Post-Acute Advisor

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Four survey readiness activities to try now

Survey readiness is a 24-hour/365-days-a-year task. As part of this focus, facilities need to know their annual survey window cycle. After the cycle is determined, the facility should plan on some focused preparatory work items at the nine-month mark (nine months after the last survey). If the facility has had numerous complaints or is a Special Focused Facility, the window for work to begin is much shorter.

Test your infection control knowledge

Use the following sample test to assess your or your staff’s infection control competencies. Answer key provided at the end.

CMS shifts from denials to RTPs for home health claims with no matching OASIS

Home health agencies will now have their claims returned when Medicare systems fail to match those claims with a corresponding OASIS assessment.

OIG reports increase in immediate jeopardy and high priority complaints in nursing homes

In a recent report published by the Office of Inspector General (OIG), the agency found that states received one-third more nursing home complaints in 2015 than in 2011, despite a decrease in occupancy. States prioritized more than half of complaints into the most serious categories,immediate jeopardy and high priority, which require onsite investigations within two or 10 working days, respectively. OIG found that most states met the required timeframes, but a few states fell short.

Analyzing the UB04 for reduced audit risk

Nursing facilities use UB-04 CMS-1450 or ANSI X12N 837-I to bill for covered Part B services. The UB-04 is a claim form suitable for billing multiple third-party payers. All payers will not require the use of the same data elements, so check with each payer to identify its individual requirements.

Steps for creating an effective quality assurance program for senior living facilities

When implementing a QA program, in many cases, the administrator is the person to create an environment that includes input from all community members and staff. Typically, the facility’s governing board has already established a statement of organizational ethics in recognition of the facility’s responsibilities to residents, staff, and the community they serve.

CMS’ Hospice Quality Reporting Program has new and updated resources

New and updated resources are available for the Hospice Quality Reporting Program, including HQRP checklists and requirements for reporting.

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New in the October issue of PPS Alert for Long-Term Care:

The caregiver crisis

It’s been referred to charitably as “a key workforce dilemma” and cynically as “a train wreck waiting to happen,” but regardless of how you spin it, the future implications for direct care workers in long-term care are looking dim. Shortages in vital frontline staff such as certified nursing assistants (CNA), home health aides, and personal care workers, as well as unpaid home caregivers, such as spouses, children, and friends of the elderly and ill or disabled, are predicted to worsen in the quickly approaching years.

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

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!

Upcoming CMS Events

Tuesday, October 17, 2:00PM, ET - CMS Employer Open Door Forum

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