In 1775, the chant of the day was “The Redcoats are coming! The Redcoats are coming!” Fast-forward to 2019 and in the realm of skilled nursing providers, the popular refrain is “PDPM is coming! PDPM is coming!”
The new Medicare fee-for-service reimbursement model known as Patient Driven Payment Model (PDPM) will drastically change how reimbursement will be determined. In the past, the Resource Utilization Groups (RUG-IV) have determined reimbursement, in which the amount of therapy a resident received played a significant part in the amount of reimbursement the facility received for that resident. Reimbursement will transition away from the volume-based payments of RUG-IV toward the new PDPM model. With PDPM, ICD-10 codes will be a crucial driver for reimbursement.
On Oct. 1, 2018 updates to Section N of the MDS were implemented by CMS. Two questions were added to Section N (N2001 and N2003) if the assessment type is coded as PPS 5-day, and one question was added to Section N (N2005) if the assessment type is coded as a SNF Part A PPS Discharge Assessment. These questions are related to reviewing the drug regimen for residents. Per the RAI Manual, the intent of the updated questions is to “document whether a drug regimen review was conducted upon the resident’s admission (start of Skilled Nursing Facility (SNF) Prospective Payment System [PPS] stay) and throughout the resident’s stay (through Part A PPS discharge) and whether any clinically significant medication issues identified were addressed in a timely manner.”
For many long-term post-acute care (LTPAC) providers, the process of ordering and receiving medications can be laborious. Nurses must frequently communicate new orders for medications and the need for more supplies of existing medication orders to the pharmacy. For years, faxing was the standard communication method. Today, integration with the pharmacy vendor can offer a better solution.
Have you reviewed your certification and recertification statements for Medicare skilled nursing care recently? My recent experiences with Medicare payment denials have indicted this continues to be an area many providers should focus on for process improvement. Denials based on certification and recertification statements cannot be appealed. The risks associated with a breakdown of certification and recertification process can significantly impact the operations of a Skilled Nursing Facility (SNF). Ensuring the certification and recertification statements for Medicare skilled nursing care are not only completed but accurately completed can prevent the loss of revenue. A review of this critical process may be the difference between a payment and a denial. As Skilled Nursing Facilities continue providing the highest quality care possible amid a myriad of budget cuts, preventing denials of payment has to be a priority.
Topics: Medicaid Consulting
All levels of Long Term Post-Acute Care (LTPAC), including Skilled Nursing Facilities (SNF), Senior Living communities, Home Care, etc. must be able to substantiate they are providing the care required by their patients. Way back when I was a nursing assistant there was a constant chorus of “if it’s not documented, it was not done” and then in nursing school and while working as a nurse the chorus became even louder.
Effective October 1, 2016, Skilled Nursing Facilities (SNF) are required to submit additional functional and quality measure data via patient assessments to the Centers for Medicare and Medicaid Services (CMS). This information will be gathered from the revised Minimum Data Set (MDS) 3.0 Section A and a new Section GG. Along with these revisions, a new MDS assessment type of an SNF Medicare Part A PPS discharge assessment for when a Medicare Part A stay ends, will be implemented.
Administering medications is one of the most common tasks completed by most nurses. Medication administration can be a monotonous and time-consuming task. One medication administration pass may take hours to complete. The actual act of giving the medications is often not the onerous part of medication administration. Gathering supplies and/or equipment and locating the patients account for large chunks of time. In my personal experience as a direct care nurse, often I would complete a medication pass only to turn around and have to start all over again with another round. Although medication administration is a common practice, it is also a matter of life and death. At times, some nurses become complacent when administering medications, but each medication error can have extreme consequences.
Topics: Clinical Consulting