C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency

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Interview with Stephen Hanse, President of New York State Health Facilities Association

Kris Mastrangelo, President of Harmony Healthcare International (HHI) interviews Stephen Hanse, President of New York State Health Facilities Association (NYSHFA), in the 2017 AHCA Provider Lounge.  Stephen talks about the process of transitioning the Case Mix payment system to a Value-Based Purchasing environment and how it is affecting providers in New York State.   Partnering with the Department of Health has helped providers better understand both the Value-Based Purchasing environment and also the New Survey Process.  (Audio transcription below).

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Topics: Case Mix, Value-Based Purchasing

Understanding the criteria and components of RUG Leveling (53 levels) and Categorization is imperative for accurate and appropriate reimbursement under the New York Case Mix reimbursement system. Protocols and defined processes are essential for success and require implementation throughout the year, (not just during the case mix "window").  Ongoing MDS coding oversight and refinements are even more important given the regulatory and reimbursement changes impacting quality measures and the ultimate crescendo of value based purchasing. The following tips may help you in preparing your documentation to properly reflect all necessary data to support the appropriate payment level.

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Topics: Medicaid, Case Mix, New York State

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In many states, Medicaid reimbursement is already transitioning to managed care, striking fear in the hearts of most operators and administrators - and for good reason.  Providing quality care for the Medicaid population has been part of the Skilled Nursing Facility (SNF) industry for years even with per diem reimbursements far below cost.   While not always the case, managing the Medicaid population can mean potentially delayed reimbursement and lead to more administrative hoops to jump through.

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Topics: Case Mix, Case Mix Reimbursement

The New York State Executive Budget, as proposed by Governor Cuomo, is considering a 2% Cap on increases in New York’s Skilled Nursing Facilities’ Case Mix Index.  The effect on SNF provider’s Medicaid reimbursement (already the largest gap between reimbursement and cost in the nation) could be significant.

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Topics: Case Mix, Case Mix Reimbursement

When the MDS is completed, it calculates a clinical score (RUG level, Resource Utilization
Group) which impacts the direct care costs under the Case Mix reimbursement system. The notion is that the higher the amount of resources rendered to care for the patient/resident, the higher the reimbursement level. There are different types of RUG systems and each state has the ability to create its own system.

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Topics: Case Mix

Topics: Rehab, Medicare Part B, Case Mix, OBRA, Assessment Schedules, Rehab Case Management, MDS Coordinator

Topics: Medicare, Medicaid, Case Mix, OBRA, MDS, PPS, MDS assessment, Medicaid Reimbursement

Impact Rehabilitation Services Impact Medicaid Case Mix:  Rehabilitation Therapists are integral members of the interdisciplinary team as is their participation in the process of resident assessment.  The routine therapy screen assists in identifying areas of decline or the potential for improvement, before loss becomes permanent or opportunities for improvement are missed. 

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Topics: Case Mix, ARD, Rehab Case Management

Topics: Case Mix, Assessment Schedules, Medicaid Reimbursement

Case Mix Assessments:  There is significant opportunity to increase the case mix index with the intervention of rehabilitation during the appropriate assessment windows.  Increased communication between the rehabilitation staff and the MDS Coordinator regarding patients receiving Medicare Part B services has the potential to increase the case mix index in two ways. 

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Topics: Case Mix, OBRA, ARD