Harmony Healthcare Blog

Medicare Part A PPS Discharge MDS Assessment

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Thu, Dec 01, 2016


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

Effective October 1st, Medicare requires a Medicare Part A PPS Discharge Assessment. This MDS contains the required data elements used to calculate current and future Skilled Nursing Facility Quality Reporting Program (SNF QRP) quality measures under the IMPACT Act. The IMPACT Act directs the Secretary to specify quality measures on which post-acute care (PAC) providers (which includes SNFs) are required to submit standardized patient assessment data. Section 1899B(2)(b)(1)(A)(B) of the Act delineates that patient assessment data must be submitted with respect to a resident’s admission to and discharge from a Medicare Part A Assessment.

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Topics: Medicare Part A, PPS, Discharge Assessment

Transitioning Rehab Services from Medicare Part A to Part B in the SNF

Posted by The Harmony Team on Mon, Jul 20, 2015

A higher level of scrutiny regarding the content of therapy documentation has been  noted  in the published findings of government funded auditing agencies. Harmony (HHI) has assisted numerous facilities in the audit process and has identified trends in risk areas as well as frequent denial reasons through analysis of government agency audit findings. An area requiring serious attention by SNF Administrators and Rehabilitation managers is documentation in the medical record supporting the patient’s medical necessity for Part B Rehabilitation services.

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Topics: Medicare Part A, Medicare Part B, Rehabilitation

Why We Love the Discharge Process (And so should you!)

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Thu, May 29, 2014

To maintain a viable Medicare program in the skilled nursing facility setting, leadership must analyze the admission and discharge process for the Medicare Part A beneficiary. Case management by the Rehabilitation professional is one of the primary factors affecting clinically appropriate stay.  Additionally, the Medicare team in the facility must have a standard procedure for handling patients who are admitted with the expectation of returning home after a brief period for Rehabilitation.  The discharge process begins once the patient crosses the threshold of the facility.

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Topics: Medicare Part A, Discharge Planning, Care Planning

Nurses Rule the World

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Sun, Aug 11, 2013

For those of you that have heard me speak about Medicare, Therapy, Case Mix, MDS, PPS or simply my four daughters, there probably has never been a session that I do not utter my favorite words that “Nurses Rule the World!”  Being intimately familiar with the day-to-day tasks (or should I say night-to-night tasks, as well) of patient care, medication administration, documentation, physician interactions, family discussions, caregiver communication, and so on, only one in the healthcare field sees the heart, sweat and tears this profession renders to their patient caseload.  Too often, the value of the nursing profession is taken for granted, especially when they do their job well.  Frequently, the field underestimates the complexity and finesse required to successfully care for the geriatric patient.

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Topics: Medicare Part A, Skilled Therapy, Skilled Nursing Documentation, Skilled Nursing Facility

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

End of Therapy (EOT) and Medicare Part A

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Wed, Dec 05, 2012

Today, we are talking about the End of Therapy OMRA. There are a couple of reasons that you would need to complete the end of therapy OMRA. One reason is when therapy services are being discontinued and the patient is going to continue to be skilled under their Medicare Part A benefit for nursing. Another reason is when there is a break in the provision of therapy services for three more consecutive days. Harmony Consultants discuss during site visits how to prevent an End of Therapy OMRA so that you can maintain your Medicare Part A revenue stream and not have an interruption in your care planning or treatment planning efforts. One of the strategies that we discuss is looking to the appointments that are scheduled for the patient, planning around those appointments or trying to schedule appointments maybe later in the afternoon so therapy can deliver service, especially when the patient is being transferred out of the building for particular appointments. Another instance you can look at is what are the activities for the day if you know a patient is going to be interested in attending a religious activity within the facility then maybe analyzing your hours of operation for therapy. Consider visits provided very early in the morning to patients or have therapists deliver treatments in the evening after the patient has had a full day of their therapy as well as visits and they may be more tired. This way the therapist can assess how the patient performs in the evening especially when the patient is going to be transferred home. This is a valuable assessment during a time when patients are most vulnerable for falls.

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Topics: Medicare Part A, OMRA, Care Planning

COT OMRA: What to Consider?

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Wed, Sep 12, 2012

Today I want to talk about the Change of Therapy (COT) Other Medicare Required Assessment (OMRA).  There are a couple of major points that should be kept in mind when considering whether COT OMRA needs to be completed.  For one, how do we manage our therapy case load to prevent continually needing to complete an off schedule assessment for our PPS or our Medicare Part A patients?  Always remember the COT OMRA is generated because there needs to be a change in the level of payment. This is due to the level of therapy intensity that is being provided.  So, if you have a PPS Assessment and it generates a nursing RUG classification, a nursing RUG score is being paid for a particular PPS Assessment.  If Therapy is involved, you are monitoring your COT Assessment Reference Dates, and the change in therapy intensity decreases, you do not need to complete a COT OMRA (if you are being paid at nursing RUG level).  Many times it is forgotten that this is both clinically related as well as payment related.

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Topics: Medicare Part A, RUG, PPS, ARD, Change of Therapy

Beneficiary Review Meeting: Medicare Part A Skilling and MORE!

Posted by The Harmony Team on Wed, Jul 11, 2012

Today we will be discussing the Medicare meeting, otherwise known as the beneficiary review meeting.  This meeting is set up so that the interdisciplinary team can discuss the clinical status of a patient and whether that patient continues to meet the criteria for skilling under their Medicare Part A benefit.  This meeting provides an opportune time to review the Medicare Part B beneficiaries or your managed care patients during this meeting.  The goal of the meeting is not to focus on when the patient is going to be discharged.   This is not a discharge planning meeting, the meeting is designed to review what the skilling criteria or the needs on a daily basis of the patient from nursing and from therapy. HHI recommends that the entire interdisciplinary team attend this meeting and that each member of the team be aware of what they are going to be reporting on during the meeting.  For example, the business office would be discussing how many days the patient has used in their benefit period or how many days the patient has left.  MDS may be discussing what the potential selected ARD date is.  As well, MDS may discuss ADL assistance provided to the patient to make sure that team members are in agreement with the level of assistance provided to assure levels are accurately reflected on the MDS.  Nursing should be talking about why the patient requires daily skilled care and therapy should talk about the patient’s status in relationship to their ability to continue to provide daily skilled care to the patient.  Again, this meeting is so that the team can assure that the facility is accurately utilizing the patient’s  Medicare Part A benefit.

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Topics: Medicare Part A, Medicare Part B, ADL, MDS, ARD

Optimizing Medicare Part A Length of Stay with Discharge Planning

Posted by The Harmony Team on Thu, Jun 14, 2012
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Topics: Medicare Part A, LOS, Length of Stay, Discharge Planning, Medicare Length of Stay

Encoding Period and the MDS. The Importance of a Triple Check System

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Wed, May 30, 2012
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Topics: Medicare Part A, MDS 3.0, Reimbursement, PPS, Quality Measures, Care Planning

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