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The Harmony Team

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COVID-19 Strategies to Alleviate the Mental and Psychosocial Impact

Posted by The Harmony Team on Tue, Apr 07, 2020

C.A.R.E.

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


Landmark legislation for long term care, OBRA ’87, mandates that certified nursing facilities are to provide services so that each resident can “attain and maintain their highest practicable physical, mental, and psychosocial well-being.”  Recent requirements in Phase 3 of the Requirements of Participation (RoP) for trauma informed care have spurred a focus on behavioral health and psychological well-being.  It has been questioned whether the attention to behavioral health issues has kept pace with the attention to the quality of medical care that we’ve seen increase in SNFs.

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Topics: Regulatory, coronavirus, COVID-19

ICD-10-CM Coding: COVID-19 Update & Searching for Codes

Posted by The Harmony Team on Mon, Apr 06, 2020

C.A.R.E.

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


The Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) is adding a new diagnosis code, U07.1, COVID-19, to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), effective April 1, 2020.  The Index and Tabular Addenda and the Coding Guidelines for the new diagnosis code U07.1, COVID-19, can be accessed on the CDC website at https://www.cdc.gov/nchs/icd/icd10cm.htm.

The Centers for Medicare & Medicaid Services (CMS) has posted an updated FY 2020 PDPM Mappings file that includes the ICD-10 CMS code “U07.1 – 2019-nCoV acute respiratory disease” as an appropriate code for MDS item I0020B, the primary reason for the skilled nursing facility (SNF) stay.  For Minimum Data Set (MDS) assessments with an Assessment Reference Date (ARD) of April 1, 2020, or later, this code, U07.1, maps to the PDPM Pulmonary clinical category for the PT, OT and SLP components.  It does not currently impact either the PDPM Nursing or the NTA component.  Providers should check with their software vendors to confirm when the update for this change has been applied.

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Topics: ICD-10 Webinar, Coding, coronavirus, COVID-19

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

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

PDPM - Where are We Now Q&A: Part 2

Posted by The Harmony Team on Mon, Feb 10, 2020

C.A.R.E.

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


Question 2 of 9: If the main reason for intensive rehab is because the resident is debilitated from being ill can I use the rehab treatment code that maps from CMS as the primary in I0020B?

The Harmony HealthCARE Specialist recommends that the Rehabilitation treatment codes should not be coded in 10020B if they are symptoms codes, return to provider codes and do not represent the primary reason for the SNF stay.  However, they do support the need for therapy and should be reported in other areas of the MDS.

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Topics: PDPM, 10020B

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