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Using Standardized Testing to Improve Therapy Documentation


With the spiraling cost of health care in the United States, it is critical to demonstrate the effectiveness and efficiency of therapy treatment.  As payers, health care systems and the public question the efficacy and cost effectiveness of rehabilitation, objective documentation is becoming more important.  Therapists must have a more scientific basis for their practice.  Evidence based treatment is indeed best practice.  Referrals are increasingly based on objective, value-based criteria including metric-driven rehabilitation performance, rates of successful home discharges, re-hospitalization rates and patient experience ratings. 

Medicare Denied Claims – How the Appeal Letter Can Make Or Break You


Many facilities believe they can relax due to the announcement that the Recovery Auditor Contractors (RACs) are taking a temporary break.  Unfortunately, this is not the case, as facilities can still fall prey to audits by Medicare Administrative Contactor (MACs), Zone Program Integrity Contractor (ZPICs), and Comprehensive Error Rate Testing (CERT) audits.  It is imperative that facilities continue to be vigilant in their efforts to monitor for Additional Development Requests (ADRs) and promptly address any received. 

Medicare Advantage Organization HIPPS Codes Update


Clarification is in order. Originally, when billing for all Medicare Advantage Organizations (MAO), PACE Organizations, Cost Plans, and certain demonstration projects, providers were originally told by CMS that they must provide Health Insurance Prospective Payment System (HIPPS) Codes for Skilled Nursing Facility (SNF) claims submitted effective July 1, 2014. This left Skilled Nursing Facility providers concerned that they would then be required to follow the traditional Medicare PPS schedule in order to accurately provide HIPPS codes for billing.  On May 23, 2014, CMS released a memo regarding Submission of Health Insurance Prospective Payment System (HIPPS) Codes to the Encounter Data System to all MAO providers clarifying the requirements.

Conducting Your Skilled Nursing Facility Risk Analysis

Protect EHI in SNF Webinar

Conducting Your Skilled Nursing Facility Risk Analysis:  Last year, HIPAA privacy, security and breach notification rules were made applicable to healthcare providers, payers and clearinghouses. The HIPAA Security Rule establishes national standards to protect individuals’ electronic personal health information that is created, received, used, or maintained by a covered entity. The Security Rule requires appropriate administrative, physical and technical safeguards to ensure the confidentiality, integrity, and security of electronic protected health information.

Keep Dementia Training Front of Mind


Keep Dementia Training Front of Mind:  Harmony often discusses clinical review of individual patient interventions with the rehabilitation and nursing team regarding identification, assessment, and management of patients with advanced dementia.  While treatment of low functioning, demented, or long term patients is challenging, Harmony believes that with increased training regarding targeted strategies, this particular group of residents will benefit greatly from skilled interventions. There are three levels of Rehabilitation that meets skilled criteria in the SNF setting.

Centers for Medicare and Medicaid Services (CMS) Proposed Rule FY2015


CMS Proposed Rule FY2015:  On May 6,2014, the Centers for Medicare and Medicaid Services (CMS) issued a Proposed Rule [CMS-1605-P] under the Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities. The Proposed Rule illustrates the proposed Fiscal Year 2015 Medicare payment rates for skilled nursing facilities (SNFs).  The Proposed Rule outlines an estimated increase in SNF payments of 2.0%.  This estimated increase is attributable to the 2.4% market basket increase, reduced by the 0.4% point multifactor productivity adjustment required by law.  As the actual amount of change in the market basket index at -0.3 did not exceed the 0.5 percentage point threshold, the payment rates for FY2015 do not include a forecast error adjustment. 

Why We Love the Discharge Process (And so should you!)


To maintain a viable Medicare program in the skilled nursing facility setting, leadership must analyze the admission and discharge process for the Medicare Part A beneficiary. Case management by the Rehabilitation professional is one of the primary factors affecting clinically appropriate stay.  Additionally, the Medicare team in the facility must have a standard procedure for handling patients who are admitted with the expectation of returning home after a brief period for Rehabilitation.  The discharge process begins once the patient crosses the threshold of the facility.

Therapy Screening Techniques: The Critical Role of the Nurse


While there is a great deal of focus on the management of post-acute patients in the SNF population, many of whom will return to the community, management of long term care patients is equally essential to the provision of services along the continuum of care. According to CMS regulations, long term care patients have a right to function at their highest practicable level, including the delivery of services to slow the progression of decline, as long as these services meet the definition of skilled criteria. In order for these services to be skilled, they must be considered reasonable and necessary and require the skills, knowledge, and judgment of a licensed qualified professional based on their inherent complexity. 

Avoid Lost Revenue by Understanding Your Managed Care Contracts


Managed Care Organizations are quickly becoming substantial components of the skilled nursing reimbursement system.  We are noticing a trend in facilities where key players have limited or no access to the specifics of different Managed Care contracts that were negotiated for the facility. 

Healthcare Corporate Compliance: Keys to Assembling A Sound Program


A Corporate Compliance Program is the Long Term Care provider's formalized and proactive approach towards detecting fraud, abuse, and waste of precious company resources.  Exact regulations for this important program have not yet been crystallized, so many facilities are left wondering what, if anything, should be implemented immediately.  Harmony (HHI) recommends taking a hands-on approach to Corporate Compliance.  Although the impending regulations remain to be seen, a Corporate Compliance Program is of benefit to every facility.

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