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Harmony Healthcare Blog

Is Your Skilled Nursing Facility Ready for the 2014 PEPPER?

Posted by Matt McGarvey on Tue, Apr 14, 2015

2014 PEPPER is just about here. 
What lessons have we learned from the first two?

The 2014 PEPPER report will be available to Skilled Nursing Facilities on April 20th.  To say that it is eagerly awaited is quite an understatement.

When the first report was released in September 2013, as an industry our reactions were “What’s a PEPPER report?”, “I’ve never heard of it.” and “How do I get a copy?”  During the months following the PEPPER release, our learning curve was vast as we collectively struggled to interpret the robust, yet complicated, data collection and analysis tool and use it to manage our business.

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Topics: PEPPER, PEPPER Report

Sustainable Growth Rate Repeal: What it Means for SNFs

Posted by Cyndi Ouellette on Wed, Apr 08, 2015

On March 26, 2015, the House of Representatives passed legislation to fix the Medicare physician payment problem and to extend the Medicare therapy cap exceptions.  The Medicare Access and CHIP Reauthorization Act (H.R. 2) repeals the Sustainable Growth Rate (SGR) formula and significantly changes payment under Medicare Part B to pay for value over volume. Within this bill the House included a two-year extension of the therapy cap exceptions process.

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Topics: Medicare Part B, Sustainable Growth Rate, Doc Fix Bill

The SNF Therapy Dilemma: In-House v. Contract

Posted by Matt McGarvey on Wed, Apr 01, 2015

Which is right for my building:
In-House or Contract Therapy?

This is a question that is repeatedly asked of me wherever I go.  Yet the answer is the same:   It depends.

Proponents of both contract and in-house therapy might be disappointed in my answer; however there are many factors to consider with regards to this critical decision.

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Topics: SNF Therapy, Contract Therapy

Case Mix Best Practices for the Skilled Nursing Facility

Posted by Matt McGarvey on Thu, Mar 05, 2015


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

HIPAA - Individually Identifiable Information: Know the Rules!

Posted by Elisa Bovee on Mon, Feb 23, 2015

As long-term care facilities continue to adapt to 2015 changes, it is important that they remember to implement compliance safe guards.  Facilities need to be committed to bridging existing codes of conduct to develop reasonable safeguards required by the Privacy Rule. One such policy includes incidental use and disclosure of confidential health information (also known as Protected Health Information or “PHI”). Per the requirements in the HIPAA Privacy Rule (See 45 CFR 164.530), protect the confidentiality of individually identifiable patient health and financial information from any unauthorized intentional or unintentional use or disclosure. 
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Topics: Compliance, HIPAA, ePHI, Privacy

RAC Auditors Resume Nationwide – SNF Part B Claims at Risk

Posted by Cyndi Ouellette on Mon, Feb 09, 2015

CMS has recently issued a notice and FAQ to organizations of providers as a notification of their intent to resume the Medicare Part B Manual Medical Review process for those beneficiaries over the threshold of $3,700 for outpatient therapy per calendar year.  These reviews were placed on hold as of February 2014 but are set to resume immediately.  The four current Recovery Auditors (RACs) have been approved to resume sending ADRs as of January 16, 2015 for those claims that hit the threshold between March 1, 2014 and December 31, 2014.

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Managing Medicare Advantage HIPPS Codes in the Skilled Nursing Facility

Posted by Melissa Fox on Tue, Jan 27, 2015

Medicare Advantage Organization (MC) HIPPS Codes Update for SNF Encounters When No Admission Assessment Was Completed:

On December 4, 2014, CMS released a memo regarding additional guidance regarding Submission of Health Insurance Prospective Payment System (HIPPS) Codes to the Encounter Data System to all MAO providers clarifying the requirements. When billing for all Medicare Advantage Organizations (MAO), PACE Organizations, Cost Plans, and certain Demonstrations 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. 

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The Critical Role of Nutrition in Wound Healing

Posted by Kim Steele on Tue, Jan 20, 2015

It's Not Just about Protein and Calories:

There are several items to consider when developing a nutritional program to promote wound healing.  Dieticians in the industry may be familiar with the acronym PEARLS.  We encourange you to use the following information to assist your facility in addressing nutritional needs for patients with wounds.

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Topics: wound care, wound, nutrition

Wound Care in the Skilled Nursing Facility: The Latest “Buzz”

Posted by Kim Steele on Fri, Jan 09, 2015

The world of wound care and clinically appropriate practices and documentation has been one area of health care that is ever evolving with the times. With heightened focus on the prevention, development and treatment of ulcers of any type, it is more important than ever that facilities remain aware of the latest acceptable practices and news. Several areas of focus in wound care have been reviewed and updated over the past year. 

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Topics: wound care, Pressure Ulcer, NPUAP

Maintaining Skilled Nursing Facility Compliance: F155 Advance Directives

Posted by Kris Mastrangelo on Tue, Jan 06, 2015

With multiple updates and revisions to the State Operations Manual in November, one of the areas that skilled nursing facilities should be mindful of when it comes to to compliance are those related to Advance Directives and the residents’ rights as they relate to medical treatment.

Per the Manual Updates:

(Rev. 127, Issued: 11-26-14, Effective: 11-26-14, Implementation: 11-26-14)

§483.10(b)(4)The resident has the right to refuse treatment, to refuse to participate in experimental research, and to formulate an advance directive as specified in paragraph (8) of this section.

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Topics: F155, Advance Directives, Resident's Rights

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