Harmony Healthcare Blog

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

MDS 3.0 Basics; Revisiting Section M: Skin Conditions

Posted by The Harmony Team on Fri, Aug 24, 2012

This section, which is rich with information for the care planning team, has significant implications for survey, payment and publicly-reported information. Because of the significant regulatory and legal implications of assessment related to skin, education and training of staff and assurance of competency in skin assessment, including measuring and staging pressure ulcers is a must. The RAI User's Manual reminds us, "(i)t is imperative to determine the etiology of all wounds and lesions, as this will determine and direct the proper treatment and management of the wound."

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Topics: MDS 3.0, Section M, RAI, RAI Manual

Responding Properly to an ARD or RFA Error

Posted by The Harmony Team on Fri, May 18, 2012
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Topics: Medicare Part A, CMS, MDS 3.0, RAI, ARD, RFA

MDS 3.0 and Care Area Assessments; A Decision Facilitator

Posted by The Harmony Team on Wed, Dec 07, 2011

Harmony often receives questions during seminars, calls and emails wondering how to improve the CAA documentation in the SNF.

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Topics: CMS, MDS 3.0, RAI

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

Identification of Therapy Candidates in a SNF

Posted by The Harmony Team on Wed, Jun 02, 2010

Identification of Therapy Candidates in the SNF
Rehabilitation Therapists are integral members of the interdisciplinary team as is their participation in the process of resident assessment to choose an Assessment Reference Date.  The routine therapy screen assists in identifying areas of decline or the potential for improvement, before loss becomes permanent or opportunities for improvement are missed. 
It is appropriate to perform routine therapy screenings.  While quarterly screens are optimal, a screen should be completed no less than annually.  The proactive timing of screens may positively impact resident function; Medicaid reimbursement as well as the Facility Quality Indicators in risk indicators.
Optimal scheduling of routine screens involves completing the screen in conjunction with the OBRA assessment.  It is beneficial to complete the screening process 2 weeks before the scheduled Assessment Reference Date in order to coordinate services as indicated.  This valued intervention is supported in regulations (F406:  §483.45 Specialized Rehabilitative Services). 
It is important to note that an MDS assessment may be done early but never beyond the 92 days allocated.  There is the option of also completing an additional assessment as the RAI Users Manual indicates that Quarterly assessments are to be completed minimally 3 times per year following a comprehensive assessment.
In order to obtain maximum impact for these delivered therapy services, an Assessment Reference Date needs to be planned and set to capture:  At least 150 minutes of therapy per week:  1 therapy  5 days/week or 5 days of therapy across 3 disciplines.

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Topics: CMS, OBRA, Reimbursement, RAI, ARD

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