COVID-19 vaccinations: ABILITY helps providers get paid

Now that COVID-19 vaccinations are available, providers across the care continuum are dealing with the same question: How will I be reimbursed for administering the vaccine?

As you likely know, the COVID-19 vaccinations are being provided at no cost to patients or providers. However, that doesn’t mean that you have to lose money for administering vaccinations. You can bill for that service. But how can you ensure that you enter these claims correctly so you can get paid without spending a lot of time on claims corrections?

Two ways to bill for COVID-19 vaccinations

Providers administering COVID-19 vaccinations are currently eligible for $16.94 reimbursement for a patient’s first shot and $28.39 for their second dose.1 According to CMS’s guidelines, you can bill for vaccine administration in one of two ways:

  1. Single claims
  2. Roster billing

Unlike previous instances in which Medicare covered the cost of patients’ medications, when submitting claims for COVID-19 vaccine administration, you should not include the vaccine codes on the claim (when vaccines are free). Also, Medicare Advantage Plan participants can submit COVID-19 vaccine administration claims to Original Medicare for all of your Medicare Advantage patients in 2020 and 2021.2

While many providers prefer single claims, others may opt to save some time with roster billing. This option allows you to submit multiple claims at once up to a certain number. Roster billing has traditionally been used for flu and pneumococcal vaccines, and CMS has announced it will be available for COVID-19 vaccines, though you will not be able to combine shot codes for different vaccines on a single roster bill.

With traditional roster billing, you can only include 10 patients per roster bill. With providers administering thousands of vaccinations per day, even roster billing can be extremely cumbersome and time-consuming.

Simplify COVID-19 vaccine billing with ABILITY

With ABILITY EASE Medicare, you can centralize and automate the billing process – whether you’re submitting single claims or roster bills. And, with ABILITY EASE All-Payer, you can automate the process for all of your payers, including Medicare and private payers.

Get more information from CMS on billing for COVID-19 vaccine administration here. Then discover how ABILITY can help you streamline the billing process for COVID-19 vaccinations and all your Medicare claims by scheduling a demo today.

 

Sources:

1. “Key Considerations for COVID-19 Vaccine Billing and Coding,” Jacqueline LaPointe, RevCycle Intelligence, December 16, 2020. Accessed January 7, 2021, https://revcycleintelligence.com/news/key-considerations-for-covid-19-vaccine-billing-and-coding

2. “Medicare Billing for COVID-19 Vaccine Shot Administration,” Centers for Medicare & Medicaid Services website, accessed January 5, 2021. https://www.cms.gov/medicare/covid-19/medicare-billing-covid-19-vaccine-shot-administration

 

ABILITY and design®, ABILITY® and ABILITY EASE® are trademarks of ABILITY Network, Inc.

Making sense of the new No Pay RAP

The Centers for Medicare & Medicaid Services (CMS) is taking the final step in eliminating up-front payments for services rendered across the healthcare industry. A new No Pay RAP (Request for Anticipated Payment) policy for home health providers begins January 1, 2021.

While CMS has relaxed the criteria for RAP submission, many home health agencies remain concerned about how to protect their revenue cycle and stay in compliance with the new policy.

8 things to know for 2021

Under the new rule, there will no longer be a payment associated with the RAP, and a late submission penalty has been added.

Because of these changes, CMS has lessened the requirements for submitting the RAP in 2021:

  • There are only two criteria for RAP submission: 1) a written or verbal physician’s order and 2) documentation of an initial visit and admission to home health care
  • A completed OASIS assessment and established plan of care will no longer be required prior to submitting the RAP
  • Only a principal diagnosis code is required on the RAP – secondary diagnoses are optional

The No Pay RAP rules that will impact home health payments for 2021 include:

  • RAP reimbursement will decrease from a 20% split payment to zero
  • Claims without RAPs will not be paid
  • A “non-timely submission payment reduction” for every day the RAP is late when not submitted within five days of the start of care date
  • For 60-day episodes of care, RAPs for both the first and second 30-day periods may be submitted at the same time
  • Any delays in claims submission will push back the payment cycle

How to protect your revenue cycle

While home health providers have come to rely on the split-payment model to keep cash flow stable, it is imperative to adjust billing processes as soon as possible to remain solvent, especially while operating under the Patient-Driven Groupings Model (PDGM).

