Did you know that in 2016, 20% of Medicare residents are hospitalized within 30 days of discharge? Nearly 90% of these hospitalizations were classified as unplanned. Early identification of a resident’s change in condition is paramount to managing and preventing unnecessary transfers. The eINTERACT™ program is a PointClickCare® module that was developed to help decrease hospital readmissions and improve quality of care. It consists of several parts including:
The Level of Care (LOC) in the PointClickCare® Census and Rates resident tab is used for the management of No Pay and Exhaust claim billing for residents, after a Medicare Part A skilled stay. The LOC has no other function but to drive this process. Skilled Nursing Facilities (SNFs) are required to submit claims to Medicare for residents to report the benefit period even though no benefits may be payable. The Centers for Medicare & Medicaid Services (CMS) maintains a record of all inpatient services for each beneficiary, whether those services are covered by Medicare or not.
The Phase 2 roll out of the Mega Rule Requirements of Participation is quickly approaching. One of the requirements of Phase 2 is the Facility Assessment. The Facility Assessment is a written report that includes items such as patient population, resources and risk assessments.
Skilled nursing facilities will be required to complete the Facility Assessment by November 28, 2017, and annually thereafter. The Facility Assessment should also be updated with any significant changes in census or services.
The three sections of the Facility Assessment are outlined below. We have also assembled a template for use by the facility when completing the Facility Assessment.Click here to download your Mega Rule Facility Assessment Tool.
When it comes to billing for your skilled nursing facility (SNF) services, you want your bills to be submitted with no errors and to be paid in a timely manner. In order for that to consistently happen, it is imperative that your facility complete a triple check prior to submitting claims.
Triple check is an internal audit process to ensure billing accuracy and compliance with regulatory guidelines prior to submission of claims to Medicare/Managed Care Providers for review and payment. It is a multi-level process requiring a group effort of interdisciplinary team (IDT) members while providing a check and balance to the entire admissions process for new Medicare A/Managed Care residents.
For a free downloadable Triple Check Checklist for Medicare A, Medicare B, and Managed Care, click here.
October 1, 2016 brought forth some significant changes to the Resident Assessment Instrument (RAI) Manual used by minimum data set (MDS) nurses throughout the country.
The RAI Manual is essentially an MDS nurse’s bible. It explains how to code and provides the rational for coding every single item on the MDS. If you have a question, it has the answer. My manual has never been far from me and the many notes and dog eared pages throughout it are a testament to that.
Today, the manual can be referenced online, so there is no need to carry the five inch binder around (although I still keep mine in the trunk of my car just in case). While the online version is a much better travel companion, I feel like we are not able to really dig our heels in and read it. For that reason, some items are much more likely to be miscoded in this new era of technology. Here are some of the most common areas I've found in which miscoding occurs:
Visit Richter Healthcare Consultants at FHCA's Annual Conference & Trade Show in Orlando!
Richter Healthcare Consultants, a leading provider of clinical, accounting and revenue cycle consulting services for long-term post-acute care facilities, ispleased to exhibit and present at the FHCA Annual Conference and Tradeshow July 31 – August 4, 2017 at the Rosen Shingle Creek, 9939 Universal Boulevard, Orlando, Florida 32819.
Topics: News & Events
It is that time of year for you to review your PEPPER!
Every year at this time we look forward to the release of The Program for Evaluating Payment Patterns Electronic Report (PEPPER). PEPPER is a Microsoft Excel file summarizing provider-specific Medicare data statistics for target areas often associated with Medicare improper payments due to billing, diagnosis-related group (DRG) coding and/or admission necessity issues. Target areas are determined by the Centers for Medicare & Medicaid Services (CMS).
Topics: Clinical Consulting
Attention PointClickCare® customers: We have your solution to the Mega-Rule Baseline Care Plan (BCP) requirement. The Mega-Rule has made the BCP a requirement for every resident within 48 hours of admission. The BCP must include instructions needed to provide effective person-centered care, including, but not limited to: