| This week’s note from the instructor is written by Judith L. Kares, JD, regulatory specialist for HCPro.
Critical access hospitals (CAH) are a special category of hospitals created to provide reasonable access to inpatient and outpatient hospital services (including emergency care) to Medicare beneficiaries located in relatively remote areas. Under the Medicare Rural Hospital Flexibility Program, assuming that relevant criteria are met, each state can implement a program to create CAHs within its borders. Subject to certain exceptions and limitations, CAHs must generally comply with the same conditions of participation and other CMS guidelines as non-CAH hospitals.
In the interest of maximum flexibility, the Social Security Act also allows CAHs and other small rural hospitals to enter into “swing bed” agreements with CMS. Under these arrangements, in addition to providing acute inpatient services, such hospitals are permitted to provide extended care services that would normally be furnished in a skilled nursing facility (SNF).
Click here for the in-depth analysis.
This article is available to Basic and Platinum members of Medicare Compliance Watch. Please sign in or subscribe to read the complete article.
This week’s updates include July quarterly update to 2016 annual update of HCPCS codes used for SNF Consolidated Billing (CB) enforcement; updates to Pub. 100-04, Medicare Claims Processing Manual, Chapters 4 and 5 to correct remittance advice messages; and more!
This news article is free for all Medicare Insider subscribers. Click here to read all of this week’s updates. The appeals process may be time consuming, but it’s worth every penny. Organizations responding to the American Hospital Association’s recent RACTrac survey appealed 50% of their denied claims during the first quarter of 2014. Some hospitals may choose to leave money on the table, but you don’t have to. Nearly half of hospitals responding to the survey revealed that they overturned a denial in their favor during the discussion period before a formal appeal in the first quarter.
Let experts in the field guide you through the process of making appeals determinations easy. During this program, Mark Michelman, MD, MBA, and Stacey Levitt, RN, MSN, CPC, will review real-world denial examples to illustrate best practices for successfully appealing claims and proactively reducing denials.
This webcast is available to Platinum members of Medicare Compliance Watch. Please sign in or subscribe to watch the webcast.
There were no newly approved Recovery Auditor issues last week.
To read past approved Recovery Auditor updates, click here.
- IMPACT Act: Data Element Library Call; Thursday, April 14
- Medicare Shared Savings Program ACO Application Process Call; Tuesday, April 19
- National Partnership to Improve Dementia Care and QAPI Call; Thursday, April 28
Events are viewable for all Medicare Insider subscribers. Click here for more details and to register.
Product Spotlight
The hospital case manager is the person many turn to when answers are scarce. A case manager can persuade the patient and family/caregiver to become actively involved in the plan of care, and he or she can draw upon resources when nothing seems possible. The information the case manager communicates to the patient, the family/caregiver, the hospital team, and the postacute care providers is paramount to getting the patient the right care in the right place at the right time and potentially avoiding a readmission. Communication is essential to the role of case management, yet crafting a universal message that both the patient and the case manager understand is a challenge for many hospitals.
The Case Management Patient Communication Toolkit, by Janet L. Blondo, LCSW-C, MSW, CMAC, ACM, CCM, C-ASWCM, ACSW, helps to ensure case managers are delivering that universal message. It covers a variety of topics, including the following: - Beginning a discharge plan early on and collaborating with the care team, patient, and family/caregiver to determine the right care, the appropriate setting for receiving care, and the appropriate time to move to that care setting
- Selecting criteria for screening and assessing patients, which can influence staffing mix and budgets
- Explaining patient status and notices to patients and families, with particular emphasis on the changes brought on by the NOTICE Act
- Evaluating a patient’s capacity and communicating with the correct decision-maker when the patient lacks capacity
For more information and to purchase, visit the HCPro Healthcare Marketplace.
Stay Connected to HCPro Don't Miss the News You Want. Spam filters exist for a reason, but not for the news you need. Make sure you aren’t missing your weekly industry coverage. Add our address -- medicare-insider@news.hcpro.com -- to your address book or e-mail whitelist to keep the news you need in your inbox.
Is All of Your Team In The Know? Our weekly e-newsletters can keep your team abreast of up-to-date industry information; including expert analysis where you need it most. Subscribe to any -- or all -- of our e-newsletters. |
