Harmony Healthcare Blog

2017 AHCA Provider Lounge Series: State of Medicaid in the State of New Jersey

Posted by Kris Mastrangelo on Fri, Jan 05, 2018

C.A.R.E.

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


Interview with Loretta Kaes, Director of Quality Improvement and Clinical Services of the Health Care Association of New Jersey Health Care

Kris Mastrangelo, President of Harmony Healthcare International (HHI) interviews Loretta Kaes, Director of Quality Improvement and Clinical Services of the Health Care Association of New Jersey Health Care (HCANJ), in the 2017 AHCA Provider Lounge.  Loretta discusses the impact recent regulatory changes, along with ACOs, have had on reimbursement, in particular Medicaid reimbursement, in the state of New Jersey.  (Audio transcription below).

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Topics: Medicaid

Accountable Care Organizations Update:  ACOs and Medicaid

Posted by Melissa Fox on Wed, Nov 23, 2016

C.A.R.E.

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


Across the country, states are exploring the viability of Medicaid Accountable Care Organizations that align the provider and payer incentive to focus on value instead of volume.  The Center for Medicare and Medicaid Services is currently aligning partnerships in order to identify a collaborative approach to providing better care at an efficient cost.  During the harmony16 LTPAC Symposium, Harmony Healthcare International (HHI) presented on the upcoming changes to CMS initiatives with Medicaid Beneficiaries.  The following topics were discussed:

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Topics: ACOs, Accountable Care Organizations, Medicaid

New York Medicaid Case Mix: 14 Tips for Accurate Reimbursement

Posted by Kris Mastrangelo on Fri, May 13, 2016

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: Case Mix, New York State, Medicaid

Medicare and Medicaid Proposed Rule:  Regulatory Changes for Long-Term Care Facilities

Posted by Joyce Sadewicz on Thu, Nov 19, 2015


On July 13, 2015, the Centers for Medicare and Medicaid Services published a Proposed Rule that revises the requirements for participation in Medicare and Medicaid programs for long-term care facilities. This CMS proposal is due to the fact that as CMS states, “The population of nursing homes has changed, and has become more diverse and more clinically complex.” Evidenced based research has been conducted that has provided greater knowledge about resident safety, health outcomes, individual choice and quality assurance and performance improvement. Major changes have not been made to the conditions for participation since 1991 despite the significant changes to service delivery in this setting.

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Topics: Medicare, Medicaid, proposed rule

Intergovernmental Transfers: Funding State Medicaid Programs

Posted by Kris Mastrangelo on Tue, Jul 14, 2015

Intergovernmental transfers (IGTs) are a transfer of funds from another government entity (e.g., county, city or another state agency) to the state Medicaid agency. The ability of a state to use IGTs to fund their Medicaid program is recognized in statute (§1903(w)(6) of the Social Security Act) and rule (42 CFR §433.51).  Medicaid has been a joint financing partnership between the states and the federal government since 1965. This provides a guarantee of federal matching funds for state expenditures for health and long-term care services for the country’s low-income population.
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Topics: Medicaid, IGT, Intergovernmental Transfers

New York State Transitions to Medicaid Managed Care Plan March 1st

Posted by Kris Mastrangelo on Tue, Mar 04, 2014

Effective March 1, 2014, all eligible beneficiaries over the age of 21 in New York City, Nassau, Suffolk and Westchester counties, in need of long term placement in a nursing facility, will be required to join a Medicaid Managed Care Plan (MMCP) or a Managed Long Term Care Plan (MLTCP).  The rest of New York State is scheduled to begin transitioning this coming September for both dual and non-dual eligible populations and all upstate counties will be phased in by December 2014.

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Topics: Medicaid, Medicaid Reimbursement, Managed Care

Case Mix as a Medicaid Reimbursement System

Posted by Peter Mastrangelo on Wed, Jun 20, 2012

Case Mix - Medicare Minute

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

Harmony Healthcare Launching Therachirps Blog!

Posted by Peter Mastrangelo on Wed, Jan 11, 2012

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Topics: Medicare, Medicaid, Therapy, LTC, Reimbursement

Revenue Isulation, Documentation and RUG-IV

Posted by Peter Mastrangelo on Thu, Jul 14, 2011

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Topics: Medicare, Medicaid, MDS 3.0, RUG-IV;

Rehab Professionals Influence on the MDS 3.0

Posted by Kris Mastrangelo on Fri, Feb 04, 2011

CMS stated very clearly from the infancy stages of development of the MDS 3.0 that this tool is designed to capture the patient's voice as well as interdisciplinary findings.  There are a number of sections on the MDS 3.0 tool that can be influenced and impacted by the consultation and provision of skilled therapy services.  Education for the Medicare team should be on-going to review the coding instructions for the MDS.  Misinformation regarding the coding elements on the MDS can lead to inaccurate reimbursement under both Medicare and Medicaid programs as well as risk for non-compliance under Medical Review.  Inaccurate coding of the MDS can also have serious survey implications.

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Topics: MDS 3.0, CMS, Medicare, Medicaid, Medical Review, Therapy Professionals

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