Here are 5 steps your agency can take to avoid unnecessary payment reductions in 2021:

  1. Ensure the start of care visit is completed and documented as early as possible
  2. Make sure accurate coding is completed expediently
  3. Submit every RAP within five days of the start of care
  4. File claims after the first 30 days of every episode of care
  5. Ensure billing compliance by using claims management software that stays up to date with CMS regulations

ABILITY helps home health agencies achieve a seamless revenue cycle with claims management and analytics technology that aligns with regulatory requirements. Position your organization for revenue success by requesting a demo today.

 

Source: “Penalty for Delayed Request for Anticipated Payment (RAP Submission – Implementation),” MLN Matters 11855, CMS, October 27, 2020, https://www.cms.gov/files/document/MM11855.pdf.

How to Master Webside Skills for Telehealth Success

For many practices, a successful transition from in-person to online care is about much more than finding the right virtual care platform. It’s also critical to consider updated regulations regarding telehealth, patient access to and literacy of technology, and building webside manner skills.

Webside manner” is the technology-conscious approach to meeting with patients online. It’s a new skillset for many healthcare professionals across specialties and organizations – to share their medical knowledge via a computer or phone screen in a way that is simultaneously tech-savvy and mindful of the patient’s experience, while still delivering quality care.

For providers who are looking to get more comfortable practicing in a digital space, we’ve identified the top five tips to master webside manners.

1. Set the scene

It’s best to take all virtual appointments from the same place every day and to make sure the dedicated area is ready for an online meeting.

Take a look at the wall or backdrop behind you. Is there too much art hung up or items on a shelf that could be distracting to your patients? Are there bright colors, big windows or moving objects? Any of these things can take away from your virtual meeting simply by being in the background.

The ideal setting for a telehealth appointment is one where there are no more than a few items visible to the camera other than yourself. This ensures you are the focus, not the art, plants or books behind you.

2. Know your angles

Once you’ve identified the best place in your home or practice to conduct telehealth visits, it’s good to know where to place yourself in relation to the camera.

Too close can be a little awkward or intimidating. You don’t want your face to take up your patients’ entire screen in their view. Too far and you become less of their focus and risk sound quality if the microphone can’t easily pick up your voice.

The best place to be in relation to the camera is centered, about a foot away. Also make sure that you are not backlit; it’s better to have lighting in front of you so that your face and expressions are clear. Avoid backlighting or dim lighting.

3. Take your time

In addition to pre-visit preparations, remember to take your time during each session. Patients are navigating this new setup, too. Those seeking mental health may have heightened levels of anxiety or stress. Elderly patients may need a little coaching on how to work the virtual meeting tool you’re using. Children may have trouble focusing and those who are caregivers for others may have many questions throughout the session.

Everyone is navigating this new setting together. While most patients and their families will be comfortable using the technology, many people may wonder if they’ll receive the same level of care they’ve come to expect. Give each patient your full attention throughout the session, be mindful of their unique needs and make the conversation more than just a medical assessment.

4. Practice and train

If you have a comfortable background, good angles and enough time for each patient, you may just need a bit of practice. Getting better at running a telehealth visit is like any other skill – it improves with repetition.

Once you’re satisfied with your telehealth skillset, share it with others. Take time to walk your scheduler, admin and/or biller through the platform you’re using. Show them the whole process. While some aspects of the visit may be more pertinent to their responsibilities, having a general understanding of your overall telehealth processes will be helpful for everyone in your practice as virtual visits become more widely used.

5. Continue to improve

We understand it can be challenging to be both the care provider and the producer or tech support for telehealth. Even with an easy-to-use virtual care platform, there will be learning opportunities that continue to arise as you, your patients and your staff get more comfortable with telehealth.

As such, your webside skills will evolve. The more you use telehealth and establish simple processes from scheduling to capturing payment for virtual visits, the more confident you’ll be in not just the medical assessment you provide, but in the way which you’re caring for patients.

For support in establishing a successful, stress-free telehealth experience, connect with our team to make your virtual visits the best they can be.

Optimize your workforce with organization-wide visibility

Healthcare facilities have often relied to some degree on traveling nurses and visiting physicians or specialists. Especially in locations where full-time positions aren’t necessary or realistic, from a budget and personnel standpoint, those healthcare professionals will spread their hours across multiple locations.

Widespread healthcare staffing shortages, coupled with the potential for calamities like the pandemic, have no doubt underscored the critical need for traveling healthcare personnel. It has also accentuated the dire need for organizations to have the flexibility to move staff from one floor to another – and one location to another – when the need arises.

Siloed departments impede quick decision-making

The challenge for many healthcare organizations is they don’t operate under one cohesive scheduling system. Different locations use different systems, and in some cases, departments within the same facility adopt different technology or staffing processes.

