Harmony Healthcare Blog

QAPI: Survey Plan of Correction (Part 3)

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Thu, Oct 22, 2020

"HHI C.A.R.E.S. about care."

C.A.R.E.S.

Compliance • Audits AnalysisReimbursement

Regulatory RehabilitationEducation Efficiency Survey


When writing a Plan of Correction for a health inspection survey, Skilled Nursing Facilities need to become fluent in critical thinking, process improvement and data-driven performance measures. 

The Auditing and Monitoring Components are an essential ingredient for acceptance of the POC.

The Top 8 Things to know about QAPI and Plan of Corrections submissions:

 

  1. If the surveyors identify that the Auditing and Monitoring Component of the POC is not consistent, not realistic or does not reflect an inherent checks and balance, the POC will not be accepted by the state. 
  2. Surveyor follow-up of the audits will hone in on seeing that the audits are completed consistently and the findings of the audits are formally reported at the QAPI committee meeting. The results need to be rolled up into a user-friendly report for the Administrator and DON to oversee.
  3. The Auditing and Monitoring Component of the POC requires simplification for completion and reporting.

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Topics: QAPI

QAPI Five Elements of a Successful Program (Part 2)

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Mon, Oct 19, 2020

"HHI C.A.R.E.S. about care."

C.A.R.E.S.

Compliance • Audits AnalysisReimbursement

Regulatory RehabilitationEducation Efficiency Survey


Harmony Healthcare International (HHI) recommends facilities investigate the current strength of the QAA committee to determine how well the team is poised for the transition to QAPI.  If the team is meeting only quarterly to meet the minimum requirements, the facility will have a more difficult transition and will want to allow plenty of time to develop initiatives, data-streams, perform root cause to identify internal trends and time for subcommittee development for initiative ownership. 

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Topics: QAPI

QAPI Program: Is Your Facility Prepared? (Part 1)

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Fri, Oct 16, 2020

"HHI C.A.R.E.S. about care."

C.A.R.E.S.

Compliance • Audits AnalysisReimbursement

Regulatory RehabilitationEducation Efficiency Survey


What are we seeing this past week?  An intense amount of focus on preparedness for Quality Assurance and Performance Improvement (QAPI) Program Development. 

QAPI is an ongoing, systematic, comprehensive and data driven system for quality improvement that merges Quality Assessment and Performance Improvement. Most Skilled Nursing Faculties focus on the identification, prevention, and quick fixes to mitigate risk areas. However, the approach described focuses purely on performance improvement

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Topics: QAPI

MDS 3.0 Revisions and PDPM State Mapping

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Tue, Oct 06, 2020

"HHI C.A.R.E.S. about care."

C.A.R.E.S.

Compliance • Audits AnalysisReimbursement

Regulatory RehabilitationEducation Efficiency Survey


 

 

 

 

 

 

 

 

 

 

 

ACHCA is a proud sponsor of the Harmony Healthcare International (HHI) blog.

CMS is delaying the release of the revised MDS 3.0, which was scheduled for October 1, 2020. CMS updated the minimum data sets of the MDS 3.0 to support the calculation of PDPM Payment for OBRA Assessments that are not combined with a Medicare Part A 5-Day PPS Assessment.

 

The revised MDS will allow states to:

 

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Topics: Regulatory

$20 Billion Provider Relief Funding Phase 3

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Mon, Oct 05, 2020

"HHI C.A.R.E.S. about care."

C.A.R.E.S.

Compliance • Audits AnalysisReimbursement

Regulatory RehabilitationEducation Efficiency Survey


Providers can start applying for relief funding Today, Monday, October 5, 2020!

 

On 10.1.2020, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced $20 billion in new funding for providers on the frontlines of the COVID-19 pandemic. 

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Topics: Regulatory

OIG Report August 2020 Medicare Part A and Part B Appeals Overpayment

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Fri, Oct 02, 2020

"HHI C.A.R.E.S. about care."

C.A.R.E.S.

Compliance Audits AnalysisReimbursement

Regulatory RehabilitationEducation Efficiency Survey


In August of 2020, the Office of Inspector General (OIG) issued a report related to overpayment reviews by Medicare Administrative Contractors (MACs). According to the OIG’s report, MACs have been inconsistent in their calculation methodology and statistically valid sample sizes for extrapolated overpayments during the provider appeals process. This resulted in approximately $42 million in extrapolated overpayments being overturned from 2017-2018.

This is something that Harmony Healthcare International (HHI) has seen firsthand and assisted many clients with avoiding overpayments to the Medicare Administrative Contractors (MACs).

(See Appeal Letter Sample - Download Below)

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Topics: Reimbursement, Compliance, audit

Length of Stay (LOS) - What is the Best Calculation?

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Tue, Sep 22, 2020

C.A.R.E.S.

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


HHI is fielding many questions regarding the calculations for Length of Stay (LOS). Skilled nursing facilities across the country track the Clinically Anticipated Stay (CAS), otherwise known as Length of Stay (LOS), to determine the amount of days a patient resides in the nursing home. Data collection is the foundation for monitoring progress, but, in itself is a daunting task. CMS uses LOS in the SNF QRP program, for patients discharged to the hospital and for patients who return to the Emergency Room or hospital within 30 days of discharge from the SNF. The accuracy and consistency of these figures is critical for care, operations, outcomes and analysis.

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Topics: LOS, Regulatory

Skilled Nursing Documentation for Medicare Part A in a SNF

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Fri, Sep 18, 2020

C.A.R.E.S.

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


Harmony Healthcare International (HHI) reinforces the importance of ongoing oversight of all nursing documentation to ensure it supports the rationale for skilled coverage. The following information should be included in all admission notes: 

  • Time and date of admission
  • Mode of Transportation, assist level and number of assist with transfers and bed mobility
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Topics: Documentation, SNF, Regulatory

HHI C.A.R.E.S. About Care Top 8 Updates for SNFs

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Wed, Jul 15, 2020

C.A.R.E.S.

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



1. COVID-19 Point-of-Care Testing Devices and Supplies

COVID-19 Point-of-Care Testing devices and supplies to be used for residents and staff will be delivered to all SNFs starting July 20th.  Nursing homes in hot spots ranked as being at risk due to community spread will receive the antigen testing devices first. 

This initiative was announced at a press conference on 7.14.20 by Seema Verma and Admiral Brett Giroir of HHS who explained that these testing devices provide rapid on the spot tests, at a rate of 20 tests per hour.  Critics have pointed out that error rates can be as high as 20%. 

Learn more directly from CMS Administrator Seema Verma today, 7.15.20 at 5:30 PM EDT.  Call 1-833-614-0824, use the Conference ID 9391146Or join the audio webcast by registering here.

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Topics: SNF

COVID-19 FAQs MLN Matters SE20011 Medicare Fee-For-Service (FFS)

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Fri, Jul 10, 2020

C.A.R.E.S.

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


Medicare and Medicare Advantage Plan’s coverage of COVID-19 diagnostic testing for nursing home residents and patients started July 6, 2020 and continues until the end of the Public Health Emergency (PHE).

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Topics: Regulatory

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