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Post-Acute Advisor

CMS announces new, more targeted Medicare audit process

 

After reporting favorable results from a pilot program started in 2014 to reduce errors in the Medicare claims submission process, CMS announced last week that they will move forward with the new auditing strategywhich combines a review of a sample of claims with educationchanging the process slightly by moving from a broad “Probe and Educate” program to a more targeted strategy, referred to as Targeted Probe and Educate (TPE).

 

 

CMS scrutiny of updates to Part B therapy coding to begin January 2018

 

In a recent MLN Matters article, the Centers for Medicare & Medicaid Services (CMS) published revisions to editing of Part B “Always Therapy” services, identifying outpatient therapy (OPT) services that must always be accompanied by a discipline-specific therapy modifier. CMS states that Change Request (CR) 10176, intended for therapists, physicians, and certain other practitioners billing MACs for therapy services provided to Medicare beneficiaries, “contains no new policy. Instead, the guidelines presented in the CR improve the enforcement of longstanding, existing instructions.”

 

 

CMS proposes canceling cardiac bundled payments and changes to CJR model

 

Last week, CMS announced a proposed rule to reduce the number of mandatory geographic areas participating in the Center for Medicare and Medicaid Innovation’s (Innovation Center) Comprehensive Care for Joint Replacement (CJR) model from 67 to 34. In addition, CMS is proposing to allow CJR participants in the 33 remaining areas to participate on a voluntary basis. In this rule, CMS also proposes to make participation in the CJR model voluntary for all low volume and rural hospitals in all of the CJR geographic areas.

 

 

Update your complaint process: New CoP requires investigation, documentation

 

Agencies should educate staff and patients now to ensure compliance with new complaint process expectations outlined in the revised Home Health Conditions of Participation (CoPs).

 

 

Dying At Home In An Opioid Crisis: Hospices Grapple With Stolen Meds

 

Nothing seemed to help the patient — and hospice staff didn’t know why. They sent home more painkillers for weeks. But the elderly woman, who had severe dementia and incurable breast cancer, kept calling out in pain.

 

 

CMS reports issues with SNF review and correct report & confidential feedback report, modifies submission deadlines

 

CMS recently notified SNF providers that they found two issues in their technical coding of the Review and Correct Report, one of which also affected the Confidential Feedback Report (due for release in October.)

 

 

HHS reports hackers are the cause of increasing healthcare data breaches

 

Data from HHS’ Office of Civil Rights shows that compared to 2016, resolved data breaches as a result of hacking have decreased by 90%, with only five hacking or IT incidents being resolved in 2017 compared to 50 that were resolved in 2016. Data also reveals that more breaches are being reported, which is correlated with more breaches occurring and organizations that are experiencing these increases becoming more aware of their duty to report them. According to security experts, the increase is due to hacking having become easier.

 

 

Other Post-Acute News

 

 

New in the August issue of PPS Alert for Long-Term Care: Expediting the Medicaid application process

The business office in a skilled nursing facility (SNF) is an extremely busy place, and it takes a highly organized, properly trained person to manage it effectively.

 

Phase 2 of the new survey process is coming…are you ready?

 

CMS delayed financial penalties for facilities found to be in noncompliance with Phase 2 regulations, but surveys will still begin November 28, 2017. Developing an effective survey compliance program now in line with the new requirements will keep your facility citation free, so you can focus on resident care. Know your survey, prepare for your survey, and be survey ready!

 

Create a Successful Activity Program for Your Community

 

Engaged and active residents create a proud community with quality care, happy residents and happy staff, and an improved bottom line.

 

Consolidated Billing for SNFs: A Close Look at the Five Major Categories

 

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.

 
 

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!

 
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Upcoming CMS Events

 

 

 

Wednesday, September 6, 1:30 pm to 3:00 pm, ET - IMPACT Act: Medicare Spending Per Beneficiary Measures Call

 

Thursday, September 7, 1:30 pm to 3:00 pm, ET - Nursing Home Facility Assessment Tool and State Operations Manual Revisions Call: Dementia Care in Nursing Homes

 

Tuesday, September 19, 1:30 pm to 3:00 pm, ET - Qualified Medicare Beneficiary Program Billing Rules Call

Thursday, September 21 - CMS SNF/Long-Term Care Open Door Forum

 

Wednesday, September 20, 1:30 pm to 3:00 pm, ET - Reporting Hospice Quality Data: Tips for Compliance Call

 

Tuesday, September 26, 1:30 pm to 3:00 pm, ET - PQRS: Feedback Reports and Informal Review Process for PY 2016 Results Call: Physician Quality Reporting System

 
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