Scheduling managers are often operating in a vacuum, focused only on their direct reports. If a nurse calls off, it usually means a shift is left under-staffed or other nurses are pushed into overtime to keep patient-to-staff ratios where they need to be. Meanwhile, on another floor within the same hospital, nurses are being sent home early because census is low.

Healthcare leaders may reach out to other departments in emergency situations when severe understaffing and too-high census collide. But that often involves an inefficient process of calling around to see who can send someone to another floor. In the meantime, employees are overwhelmed, and patients are waiting for care.

Leaders need more visibility across the organization

To prevent understaffing, overstaffing and overtime, leaders need more visibility into specific schedules and across locations. That’s true across all levels of the organization, from team leaders to executives. You just can’t get that level of visibility without scheduling applications or software. For example, with SMARTFORCE Scheduler, managers, on a permissions basis, can see who is available to work across multiple locations, whether those locations are in the same building or across the state. With ABILITY, you also get these time- and money-saving benefits:

  • PowerScheduler™. In one screen, managers can view schedules in one-week, two-week, four-week or six-week formats, to see when all staff members are scheduled to work. It provides a simple, complete view that enables quicker, smarter decision-making when it comes to covering open shifts with both home unit staff and staff from other locations.
  • “By Employee” scheduling. Move staff into any department they are qualified for and can access regardless of their location. Units that don’t allow staff to float in can be locked down so only home unit staff will be scheduled.
  • Overtime monitoring. See immediately who is approaching overtime in your specific department. Plus, because overtime and hour commitments are not locked to a single location or unit, you can easily determine the overtime risk of moving staff between locations.
  • Staff collaboration. Using their personal devices, staff can access the schedule, receive communication about open shifts, swap shifts and volunteer for shifts. The application also enables staff to pick up shifts at other locations if they possess the right credentials and qualifications.

At the highest level, ABILITY SMARTFORCE Scheduler enables you to optimize staff across your entire organization, helping to ensure individual units’ needs are met, while reducing the cost of overstaffing and overtime. To see the top mobile scheduling app ABILITY SMARTFORCE Scheduler in action, request a demo now.

 

ABILITY and design®, ABILITY® and ABILITY SMARTFORCE® are trademarks of ABILITY Network, Inc.

Mobile readiness is a must-have for scheduling software

In an environment where the expectation is quickly becoming “anytime, anywhere” access to data, the need for mobility in staff scheduling has never been greater.

For starters, consider the prevalence of smartphone usage: More than 80% of Americans own a smartphone, and they aren’t using it solely to make calls or send text messages. In fact, increasingly people are using their phones as their only means to go online. The World Advertising Research Center (WARC) estimates that globally 51% of people access the internet only via their smartphone. By 2025, the organization expects that number to rise to more than 72%.

In healthcare settings, where nurses typically aren’t seated in front of a computer, communication about schedule changes via smartphone is rapidly becoming the norm. We’ve reached the tipping point where scheduling must be mobile-ready to ensure fast and easy shift management and communication with staff.

When your scheduling software isn’t available as a mobile app, a free mobile option isn’t available with your workforce management solution, or your app simply isn’t that good, you also miss out on these important benefits that you get with ABILITY SMARTFORCE Scheduler:

Broad visibility and intelligence

With a few taps on any device, you and staff can see real-time schedule data across your organization. For example, in the event a staff member calls off, you could in minutes ascertain not only who is available, but who could cover the shift without racking up overtime.

Plus, you can do that regardless of where you and your staff are located, whether that’s when you are running errands or at the bedside of a patient. That type of visibility it critical for making informed decisions to prevent staffing shortages that could impact patient care.

Simplified communication

With a mobile application, you take the guesswork out of connecting with your staff. You don’t have to call or text multiple people, potentially at multiple numbers, to notify your team of schedule changes or shift needs. You simply send one push notification through ABILITY SMARTFORCE Scheduler and everyone receives it at the same time.

The mobile application also enables staff to request time off, volunteer for shifts, swap shifts or make recommendations for covering the shifts.  The collaboration eases leaders’ burden and empowers staff to be part of the solution, which is outstanding for morale. A process that might have taken hours can be reduced to minutes, and you don’t have to worry about communications being missed or overlooked.

