Harmony Healthcare Blog

Medicare & Medicaid Integrity Issues: Who Is Auditing Us Now?

Posted by The Harmony Team on Wed, Aug 28, 2013

In the ever changing world of Medicare review contractors, it can be hard to tell who’s auditing us now.  New Program Safeguard Contractors (PSCs) are continually being developed while others fall to the side.  To help keep you up to speed, here is some background information along with a recent update from CMS Program Integrity. 

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Topics: CMS, Denial Management

Quality Assurance and Performance Improvement (QAPI)

Posted by The Harmony Team on Wed, Aug 21, 2013

CMS is undertaking a bold initiative to broaden quality assurance and performance improvement activities (QAPI) in nursing homes.  In March 2010, Congress passed the Affordable Care Act. The Provisions set forth significantly expand the level and scope of required QAPI activities to ensure that facilities continuously identify and correct quality deficiencies as well as sustain performance improvement. The new QAPI regulations will include the requirement that all homes must submit to the Secretary a plan for the facility to meet QAPI standards and implement QAPI best practices, including how to coordinate the implementation of a QAPI plan with QAA activities conducted under existing regulations.

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Topics: CMS, QAPI

Data, Data, Data - You Cannot Make Bricks Without Clay

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Mon, Aug 12, 2013

Uncertainty.  That is the word that best defines our country at the present time.  The Supreme Court upheld Obamacare in June 2012, which again magnifies the significance of healthcare decisions for providers. Think about it.  This decision continues to impact every organization, employer, employee, i.e., person in the United States.  This impacts one of the largest sectors of the world’s largest economy.  

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Topics: ACOs, CMS, MDS

CMS SNF PPS Final Rule for FY 2014 Published

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Sat, Aug 10, 2013

On August 1, 2013, the Centers for Medicare & Medicaid Services (CMS) published the Final Rule for the Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNF) for FY 2014. The Medicare rates posted in Final Rule will go into effect October 2013.

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Topics: Final Rule, SNF, Medicare Part A, CMS, RAI, PPS

Program for Evaluating Payment Patterns Electronic Report (PEPPER)

Posted by The Harmony Team on Wed, Aug 07, 2013

Skilled Nursing Facilities (SNFs) should check the mailbox on and around August 30, 2013 for an envelope with red print on the outside containing your facility specific PEPPER. What is PEPPER? CMS has announced that they will be mailing all SNFs a “Program for Evaluating Payment Patterns Electronic Report” (PEPPER). This report will detail Medicare claims data in certain targeted areas and compare your facility to other SNFs nationally.

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Topics: PEPPER, CMS

Improve the Accuracy in Coding of Section G; ADL Functional Status

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Wed, Jul 31, 2013

One of the most frequently asked questions during our facility site visits is about how to improve the accuracy in coding of Section G; ADL Functional Status.  The answer is always education, education, education!  Staff turnover and "urban myths" about coding are two barriers that make frequent education a must.  

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Topics: Legislation, Documentation, Medicare, Therapy, CMS, Skilled Nursing

Skilled Therapy Documentation/Standardized Testing

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Sat, Jul 20, 2013

With the spiraling cost of health care in the United States, it is critical to demonstrate the effectiveness and efficiency of therapy treatment.  As payers, health care systems and the public question the efficacy and cost effectiveness of rehabilitation, objective documentation is becoming more important.  Therapists must have a more scientific basis for their practice.  Evidence based treatment is indeed best practice.  Referrals are increasingly based on objective, value-based criteria including metric-driven rehabilitation performance, rates of successful home discharges, re-hospitalization rates and patient experience ratings. 

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Topics: Therapy, Medicare Part B, CMS, G-Codes, ARD

Making Sense of New CMS Guidelines for Maintenance Therapy

Posted by The Harmony Team on Wed, Jul 17, 2013

The Jimmo v. Sebelius lawsuit was brought on behalf of a nationwide class of Medicare beneficiaries by six individual Medicare beneficiaries and seven national organizations representing people with chronic conditions. The Jimmo v. Sebelius case challenged Medicare's use of an "Improvement Standard" to make coverage determinations. On January 24, 2013, a settlement was approved by the federal district court of Vermont expanding Medicare Part A and Part B coverage to include the rendering of skilled nursing and therapy services necessary to maintain a person's condition.

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Topics: Legislation, Documentation, Therapy, CMS, Maintenance Therapy

ICD-10 in the SNF - Be Prepared

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Wed, Jun 26, 2013

The implementation date of the ICD-10 transition has been delayed until October 1, 2014.  It is recommended that providers gear up for the transition by taking a look at the ICD-9 codes most commonly used in their facility and problem-solving what ICD-10 code(s) will most likely replace them.

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Topics: CMS, Denial Management

Updates to MDS 3.0; Section G May 2013 - A Few Recommendations

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Sat, Jun 08, 2013

Skilled Nursing Facility providers have been concerned about potential changes to Section G that would change common interpretation of coding instructions in Section G.  The example cited is as follows:  

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Topics: CMS, Denial Management, Medical Record Review

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