• Calendar 2020 Medicare Physician Fee Schedule Proposed Rule Tackles Part B Payment Including Therapy (7/19)

    By CMS - July 29, 2019

    Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2020

    On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2020.

    The calendar year (CY) 2020 PFS proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation.

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  • Documentation Basics and Best Practices

    By Jane Belt, MS, RN, RAC-MT, RAC-MTA, QCP - July 23, 2019

    A persistent challenge confronts the hard-working staff in nursing homes. How can we take care of our residents when we have so much paperwork? We all have been there: whether electronic or hardcopy, finding the time to document seems to be the last thing we pack into our busy agendas. Considering those busy schedules, we all can use a gentle reminder of just how important every piece of documentation really is. Nurses do not relish the task, but documentation can make the difference between saving or sacrificing you and your license. Moreover, quality documentation can provide a positive impact on resident outcomes. In future articles, we will explore the keys for successful skilled documentation and the records needed to battle any sort of denial scenario. The purpose of this article is to examine the fundamental role charting plays in effective long-term care.

     

    Why is documentation so important to every nurse’s job? Let’s review the basics.

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  • Use the ICD-10 Mappings Tool Now to Train for PDPM

    By Caralyn Davis, Staff Writer - July 22, 2019

    Nurse assessment coordinators (NACs) and other members of the interdisciplinary team (IDT) who work with ICD-10-CM diagnosis codes should be using the PDPM ICD-10 Mappings tool provided by the Centers for Medicare & Medicaid Services (CMS) to prepare for the October 1 implementation of the Patient-Driven Payment Model (PDPM) in the Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS), says Tracy Montag, BSN, RN, RAC-MT, clinical consultant with the Senior Living Services Consulting Group at RKL LLP in York, PA.

     

    “In various ways, ICD-10 diagnosis codes can drive case-mix classification for all five case-mix-adjusted PDPM components, and the mapping tool impacts four of the five,” says Montag. “Consequently, it’s important to have a firm grasp of how the ICD-10 codes you commonly use now will play out under PDPM—not only to educate your IDT about documentation requirements but also to educate physicians about the need to narrow down diagnoses.”

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  • CMS Proposes New Revisions to the Requirements for Participation

    By Caralyn Davis, Staff Writer - July 19, 2019

    The Centers for Medicare & Medicaid Services (CMS) has published a key proposed rule that would significantly impact the revised requirements for participation for Medicare- and/or Medicaid-certified long-term care facilities—and require implementation delays for some pending Phase 3 requirements. Proposals in the Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency and Transparency Proposed Rule would affect the requirements for participation related to resident rights, clinical care, documentation requirements, and survey. These changes would range from substantially reducing the detailed, specific requirements in the Quality Assurance and Performance Improvement (QAPI) regulations to removing the existing prescription renewal requirements for PRN antipsychotic medications to make them the same as the prescription renewal requirements for other psychotropic medications.

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  • CMS Proposed Rule Would Revise Medicare/Medicaid Requirements for Participation, Including Some Phase 3 Delays (7/19)

    By CMS - July 16, 2019

    Medicare and Medicaid Programs: Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency, and Transparency

    AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Proposed rule.

    Areas of Major Provisions:

    a. Requirements for Participation

    Resident Rights (§483.10)

    Admission, Transfer, and Discharge Rights (§483.15)

    Nursing Services (§483.35)

    Behavioral Health (§483.40)

    Pharmacy Services (§483.45)

    Food and Nutrition Services (§483.60)

    Administration (§483.70)

    Quality Assurance and Performance Improvement (§483.75)

    Infection Control (§483.80)

    Compliance and Ethics Program (§483.85)

    Physical Environment (§483.90)

    Technical Corrections

    b. Survey, Certification, and Enforcement Procedures

    Informal Dispute Resolution and Independent Informal Dispute Resolution (§488.331 and §488.431)

    Civil Money Penalties: Waiver of Hearing, Reduction of Penalty Amount (§488.436)

    Phase 3 Implementation of Overlapping Regulatory Provisions

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  • Balancing Sections G and GG Requirements

    By Jessie McGill, RN, RAC-MT, RAC-MTA - July 10, 2019

    With the enormous focus on the transition from RUG-IV to PDPM, some may consider abandoning their section G Activities of Daily Living (ADLs) training materials, audits, and tools— but wait just a moment! Although section GG is stepping into the Medicare reimbursement spotlight, section G still plays a big role in other types of reimbursement and Quality Measures. To ensure success, the nurse assessment coordinator (NAC) must have a full understanding of the coding instructions, documentation requirements, impact on Quality Measures, and reimbursement for both section G and GG. Here are four key differences between the two sections and tips for successfully managing both.

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  • PDPM Lessons Learned From the Nursing RUGs

    By Caralyn Davis, Staff Writer - July 10, 2019

    On October 1 2019, the nursing case-mix groups used in the RUG-IV case-mix classification system will be streamlined and consolidated to form the nursing component of the Patient-Driven Payment Model (PDPM). By decreasing distinctions based on function for certain groups, the PDPM nursing component will use only 25 case-mix groups (ES3 – PA1) compared to the 43 RUG-IV nursing case-mix groups. For example, the RUG-IV groups HE2 and HD2 will be collapsed into the modified PDPM nursing case-mix group HDE2.