Data for prevention

As the old adage goes, the best offense is a good defense. The predictive analytics available through ABILITY SMARTFORCE Scheduler enable you to use data from the past to forecast your future needs and staff more smartly. With features such as our quick-look staffing grid, you can better manager staff-to-patient ratios and prevent under- and over-staffing. And with the Overtime Dollars and Avoidable Overtime reports you can pinpoint costly inefficiencies and reduce your labor costs.

It’s time to go mobile

Not all scheduling software is created equal. For more efficient, accurate and collaborative scheduling, it must meet the mobile needs of you and your staff. 

Plus, add-ons bring even more flexibility and efficiency. Add ABILITY SMARTFORCE Attendance to enable contactless time capture and enable staff to clock in from their personal phones – using geo-location to confirm they’re on site. And approve timecards and track punches from your own device and receive real-time alerts for missed or late punches. Along with our top-rated mobile scheduling and attendance applications, add ABILITY SMARTFORCE Credentialer so you and your staff can organize licenses, certifications and in-services in one secure, intuitive dashboard.

To see the top mobile scheduling app ABILITY SMARTFORCE Scheduler in action, request a demo now.

 

ABILITY and design®, ABILITY® and ABILITY SMARTFORCE® are trademarks of ABILITY Network, Inc.

Secure COVID-19 relief funds for your skilled nursing facility

Has your skilled nursing facility been diligent in tracking infection control and prevention during the COVID-19 pandemic? If so, your facility could be eligible for a portion of the $2 billion in relief funds being distributed by the U.S. Department of Health and Human Services (HHS). Additional details on how SNFs can receive incentive payments were recently released.

Eligibility for incentives

Previously, HHS announced that SNFs would be eligible for incentive payments based on how well they were able to control rates of COVID-19 infections, as well as COVID-19 mortality rates. HHS clarified the requirements last month, stating that facilities had to show that their rates of COVID-19 infections were lower than their counties’ rates of infection. The death rate among residents within the facility who tested positive for COVID-19 also had to be below a national performance threshold for mortality within nursing homes.

Those two measures serve as a “gateway” for participation in the incentive program. Each month, facilities must meet those two criteria to receive incentive payments. Eligible facilities will have their performances evaluated, with infection rates accounting for 80 percent of the incentive payment. Calculations will be made by dividing the facility’s number of non-admission COVID-19 infections by the total number of resident-weeks reported to the National Healthcare Safety Network (NHSN). The mortality rate will be calculated for any facility that reported at least one non-admission COVID-19 infection.

Tracking your facility’s incentive eligibility

How can you track your facility’s COVID-19 infections accurately to help qualify for relief funds? Many SNFs are turning to ABILITY INFECTIONWATCH to carefully track resident symptoms, infections and infection control measures. The application allows you to map infections within your facility and monitor data in real time to keep infection rates lower and maximize protection for residents and staff. ABILITY INFECTIONWATCH also helps administrators pull infection information and track the documentation required by NHSN.

Another application that can help SNFs qualify for COVID-19 incentives is ABILITY CAREWATCH. Facilities using ABILITY CAREWATCH to manage quality and QAPI incentives can more easily manage their Medicare and Medicaid licensing. Current licensing is required to receive incentive payments.

Staying up to date with infection reporting

COVID-19 incentive payments can help skilled nursing facilities like yours invest more in testing and PPE to keep residents and staff safe. Learn more about how ABILITY INFECTIONWATCH and ABILITY CAREWATCH can help your facility qualify for payments.

 

ABILITY and design®, ABILITY®, ABILITY INFECTIONWATCH® and ABILITY CAREWATCH® are trademarks of ABILITY Network, Inc.

CMS audits have restarted: how skilled nursing facilities can prepare

The Centers for Medicare & Medicaid Services (CMS) resumed Recovery Audit Contractor (RAC) and Medicare Administrative Contractor (MAC) medical review audits in August.

Here’s what you need to know and how to prepare your skilled nursing facility in the event of an audit.

RACs and MACs are back

The ongoing COVID-19 public health emergency (PHE) brought considerable changes to healthcare facilities, including a temporary halt to most CMS audits on March 30, 2020. The suspension included prepayment and post-payment medical reviews conducted by MACs and RACs.

In July, CMS announced that it would be resuming medical review activities in August regardless of the status of the PHE. Audit activity ramped back up on August 17, prioritizing post-payment reviews of COVID claims submitted prior to March 1, 2020.

While CMS has not yet announced when the audits on claims submitted after March 1 will begin, they will likely commence in the coming months.

