Harmony Healthcare Blog

Isolation and Quality Care Top 10 Criterion You Need to Know: Coronavirus (COVID-19) Pandemic

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Sun, Mar 22, 2020

C.A.R.E.

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


As the Coronavirus pandemic evolves, we are actively observing our world change at an exponential pace.  Despite this rapid change, the commitment level of the team at Harmony Healthcare International (HHI) has not deviated from our uppermost dedication to you, your staff and most importantly, to our role in helping you provide the highest quality care to your residents.

First, and most importantly, the safety of you, your staff and your residents remain the number one priority.  Most of you have readily adapted and maintained our Harmony Healthcare International (HHI) services using remote access.  We are grateful for your flexibility and appreciate your awareness of the potential risks of missing your monthly medical record reviews.  Many scenarios cannot be recouped and a heightened focus on care and reimbursement is essential to successfully navigate the upcoming months.

This leads me into a very important subject matter that fits the current world situation:

Isolation of patient’s with infectious diseases.

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Topics: Isolation, coronavirus, COVID-19

Coronavirus and Influenza Outbreak: Top 20 Things You Need to Know

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Fri, Mar 06, 2020

C.A.R.E.

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


  1. Number one goal is to prevent the virus from entering the Skilled Nursing Facility.
  2. If a virus enters the Skilled Nursing Facility, place full court press with goal to prevent the spread of infection.
  3. If there is a confirmed or suspected influenza outbreak, implement Outbreak Control Measures.
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Topics: coronavirus

PDPM - Where are We Now Q&A: Part 9

Posted by The Harmony Team on Thu, Mar 05, 2020

C.A.R.E.

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


Question 9 of 9: Where can we obtain data from cost reports for comparison?

Cost reporting data can be found at the following link:

https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Cost-Reports

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Topics: PDPM

PDPM - Where are We Now Q&A: Part 8

Posted by The Harmony Team on Tue, Mar 03, 2020

C.A.R.E.

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


Question 8 of 9: Can you talk a little bit about the use of Return-to-Provider codes ?

When coding the MDS in Section I0020B, we need to identify the primary medical diagnosis.  This represents the reason a person skilled and allows them to access their skilled Medicare A benefit.  These medical diagnosis codes are utilized with the CMS crosswalk to determine the PDPM clinical category.

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Topics: Coding, PDPM

PDPM - Where are We Now Q&A: Part 7

Posted by The Harmony Team on Fri, Feb 28, 2020

C.A.R.E.

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


Question 7 of 9: In order to capture IV fluids for hydration, do we need documentation supporting reason is for hydration/nutrition, or can we assume IV fluids are delivered for this purpose?

Harmony Healthcare International (HHI) recommends reviewing the hospital documentation including the MAR prior to establishing the ARD for the 5-day assessment so that all resident complexities are included.

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Topics: Coding, PDPM, AHIMA

PDPM - Where are We Now Q&A: Part 6

Posted by The Harmony Team on Tue, Feb 25, 2020

C.A.R.E.

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


Question 6 of 9: I am curious as to why organizations do not hire a credentialed coder/Medical Records professional to abstract, review, code, and audit for the primary and secondary diagnoses codes using ICD-10-CM.  Do you hear this as a recommendation?  Do you recommend? 

Harmony Healthcare International (HHI) has found that professional coders are not needed by SNF facilities for several reasons.

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Topics: Coding, PDPM, AHIMA

PDPM - Where are We Now Q&A: Part 5

Posted by The Harmony Team on Thu, Feb 20, 2020

C.A.R.E.

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


Question 5 of 9: Is it appropriate to use diagnoses added by consulting physicians?

It is appropriate to use diagnoses added by consulting physicians, in addition to those listed by the admitting physician and those identified by non-physician providers such as nurse practitioners and physician assistants.  According to the RAI User’s Manual, active diagnoses are intended to code diseases that have a direct relationship to the resident’s current functional status, cognitive status, mood or behavior status, medical treatments, nursing monitoring, or risk of death. 

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Topics: MDS, PDPM, Physician Diagnosis

PDPM - Where are We Now Q&A: Part 4

Posted by The Harmony Team on Tue, Feb 18, 2020

C.A.R.E.

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


Question 4 of 9: For the certification form on admission, how many days does the MD/NP have to sign? If a person admits late on a Friday and the practitioner is not in the facility until Tuesday or after, would that suffice?

According to the Medicare Benefit Policy Manual Chapter 8 – Coverage of Extended Care (SNF) Services under Hospital Insurance. 40- Physician Certification and Re-Certification for Extended Care Services,

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Topics: PDPM, Certification Form, Admission

Trauma Informed Care: Top 10 Trauma Causing Events from Childhood

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Mon, Feb 17, 2020

C.A.R.E.

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


“Childhood Trauma leads to a Shorter Lifespan.”

Thank you for all the comments and notes on the Medicare Minutes. Many of you are seeking more information on Trauma Informed Care. As I have said since the draft RoP Requirements of Participationwas published, (I read it in a Cambridge Massachusetts Hotel while my daughter Savannah wrote her college application essays), CMS is on top of their game and ahead of the curve.

The Skilled Nursing Industry is working diligently to understand how to provide care to an individual with Trauma. Trauma can be caused by a multitude of events within a lifetime. However, it is prudent to educate staff on root causes from childhood events.

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Topics: trauma-informed care

PDPM - Where are We Now Q&A: Part 3

Posted by The Harmony Team on Fri, Feb 14, 2020

C.A.R.E.

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


Question 3 of 9: In a patient with a hip fracture, is there a need to code “muscle weakness",“difficulty walking” listed by PTs? These diagnoses are usually not listed/signed by a physician.

“Physical therapy services are those services provided within the scope of practice of physical therapists and necessary for the diagnosis and treatment of impairments, functional limitations, disabilities or changes in physical function and health status.” 230.1 - Practice of Physical Therapy, Medicare Benefit Policy Manual Chapter 15 – Covered Medical and Other Health Services.

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Topics: Coding, PDPM

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