• At A Glance QM, QRP, and VBP Tool

    By AANAC - August 17, 2017
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  • Sound the Alarm: Attention Needed for Personal Alarms

    By Jane Belt, RN, MS, RAC-MT, RAC-CT, QCP - August 16, 2017

    Even as long-term care providers are busy digesting the 696-page-long advance copy of the Revised Requirements of Participation and Interpretive Guidelines and await the October 2017 additions to the Minimum Data Set 3.0 (MDS), a new laser focus has been trained on the world of restraints and alarms.

    With this flurry of activity going on in your mind, do remember that the philosophy of OBRA (the Omnibus Budget Reconciliation Act) has not changed. At the core of OBRA, the overarching mandate continues to be that long-term care facilities must provide care and services such that each resident maintains or attains the highest practicable physical, mental, and psychosocial functioning of which he or she is capable.

    Now enter the bits and pieces we have been seeing over the past several months, which will ultimately tie in to the new survey process. Although we are still waiting for the updates to the RAI User’s Manual, we do know that section P of the MDS has been renamed “Restraints and Alarms” and that various personal alarms have been added to item P0200. The coding options are similar to the restraint items in that the assessor must indicate whether the device is 0, Not used; 1, Used less than daily; or 2, Used daily.

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  • CMS Irons Out Details for FY 2019 SNF VBP Launch

    By Caralyn Davis, Staff Writer - August 16, 2017

    In the Fiscal Year (FY) 2018 Skilled Nursing Facility Prospective Payment System (SNF PPS) Final Rule, the Centers for Medicare & Medicaid Services sailed smoothly toward implementation of the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program, implementing all policies as proposed in the FY 2018 SNF PPS Proposed Rule. The program will launch using the Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM) (NQF #2510) and will impact Medicare Part A payments in FY 2019 effective Oct. 1, 2018. CMS plans to transition to another measure, the Skilled Nursing Facility 30-Day Potentially Preventable Readmission Measure (SNFPPR), “as soon as practicable.”

     

    CMS anticipates that the first opportunity to replace the SNFRM with the SNFPPR would be the FY 2021 program year. “However, we have not yet determined if it would be practicable to replace the SNFRM at that time,” the agency said. Note: CMS expects to submit the SNFPPR to NQF for endorsement consideration as soon as possible.

     

    “We intend to provide SNFs with SNFPPR rates [in their quarterly reports] prior to the replacement [of the SNFRM] for SNFs to learn more about the measure and incorporate [it] into their quality improvement and care transitions efforts to reduce readmissions. We also intend to further analyze the SNFPPR prior to replacing the SNFRM for any association with social risk factors. …,” said the agency. “We intend to update affected stakeholders on timing in future rulemaking.”

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  • Review and Correct Report Q&As: Open vs. Closed Quarters and Other Issues

    By Caralyn Davis, Staff Writer - August 16, 2017

    Many providers are still on a learning curve when it comes to accessing, understanding, and using the Review and Correct Reports that the Centers for Medicare & Medicaid Services (CMS) has made available in the Skilled Nursing Facility Quality Reporting Program (SNF QRP). To help SNFs navigate the reports, on Aug. 7 Roberta Constantine, RN, MBA PhD, a senior policy analyst with CMS contractor RTI International, led “SNF Quality Reporting Program: Review & Correct Reports Refresher Webinar.” Note: Access the webinar slides here. Watch for news of a webinar video here.

    The Review and Correct Reports are designed to help providers preview and correct their MDS-based SNF QRP quality measures (QMs) for each reporting quarter prior to the QMs being calculated a final time and frozen for the public reporting on Nursing Home Compare that will begin in fall 2018. The following Q&As culled from Constantine’s presentation could help nurse assessment coordinators (NACs) better understand the reporting system:

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  • MDS Frequency Reports: MDS Management Tool Updated (8/17)

    By CMS - August 14, 2017
    2Q 2017 posted
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  • October 2017 Consolidated Billing HCPCS Code Update Announced (8/17)

    By CMS - August 14, 2017

    SUBJECT: October Quarterly Update to 2017 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement

    SUMMARY OF CHANGES: This notification provides updates to the lists of Healthcare Common Procedure Coding System (HCPCS) codes that are subject to the consolidated billing provision of the SNF Prospective Payment System (PPS). Changes to CPT/HCPCS codes and Medicare Physician Fee Schedule designations will be used to revise CWF edits to allow MACs to make appropriate payments in accordance with policy for SNF consolidated billing in Chapter 6, section 20.6.