What you need to know

CMS has indicated that audits will be conducted in accordance with existing statutory and regulatory provisions, including related billing and coding requirements. However, any waivers or flexibilities that were allowed for any date of service under review will be applied in the audit.

Keep in mind that the rules changed rapidly at the onset of the PHE, which may increase the chances of audit errors as well as misapplication of rules and regulations.

If auditors are unable to make a determination on prepayment or post-payment claims review based on the information that’s been provided, they will issue an additional documentation request (ADR) to solicit supporting documentation.

While RAC and MAC audits historically have been done in person, CMS has expanded desk reviews during the pandemic. Although a remote audit may potentially be less burdensome on your organization, it will still be crucial to be organized and prepared.

Tips for audit response

CMS recognizes that many skilled nursing facilities have limited staffing and resources to respond to audits during this time. If your facility is selected for medical review, there are several actions you can take to facilitate the process.

  • Identify someone to manage the ADR and denial process
  • Promptly respond to every overpayment and audit letter (ADR)
  • Contact your auditor to discuss any COVID-19 related hardships you may be experiencing that could impact audit response timeliness
  • Avoid returning any overpayment before confirming and accepting the audit findings
  • Only send the specific information in the ADR to expedite the process
  • Make sure all documentation is legible and supports MDS coding and the UB-04

Boost audit success

Audits are disruptive even during the best of times. It’s more critical than ever to have an efficient and effective process in place to not only respond to an audit in a timely manner, but to also help you avoid one in the first place.

ABILITY CAREWATCH and ABILITY UBWATCH can help you get ahead of an audit request and potentially minimize the risk of an audit by ensuring accuracy between the MDS and UB-04. Data analytics and real-time reports give you access to:

  • Medicare roster
  • RUG 66 Watch page
  • Built-in Triple Check
  • Quality pages
  • And more!

There’s no time to waste! Get a first-hand view of how to use these applications to boost your audit response by requesting a demo today.

 

Sources:

“Coronavirus waivers & flexibilities,” CMS, accessed October 9, 2020, https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers.

“MACs Resume Medical Review on a Post-Payment Basis,” MLN Connect eNews, CMS, August 6, 2020, https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-08-06-mlnc#_Toc47449031.

“CMS Announces Resumption of Routine Inspections of All Provider and Suppliers, Issues Updated Enforcement Guidance to States, and Posts Toolkit to Assist Nursing Homes,” CMS, August 17, 2020, https://www.cms.gov/newsroom/press-releases/cms-announces-resumption-routine-inspections-all-provider-and-suppliers-issues-updated-enforcement.

 

ABILITY and design®, ABILITY®, CAREWATCH® and UBWATCH® are trademarks of ABILITY Network, Inc.

Simplify your claims management

When it comes to claims management, nothing is more exhausting and labor-intensive than jumping between portals to gather information and cross-reference the data you need. Healthcare providers with disparate systems report bigger issues with denials than those using one revenue cycle management solution.1 The ongoing back-and-forth from one vendor platform to another is where manual errors are often introduced, slowing your revenue cycle with denials and additional research. Reports show that having multiple vendors makes it more challenging to identify billing errors or keep up with data variances.2

Plus, if your claims management also involves tools from a vendor whose software lacks integration, you’re probably experiencing fragmentation that can be avoided.

As an ABILITY customer, you know the value of an application that automates your work and adds convenience with a single sign-on for all team members. Imagine replicating that efficiency across your entire claims management process, whether you’re focusing on reimbursement from Medicare or pursuing revenue from private insurers.

How to simplify your processes for better results

Eliminating disjointed platforms not only removes frustration for you and your team, but it also saves money through increased efficiency. With integrated applications for eligibility, claims processing, remits, audits and additional documentation requests (ADRs), you can truly streamline your data and workflow from end to end.

Although integrated software remains a goal for some vendors, ABILITY has a long track record of delivering this technology. Our end-to-end applications work together seamlessly, allowing healthcare providers to easily connect directly with all their payers – from private insurance companies to Medicare – to collect payment quickly and efficiently.

Discover how consolidating to a single platform can help you save labor, accelerate revenue and take control of your processes.

 

1. HIMSS RCM Survey: Understanding Health Systems’ Revenue Cycle Management and Challenges, Dimensional Insight, May 8, 2018, https://www.dimins.com/white-papers/himss-rcm-survey/

2. “Want to reduce denials? Slim down your RCM solutions” Samantha Meyer, Becker’s Hospital CFO Report, July 12, 2018, https://www.beckershospitalreview.com/finance/want-to-reduce-denials-slim-down-your-rcm-solutions.html#link_tab

ABILITY and design®, ABILITY® and ABILITY EASE® are trademarks of ABILITY Network, Inc.

