Harmony Healthcare Blog

Medicare Part A Required SNF PPS Assessments: Back to Basics (Part 3 of 3)

Posted by Sally Fecto on Fri, Mar 30, 2018

C.A.R.E.

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


As a final Blog on the SNF Assessments series, here is an overview of the Discharge Assessments.  There are 3 Assessments to address: 

  1. OBRA Discharge Assessment – Return Anticipated 
  1. OBRA Discharge Assessment – Return Not Anticipated 
  1. Medicare-Required Part A PPS Discharge Assessment 
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Topics: PPS

Medicare Part A Required SNF PPS Assessments: Back to Basics (Part 2 of 3)

Posted by Kris Mastrangelo on Tue, Mar 27, 2018

C.A.R.E.

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


Unscheduled Assessments 

Last week we reviewed the PPS MDS Scheduled Assessments required for Medicare Part A Billing.  Often, situations arise in which the MDS Coordinator must complete an assessment outside of the planned assessments.  These types of assessments are known in the industry as “Unscheduled Assessments.”  There are six types of unplanned MDS Assessments: 

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Topics: PPS

Medicare Part A Required SNF PPS Assessments: Back to Basics (Part 1 of 3)

Posted by Kris Mastrangelo on Thu, Mar 22, 2018

C.A.R.E.

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


While the Skilled Nursing Facility prepares for Payment Reform in the form of a bundled payment or RCS-1, the facility clinical teams need to ensure that the basics of the current PPS System are completed correctly and timely.  The Harmony Healthcare International (HHI) Team who travel the country (Harmony HealthCARE Specialists) to audit and educate on the multiple aspects of Compliance, Regulatory, Reimbursement and Efficiency share that getting back to basics must be a focus.  Especially now given the looming changes. 

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Topics: PPS

Medicare Leave of Absence: Home for the Holidays

Posted by Kris Mastrangelo on Thu, Dec 08, 2016

C.A.R.E.

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


With the upcoming holidays comes increased confusion related to the Medicare beneficiary’s ability to enjoy a temporary visit home to participate in holiday celebrations with his or her loved ones.  While many Medicare beneficiaries are too acutely ill to leave the facility even for a brief home visit, there are no regulations preventing Medicare beneficiaries who are physically able, from enjoying a temporary home visit to participate in the holiday festivities. 

According to the Medicare Benefit Policy Manual, “An outside pass or short leave of absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride, or a trial home visit, is not, by itself evidence that the individual no longer needs to be in a SNF for the receipt of required skilled care.”

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Topics: Documentation, PPS, ARD, Leave of Absence

Medicare Part A PPS Discharge MDS Assessment

Posted by Kris Mastrangelo on Thu, Dec 01, 2016

C.A.R.E.

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


Effective October 1st, Medicare requires a Medicare Part A PPS Discharge Assessment. This MDS contains the required data elements used to calculate current and future Skilled Nursing Facility Quality Reporting Program (SNF QRP) quality measures under the IMPACT Act. The IMPACT Act directs the Secretary to specify quality measures on which post-acute care (PAC) providers (which includes SNFs) are required to submit standardized patient assessment data. Section 1899B(2)(b)(1)(A)(B) of the Act delineates that patient assessment data must be submitted with respect to a resident’s admission to and discharge from a Medicare Part A Assessment.

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Topics: PPS, Discharge Assessment, Medicare Part A

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

Posted by Kris Mastrangelo on Mon, Jun 09, 2014

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. 

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Topics: Final Rule, Medicare, CMS, OIG, PPS, Skilled Nursing Facility

CMS SNF PPS Final Rule for FY 2014 Published

Posted by Kris Mastrangelo on Sat, Aug 10, 2013

On August 1, 2013, the Centers for Medicare & Medicaid Services (CMS) published the Final Rule for the Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNF) for FY 2014. The Medicare rates posted in Final Rule will go into effect October 2013.

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Topics: CMS, Medicare Part A, PPS, SNF, Final Rule, RAI

COT OMRA: What to Consider?

Posted by Kris Mastrangelo on Wed, Sep 12, 2012

Today I want to talk about the Change of Therapy (COT) Other Medicare Required Assessment (OMRA).  There are a couple of major points that should be kept in mind when considering whether COT OMRA needs to be completed.  For one, how do we manage our therapy case load to prevent continually needing to complete an off schedule assessment for our PPS or our Medicare Part A patients?  Always remember the COT OMRA is generated because there needs to be a change in the level of payment. This is due to the level of therapy intensity that is being provided.  So, if you have a PPS Assessment and it generates a nursing RUG classification, a nursing RUG score is being paid for a particular PPS Assessment.  If Therapy is involved, you are monitoring your COT Assessment Reference Dates, and the change in therapy intensity decreases, you do not need to complete a COT OMRA (if you are being paid at nursing RUG level).  Many times it is forgotten that this is both clinically related as well as payment related.

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Topics: Medicare Part A, PPS, RUG, ARD, Change of Therapy

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

Encoding Period and the MDS. The Importance of a Triple Check System

Posted by Kris Mastrangelo on Wed, May 30, 2012

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Topics: Medicare Part A, PPS, Quality Measures, MDS 3.0, Reimbursement, Care Planning

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