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  • 2017 Comparison of the Parts A, B, C, and D Appeal Processes (8/17)

    By CMS - August 14, 2017
    Flow chart explaining Medicare appeals process for Part A, Part B, Part C, and Part D.
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  • FINAL MDS 3.0 Data Specs for Oct. 1, 2017, Implementation

    By CMS - August 14, 2017
    become effective October 1, 2017.  This FINAL version incorporates the changes identified for the FINAL version (v1.15.0) of the MDS 3.0 item sets. Note that there have been no additional specification changes since Errata V2.01.1. New items have been added to Sections N and P, and there are a number of new Section S items as well.
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  • FINAL MDS 3.0 Item Sets for Oct. 1, 2017, Implementation

    By CMS - August 14, 2017
    The final 2017 MDS 3.0 item sets (v1.15.1) were posted.  These item sets are in effect October 1, 2017.
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  • Part B Therapy Caps: 'Always Therapy' Services (8/17)

    By CMS - August 14, 2017

    Updated Editing of Always Therapy Services – MCS. Medicare Part B therapy services that are coded as "always therapy" services and the Part B therapy caps.

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  • Two Key SNF QRP Deadlines Are Coming: Are You Ready?

    By Caralyn Davis, Staff Writer - August 08, 2017

    Two key deadlines for the Skilled Nursing Facility Quality Reporting Program (SNF QRP) are just around the corner, noted officials with the Centers for Medicare & Medicaid Services (CMS) during the Aug. 3, 2017, Skilled Nursing Facility/Long-term Care Open Door Forum (SNF/LTC ODF). Meeting these deadlines—one for reconsideration requests and one for data reporting—is critical for SNFs that want to avoid taking a significant financial hit to their Medicare Part A payments.

    “Under the SNF QRP, SNFs that fail to submit the required quality data to CMS for measures that have been finalized for use in the SNF QRP will be subject to a 2 percentage point reduction to the otherwise applicable annual market basket percentage update with respect to that fiscal year,” explained officials.

    Here are the two critical SNF QRP deadlines:

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  • Mega-Rule Phase 2 Implementation: CMS Training Videos UPDATED (8/17)

    By CMS - August 03, 2017
    LTC Survey Process Videos: This course consists of a series of videos created by CMS outlining essential topics related to changes in the LTC regulations scheduled to be implemented for Phase 2. CMS videos on guidance provide regions and states a resource that can be used for training and education with surveyors, providers, and other stakeholder groups. August 2017 update: CMS has added a Pharmacy Services training video.
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  • CMS Dials Back Fear Factor Over Standardized MDS Data in October 2018

    By Caralyn Davis, Staff Writer - August 02, 2017
    Speaking up can make all the difference. In the Fiscal Year (FY) 2018 Skilled Nursing Facility Prospective Payment System (SNF PPS) Proposed Rule, the Centers for Medicare & Medicaid Services (CMS) had proposed that SNFs be required to report a significant amount of new standardized resident assessment data (typically on both the 5-day PPS MDS and the Part A PPS Discharge assessment) beginning Oct. 1, 2018, for the FY 2020 Skilled Nursing Facility Quality Reporting Program (SNF QRP). CMS proposed these standardized resident assessment data elements for five categories designated by the IMPACT Act:
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  • Part A Certs/Recerts Part 1: How to Avoid Denials

    By Caralyn Davis, Staff Writer - August 01, 2017
    Several AANAC master teachers are reporting an increase in Medicare Part A denials from Medicare administrative contractors (MACs) and other medical reviewers related to issues with physician/nonphysician practitioner certifications and recertifications (certs/recerts) for skilled care. “While the cert/recert documentation doesn’t have to be on a specific form, providers that choose to use forms need to complete them carefully,” says Christine Twombly, RN, RAC-MT, LHRM, CHC, vice president of MDS at Harmony Healthcare International in Topsfield, MA.
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  • Is Your Facility Ready to Provide the Baseline Care Plan Summary?

    By Caralyn Davis, Staff Writer - August 01, 2017
    As part of the Phase 2 rollout of the Mega Rule, nursing homes that participate in the Medicare and/or Medicaid programs must provide residents (and their representatives when applicable) with a baseline care plan summary starting Nov. 28, 2017. The Centers for Medicare & Medicaid Services (CMS) laid out the approach surveyors will take toward assessing compliance in the recently released advance copy of Appendix PP, “Guidance to Surveyors for Long-term Care Facilities,” of the State Operations Manual.
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