Harmony Healthcare Blog

Long-Term Care Regulations & Policy in the Face of Health Care Reform: 2015 and Beyond

Posted by The Harmony Team on Mon, Dec 29, 2014

There’s no doubt that 2014 introduced a number of substantial regulatory and policy changes to the long-term care industry, many of which are an evolution of what’s to come under the Affordable Care Act.  Health care reform initiatives will undoubtedly continue to drive sweeping changes to providers across the care continuum, particularly as it relates to improving the patient experience, improving health of populations and reducing the cost of health care (otherwise known as “The Triple Aim”).  

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Topics: MDS Coding, F-Tags, Health Care Reform, Survey, Long-term Care Regulations, Affordable Care Act

An Introduction to ICD-10

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Thu, Dec 04, 2014

With the upcoming transition date of October 1, 2015 from ICD-9 to ICD-10 quickly approaching, it is important to note the coding changes from ICD-9 to ICD-10.  Specific areas of this transition will impact skilled nursing facilities and the coding of both the short and long term population in the facility.

ICD-9 has been utilized for over 30 years for a number of uses in the American Healthcare system.  These uses include reimbursement, payer contracts and coverage determinations, assessment of provider performance with disease management, and monitoring utilization patterns.  It has also been utilized for providing criteria for inpatient care vs. outpatient services, tracking the severity of illness data including mortality and complications, as well as public health tracking
and reporting.

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Topics: ICD 9 Coding, MDS Coding, ICD-10, ICD-9

Medicare Advantage Organization HIPPS Codes Update

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Mon, Jul 07, 2014

Clarification is in order. Originally, when billing for all Medicare Advantage Organizations (MAO), PACE Organizations, Cost Plans, and certain demonstration projects, providers were originally told by CMS that they must provide Health Insurance Prospective Payment System (HIPPS) Codes for Skilled Nursing Facility (SNF) claims submitted effective July 1, 2014. This left Skilled Nursing Facility providers concerned that they would then be required to follow the traditional Medicare PPS schedule in order to accurately provide HIPPS codes for billing.  On May 23, 2014, CMS released a memo regarding Submission of Health Insurance Prospective Payment System (HIPPS) Codes to the Encounter Data System to all MAO providers clarifying the requirements.

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Topics: CMS, Managed Care, MDS Coding

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