednesday and Thursday, May 3-4, Baltimore, MD - 2-day, in person Home Health Quality Reporting Program Provider Training

Thursday, June 15, 1:30pm – 3:00pm ET - National Partnership to Improve Dementia Care and QAPI Call