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Richter ShareSource Blog

How the New Medicare-Medicaid Crossover Change Will Affect Your LTPAC’s Financial Statements

Posted by Liz Lane, CPA, Manager of Accounting Services on Jul 12, 2019 2:22:27 PM

This past April, the Centers for Medicaid and Medicare Services (CMS) issued guidance on how crossover bad debts are to be recorded within the income statement. Typically, these amounts are written off to a contractual allowance revenue account. With this new guidance, these unpaid amounts for Medicare-Medicaid crossover claims must correctly be classified to a bad debt expense account.

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Topics: Medicaid Consulting

6 Steps to Reduce Harm in Nursing Homes

In December 2018, the Centers for Medicare & Medicaid Services (CMS) and the Medicare Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) released the All Cause Harm Prevention in Nursing Homes Change Package, which was developed as a means to help prevent harm (i.e., adverse events, abuse, and neglect) for nursing home residents. The intended audience of this piece includes nursing homes participating in the National Nursing Home Quality Care Collaborative and anyone interested in improving the quality of life and quality of care for those living in nursing homes.

The following includes answers to some frequently asked questions about the Change Package.

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Topics: Clinical Consulting, Financial Consulting

Understanding How Functional Score Works Under PDPM

Posted by Jacklyn Brown, RN on May 21, 2019 4:34:42 PM

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!” 

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Topics: Clinical Consulting, Financial Consulting

Understanding Diagnosis Coding Under the New Payment Driven Patient Care (PDPM) Model

Posted by Jacklyn Brown, RN on Apr 5, 2019 12:11:52 PM

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. 

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Topics: Clinical Consulting, Financial Consulting

Tips on Choosing Diagnoses for the LTPAC Resident Stay

Posted by Celeste Rininger on Apr 5, 2019 11:42:51 AM

Trepidation, fear and confusion have all been experienced by minimum data set (MDS) coordinators and staff alike at various long-term post-acute care (LTPAC) facilities regarding selecting and/or having to code diagnosis for residents—especially upon admission. Some common questions include: “What do I choose?” “How do I know if it is the correct primary or admitting diagnosis?” “I’m not a coder—how do I know what diagnosis to choose?”

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Topics: Clinical Consulting, Financial Consulting

Understanding the CMS Requirements of Participation Past and Future

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

Did you know that one in three long-term post-acute care (LTPAC) residents is harmed by an adverse event within 35 days of their stay? Indeed, it is true, and the statistics from the Office of Inspector General don’t stop there:

  • 59% of events are preventable
  • 37% of such events medication related (medication induced change in mental status, excessive bleeding)
  • 37% are resident related (fall, electrolyte imbalance, pressure injury)
  • 26% are infection related
  • 50% of those residents affected returned to the hospital
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Seeing the Connection Between Phase 3 Requirement of Participation and Quality Assurance and Performance Improvement (QAPI)

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

Nov. 28, 2019 is quickly approaching, and with that will come Phase 3 of the Centers for Medicare and Medicaid Services’ (CMS’) Requirements of Participation. As part of this, a fully integrated QAPI program will be required on this date. This should come as no surprise since some of the QAPI components should have already been implemented by your long-term post-acute care (LTPAC) facility, as stated below. This requirement is not going away and should be implemented soon rather than later. 

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Topics: Qapi, QAPI Consulting

The Role of Trauma-Informed Care in Phase 3 Requirement of Participation

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

Individual trauma is an experience (or series of circumstances, events or occurrences) that an individual considers emotionally, physically or socially threatening or harmful and that has a long-term negative impact on the individual’s emotional, physical and/or social well-being. An event becomes traumatic when the ability to cope is overwhelmed.

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