     

    However, the core process for assigning residents to a nursing case-mix group will remain basically the same, taking into account the use of extensive services, the presence of certain clinical conditions, the presence of depression, the provision of restorative nursing services, and the resident’s functional score (using section GG instead of section G). Consequently, nurse assessment coordinators (NACs) and other interdisciplinary team (IDT) members can learn some lessons about historically undercoded MDS items that could impact their ability to achieve the most accurate case-mix group for the PDPM nursing component, says Robin Hillier, CPA, STNA, LNHA, RAC-MT, president of RLH Consulting in Westerville, OH.

     

    Here are four items or sections worth revisiting:

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  • Beta PDPM Grouper DLL Released (7/19)

    By CMS - July 04, 2019

    A BETA version of the PDPM Grouper DLL has been posted, along with its source code.  Please read the READ ME FIRST.PDF within the ZIP file before attempting to use the grouper software.  Note that testing of the DLL is ongoing.  Please report any issues found to PDPM@cms.hhs.gov.

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  • PDPM Training and Technical Resources, Including Grouper Logic & ICD-10 Mappings (7/19)

    By CMS - July 02, 2019

    PDPM Training Presentation

    This section includes a training presentation which can be used to educate providers and other stakeholders on PDPM policy and implementation.

    PDPM Resources

    This section includes additional resources relevant to PDPM implementation, including various coding crosswalks and classification logic.

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  • PBJ Provider User Guide V3.0.1, Incl. Error Messages / Descriptions - UPDATED (6/19)

    By QTSO - July 01, 2019
    This manual explains how to connect to the Payroll-Based Journal (PBJ) system and submit data. It also defines error messages and descriptions, identifying errors by number, severity, error message, and error description. The description section includes potential corrective actions for providers to take to resolve the errors.
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  • Section GG Web-based Training Module UPDATED (6/19)

    By CMS - June 27, 2019

    The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course on how to properly code of Section GG. This 45-minute course is intended for providers in the following care settings: Skilled Nursing Facilities (SNFs), Long-Term Care Hospitals (LTCHs), Inpatient Rehabilitation Facilities (IRFs), and Home Health Agencies (HHAs); and is designed to be used on demand anywhere you can access a browser. The course is divided into the following four lessons and includes interactive exercises that allow you to test your knowledge in real life scenarios:

    • Lesson 1: Importance of Section GG for Post-Acute Care

    • Lesson 2: Section GG Assessment and Coding Principles

    • Lesson 3: Coding GG0130.Self-Care Items

    • Lesson 4: Coding GG0170.Mobility Items

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  • CASPER Reporting User’s Guide for PBJ Providers UPDATED (6/19)

    By QTSO - June 21, 2019
    This user’s guide provides information and instructions pertaining to the CASPER Reporting application. Section 12, Payroll Based Journal (PBJ) Reports, addresses the staffing and census reports available to providers, including the Employee Report, the Census Report, the Staffing Summary Report, and the PBJ Submitter Final File Validation Report.
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  • CASPER Reporting User’s Guide for MDS Providers UPDATED (6/19)

    By QTSO - June 21, 2019
    Provides information and instructions pertaining to CASPER Reporting, including accessing Final Validation Reports.
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  • AAPACN CEO Attends NASEM Town Hall to Discuss Future of Nursing

    By AAPACN - June 18, 2019

    The National Academies of Sciences Engineering and Medicine (NASEM) hosted a Town Hall meeting in Chicago, IL on Friday, June 7 as part of the Future of Nursing: 2020-2030 project. The Future of Nursing project aims to “chart a path for the nursing profession to help our nation create a culture of health, reduce health disparities, and improve the health and wellbeing of the U.S. population in the 21st century.” Together with their Future of Nursing Campaign for Action and information about the latest in science and technology, they will put together a final report to assess “the capacity of the profession to meet the anticipated health and social care demands from 2020 to 2030.”

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  • Variable Per-Diem Adjustments Will Spotlight Skilling Decisions

    By Caralyn Davis, Staff Writer - June 18, 2019

    This October 1, the Patient-Driven Payment Model (PDPM) will introduce variable per-diem payment adjustments to providers paid under the Skilled Nursing Facility Prospective Payment System (SNF PPS). PDPM has five case-mix-adjusted components that each have an associated payment based on the case-mix group classification: physical therapy (PT), occupational therapy (OT), speech-language pathology services (SLP), nursing, and nontherapy ancillaries (NTA). For the PT, OT, and NTA components, case-mix group payments will decrease over the course of a Part A patient’s stay according to the predetermined schedules and adjustment factors found in Table 20, PT and OT Variable Per Diem Adjustment Factors, and Table 21, NTA Variable Per Diem Adjustment Factors, on page 6-48 of the draft version 1.17 Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual.

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