All claims management isn’t created equal: what you should know

Jarred by a once-in-a-century global pandemic, market volatility and other challenges, 2020 will almost certainly be remembered for widespread uncertainty. Healthcare providers navigating this environment may have the additional burden of outdated or underperforming claims management solutions that contribute to rework and high denial rates.

Unplanned changes can take a heavy toll on organizations struggling to make ends meet, particularly as budgets are strained by increased spending on PPE and other supplies. Faced with so much turmoil, the last thing you need is disruption to your revenue. Adding to the uncertainty is consolidation among software vendors, which may cause disruption and lead many healthcare providers to re-evaluate partnerships.

Is it time to reconsider?

When comparing your current claims management platform to other options, several questions should be top of mind:

  • Is your relationship with your software vendor meeting your needs?
  • Do you have to alter your workflows to accommodate for limited software capability?
  • Are your rejections and denials increasing or improving?

ABILITY’s single sign-on platform trusted for 20 years

As you research the topic, look for technology that enables one stop for smoothly handling claims for Medicare and Medicaid, as well as all private insurers. With ABILITY, your entire team can enjoy single sign-on efficiency and the convenience of integrated applications. Our all-payer claims platform works directly with Medicare to provide real-time data at your fingertips.

You’re not alone with the issues you’re facing. Remember, 2020 has been challenging for healthcare providers of all sizes and in all locations. For two decades, ABILITY has helped organizations like yours simplify administrative complexities through easy-to-use applications and data analytics. Discover how you can save labor, accelerate revenue and take control of your billing with a single platform.

 

ABILITY and design® and ABILITY® are trademarks of ABILITY Network, Inc.

How to prepare for the impact of MDS 3.0 for FY 2021

The Centers for Medicare & Medicaid Services (CMS) was set to release the Minimum Data Set (MDS) 3.0 version 1.18.1 on October 1, 2020. However, the COVID-19 public health emergency upended that plan.

Prior to the pandemic, CMS intended to eliminate Section G along with making some changes to other sections of the MDS. Then in March, as part of the blanket 1135 waiver, the regulatory agency delayed the release of the planned version of the MDS to give skilled nursing facilities more flexibility in their response to COVID-19.

With a new scaled-down MDS 3.0 going into effect on October 1, it’s crucial for facilities to understand the impact of the changes and take the necessary steps to manage Medicaid revenue for FY 2021.

Understanding the impact

The interim MDS 3.0 version 1.17.2 is designed to facilitate the calculation of Patient Driven Payment Model (PDPM) payments on all Omnibus Budget Reconciliation Act (OBRA) assessments.

Each state has the option of requiring PDPM data on OBRA comprehensive and quarterly assessments. New item sets include section GG, item I0020B ICD-10 for the primary medical condition and J2100 recent surgery requiring active SNF care.

The key takeaway here is knowing where your state has landed regarding the collection of PDPM data on the OBRA assessments, and if you will be required to complete an Optional State Assessment (OSA).

Tips for success

First and foremost, there’s no need to panic. While your state may require PDPM data beginning October 1, your payments on that data will not be affected. Keep in mind that the purpose of these changes is to inform future Medicaid models.

Here are several steps your facility can take to adapt to the new MDS for FY 2021:

  • Contact the RAI Coordinator for your state to find out the new requirements
  • Educate your team on how to accurately code for the new section and items on MDS version 1.17.2
  • Make sure your Electronic Health Record (EHR) is updated to align with the October 1 changes
  • Implement a robust process for collecting PDPM data across all payers

How ABILITY can help

ABILITY CAREWATCH equips you with software tools that will enable your facility to be ready for any quality management changes coming its way. With updated logics, you can create real-time reports to closely monitor quality and revenue and comply with state and federal requirements.

Specific to MDS 3.0, you’ll have access to:

  • An MDS Detail Report and ADL Report to improve data accuracy on Sections GG and J
  • Diagnosis Watch and PDPM tools to help manage Section I and boost reimbursement
  • Restorative Watch to improve resident outcomes via a robust restorative nursing program

Discover firsthand how to put this application to work for your facility by requesting a demo today.

 

“MDS 3.0 Technical Information,” CMS, accessed September 21, 2020, https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIMDS30TechnicalInformation

ABILITY and design®, ABILITY® and CAREWATCH® are trademarks of ABILITY Network, Inc.