Harmony Healthcare Blog

C.A.R.E.S.

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

Skilled Nursing Facilities are accustomed to the inordinate amount of regulatory oversight and changes that occur in the industry on a regular basis.  

HHI, Harmony Healthcare International (HHI), helps Nursing Homes understand and implement the rules of engagement via monthly site visits, medical record reviews, education and analysis.   This blog highlights most of the recent and upcoming changes that Nursing Homes need to assimilate and implement.

HHI, Harmony Healthcare International (HHI), reinforces the importance of ensuring that the Skilled Nursing Facility is diligent in safeguarding that below directives are not only executed, but that there is documentation present to support compliance within each of these areas (i.e., blanket waivers, flexibilities, regulations and guidance related to this pandemic).

C.A.R.E.S.

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

Five Star History

Back in December 2008, CMS enhanced the Nursing Home Compare public reporting site to include a set of quality ratings for each nursing home that participates in Medicare or Medicaid.  This Nursing Home Compare website displays a facility “star rating” for the public. 

The goal is to provide residents, families and the public with an easy way to understand nursing home quality and make informed decisions regarding high and low performing facilities.  This is the essence of value-based purchasing (metric, report and a reward).

The Overall Quality Five-Star Rating ranges between of one to five stars is based on the facility’s performance of 3 Domains:

C.A.R.E.S.

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

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.

C.A.R.E.S.

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

Medicare Minute with Kris Mastrangelo: COVID ICD-10

C.A.R.E.S.

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

Medicare Minute with Kris Mastrangelo: Spell of Illness

C.A.R.E.S.

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

Medicare Minute with Kris Mastrangelo: 3 Night Qualifying Stay

C.A.R.E.S.

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

Medicare Minute with Kris Mastrangelo: Skilling the COVID-19 Patient

C.A.R.E.S.

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

The CDC, CMS, AHCA and all State Associations are working around the clock to assist Skilled Nursing Facilities with navigating through this unprecedented time.  The resources are available, but it may difficult for operations to problem solve and prioritize due to the overwhelming risk and mortality of the senior population from COVID-19.

Coronavirus is a member of larger “family of viruses” called Coronaviruses (which includes the common cold). The name is derived from the shape of the virus at the molecular level, it looks like a “crown” with projections.  Those spikes on the virus allow it to stick to human cells and proceed to take over the normal cellular structure and then replicate itself.  This family of viruses has been around over 50 years.  COVID-19 (SARS-CoV-2) is the 7^th coronavirus known to effect humans.

C.A.R.E.S.

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

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.

C.A.R.E.S.

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

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.