Richter ShareSource Blog

All skilled nursing facility (SNF) administrators should be aware of the state of Ohio Department of Medicaid (ODM) adjudication process, but many may not know that the findings of the state’s audit can – and should be – refuted.

Setting your goals is a vital part of the Quality Assurance/ Performance Improvement (QAPI) process. The first step entails establishing thresholds. In order to determine your thresholds, you must first collect the relevant data. When collecting data, it is important to ensure that the data is meaningful and not erroneous. Once the appropriate data is gathered, you will use that information to identify a threshold. The QAPI process must include this step for establishing an acceptable threshold, target or goal. Although benchmarks can be set for any threshold, clinical benchmarks should be set based on the consideration of standards of care or best practice for that specific benchmark. Such information can be obtained through professional organizations, research and databases within your industry. Another good source of information is the Centers for Medicare and Medicaid Services (CMS) website.

Note: Do you want to learn more about Quality Assurance and Performance Improvement (QAPI), or have questions about how QAPI can help your LTPAC facility? Read our blog: What IS QAPI? Your Guide to the new LTPAC and Skilled Nursing Facility Standard for Quality Assurance and Performance Improvement.

What is a Performance Improvement Project in a skilled nursing or LTPAC facility?

A Performance Improvement Project (PIP) is a focused effort on a specific problem in one area of a long term post acute care (LTPAC) facility or agency, or for the entity as a whole. The process involves methodical gathering of data to bring additional clarity to facility issues or problems. The facility initiates a PIP to examine and improve care and/or services in areas that the facility has identified as areas of concern. Areas of concern will vary depending on the type of facility or agency and the distinctive scope of services provided.

An Additional Development Request (ADR), also known as an Additional Document Request, is issued for the purpose of reviewing documentation for specific issues as determined by the Centers for Medicare and Medicaid Services (CMS) or other governing agencies of the federal government.