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Richter ShareSource Blog

CMS Phase 3 Requirement of Participation: Compliance and Ethics Program


Note: This is the fourth blog in our multi-part blog series on the CMS Requirements of Participation.

The Compliance and Ethics section of the Centers for Medicare and Medicaid Services’ (CMS’) Requirements of Participation is a new section developed in response to a mandate under the Affordable Care Act that requires the operating organizations of skilled nursing facilities to have a compliance and ethics program that is effective in preventing and detecting criminal, civil and administrative violations and in promoting quality of care consistent with current regulations.

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Topics: QAPI Consulting

Business Office Work Flow in LTPAC Settings – Is Yours Stop or Go?

Posted by Gina Toigo, MBA, Revenue Cycle Manager on Nov 30, 2018 1:46:58 PM

The life cycle of the business office in long-term post-acute care (LTPAC) settings is a science if you get it right—and a science experiment gone horribly awry if you don’t.

Process is the key word to success when it comes to managing your accounts receivable; but the wheel going round and round has to make sense and includes many moving parts outside of your control—hence the reason it is so important to have a work flow!

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Certifications and Recertifications – the Golden Ticket for Skilled Nursing Services

Posted by Celeste Rininger, RN RAC-CT on Nov 29, 2018 12:06:32 PM

Wouldn’t you hate to work hard all day, every day, only to have your employer tell you that you messed up and the paycheck you just received had to be turned back over to them? That is exactly what could happen to many long-term post-acute care (LTPAC) facilities in the case of an audit due to the status of the certification/recertification for skilled services. 

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Topics: Clinical Consulting

MDS Update – Section N and What You Need to Know

Posted by Jacklyn Brown, RN on Nov 29, 2018 10:51:52 AM

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.” 

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LTPAC Budgeting Strategies for 2019

Posted by Liz Lane, CPA, Manager of Accounting Services on Nov 12, 2018 3:17:29 PM

For long-term post-acute care (LTPAC) providers, it’s already time to think ahead to the coming year. Specifically, it is budgeting season if your organization has a December fiscal year end. Budgeting is critical for purchasing decisions, and having an accurate budget is necessary when it comes time to analyze financial performance. Instead of just assuming the same performance from year to year, we recommend focusing on the areas below and adjusting your budget projections as necessary. 

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Topics: Employee Engagement

Targeted Probe and Educate – Appeal Options and Recommendations

In recent blogswe outlined medical Medicare review strategies; explained probe and educate (PE), as well as Targeted Probe and Educate (TPE), Medicare’s new medical review strategy; we offered strategies for preparing and submitting TPE documentation; we outlined the TPE claims review process; and we highlighted top hospice TPE denial reasons. In this blog, we will share some TPE appeal options and recommendations.

If your hospice agency’s TPE claim is denied or partially denied, you can utilize the 5 Levels of Appeal process. We explain each level in detail below.
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Topics: Home Health & Hospice

An LTPAC Checklist to Promote Business Office Manager (BOM) Success

Posted by Candace LaRochelle, Revenue Cycle Manager on Oct 26, 2018 2:42:35 PM

To all of the great BOMs out there in the long-term post-acute care (LTPAC) realm, let me say, thank you! You are valued employees in skilled nursing. When one considers everything that you do, it’s obvious that BOMs wear many hats! You must effectively manage and oversee the bookkeeping function, manage and oversee patient accounts, recruit, select, hire, train, evaluate, counsel and supervise business office staff, manage and operate within budgetary parameters, and exhibit excellent customer service and a positive attitude toward residents and families. 

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EMPLOYEE ENGAGEMENT – AN ORGANIZATIONAL-WIDE PRIORITY AND EFFORT

Posted by Reba Allison, BCP, Director of Human Resources on Oct 26, 2018 1:45:52 PM

Employee engagement is not a human resources thing, it is not a CEO thing, and it is not an administrative assistant thing. In a long-term post-acute care (LTPAC) organization, there should be a multitude of individuals that must become the “drivers” of cultivating sustainable change when it comes to employee engagement. 

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Topics: Employee Engagement