Harmony Healthcare Blog

How to Manage the COT OMRA

Posted by The Harmony Team on Fri, Oct 14, 2011

Effective October 1st, a COT OMRA will be required for patients classified into a RUG-IV therapy category whenever the intensity of therapy changes to such a degree it no longer reflects the RUG-IV classification and payment assigned based on the most recent assessment used for Medicare payment.  CMS stresses that SNFs would be required to complete a COT OMRA only if the intensity of therapy changes to such an extent that the patient's RUG classification, based on their last PPS assessment, is no longer an accurate representation of the patient's current clinical condition.  This change in the therapy intensity may be due to scheduled changes or unscheduled changes.  The COT is indicated when the different RUG category is higher or lower than the RUG category in which the resident is currently placed.

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SNF PPS Final Rule FY2012: Strategies For The Transition

Posted by The Harmony Team on Tue, Sep 13, 2011


The SNF PPS FY2012 Final Rule (76 FR 48486) outlined several policy changes in the SNF PPS effective for FY 2012.  These changes include:  a revised MDS assessment schedule, the Change of Therapy (COT) Other Medicare Required Assessment (OMRA), a resumption of therapy option for the End-of-Therapy OMRA, the allocation of group therapy time, and a revised student supervision policy.  CMS has posted a transition document for implementation of these changes scheduled for October 1, 2011.

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Topics: Final Rule, SNF, MDS 3.0, MDS, OMRA, PPS

MDS 3.0 RAI Manual Changes

Posted by The Harmony Team on Fri, Sep 09, 2011

The Resident Assessment Instrument (RAI) User's Manual has been updated to reflect changes that take effect on October 1, 2011, the manual version is 1.07 (V1.07). Providers should take extra care to ensure that materials used after October 1st reflect this version of the RAI. Several chapters and appendices include only minor changes and edits however there are several significant changes that providers should make note of. Harmony has outlined some significant updates from Chapter 2 below and encourages clients to contact either their Harmony Consultant or the Corporate Office with any questions, including those regarding how to operationalize the changes.

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Topics: CMS, MDS 3.0, RAI, RAI Manual, PPS, ARD

MDS 3.0, PPS rate adjustments, What is the Focus for Fiscal Year 2012

Posted by The Harmony Team on Fri, Aug 26, 2011

Looking for ways to off set the PPS rate adjustment? Take a look at the nursing RUG scores generated each month. Does the RUG mix include "2" scores for nursing? Some studies have revealed that up to 25% of the elderly in nursing home suffer from depression. The RAI process now includes the PHQ-9© designed to identify mood disorders and allow SNF staff to investigate individualized treatment approaches. Once identified on the MDS, the Special Care High, Special Care Low, and Clinically Complex RUG groups are all affected by the PHQ-9© -driven end-split.

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Topics: MDS 3.0, RAI, PPS

SNF PPS FY 2012; Final Rule Considerations and Preparations

Posted by The Harmony Team on Fri, Aug 12, 2011

SNF Leaders do not have a long lead time between July 27 and October 1 when SNF PPS changes posted in the Final Rule go into effect.  The next two months will be filled with reading and re-reading the SNF PPS Final Rule, working on assimilating and interpreting the planned changes as well as participating in the CMS ODFs and web education to confirm each facet of this complex reimbursement program. Language in the Final Rule regarding MDS 3.0 guidance, billing allowances and documentation requirements can easily be misinterpreted.

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Topics: Final Rule, SNF, CMS, MDS, PPS

CMS Posts SNF Final Rule FY 2012

Posted by The Harmony Team on Mon, Aug 08, 2011

In time to meet the July 31 deadline, CMS posted the Final Rule for The Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2012. The Press has taken hold of one aspect of this Rule and has been reporting overall estimated payments for SNFs in FY 2012 are projected to decrease by $3.87 billion, or 11.1 percent, compared with those in FY 2011. This reflects a $600 million increase from the update to the payment rates and a $4.47 billion reduction from the recalibration of the case-mix adjustment. CMS estimates that under RUG-IV, SNFs in urban areas would experience, on average, an 11.3 percent decrease. In the Final Rule CMS points out that the FY 2012 payment rates are still 3.4 percent higher than the FY 2010 rates.  Additionally, CMS strongly states "We do not believe that the recalibration constitutes a rate cut but instead represents a return to the appropriate level of SNF payments, which have been found to be more than adequate for SNFs and small entities within the SNF industry." CMS continues  "It is also important to note that this recalibration would serve to remove an unintended spike in payments rather than decreasing an otherwise appropriate payment amount; thus, we do not believe that the recalibration should negatively affect facilities, beneficiaries, or quality of care, or create an undue hardship on providers."

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Topics: Final Rule, CMS, MDS 3.0, PPS

The Final Rule on PPS

Posted by The Harmony Team on Fri, Aug 05, 2011

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Topics: Final Rule, Medicare, MDS 3.0, PPS, ARD

Harmony to offer AANAC Medicare University

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Fri, Jun 03, 2011

Harmony Healthcare International is excited to offer AANAC’s Medicare University. This class has been designed to enable the clinicians or other SNF staff to proactively manage the complex, ever-changing rules of Medicare. Below are just a few of outcomes that attendees can expect from the class:

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Topics: Medicare, AANAC, PPS

CMS Posts Proposed Changes to SNF PPS FY 2012

Posted by The Harmony Team on Mon, May 16, 2011

On April 28, 2011 CMS released  the Proposed Rule for updates to the SNF PPS system for FY 2012.  CMS has a 60 day comment period currently underway regarding these proposed changes.  The deadline to file a comment is June 27, 2011.  Harmony encourages SNF management and staff to read through the proposed changes and submit comments  addressing support or appeal for negating the changes.  The complete document can be accessed at the following link:

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Topics: Medicare, CMS, MDS, OMRA, PPS

AANAC MDS Certification Program

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Wed, Jun 02, 2010


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Topics: OBRA, MDS, AANAC, PPS, Quality Measures, Quality Indicators

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