Timely updates about the healthcare industry

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.

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.

Avoid postal delays with paperless claims and statements

The U.S. Postal Service is experiencing delays in mail delivery across the country. At the same time, Americans everywhere – especially vulnerable populations, such as elderly people and those living with comorbidities – are being asked to stay home. As a result, many of your patients have very real anxiety over when (or whether) they’ll receive their medications.

According to a recent article from NPR, “Nationally, an Ipsos poll found that 1 in 5 Americans got medication through the mail in the past week, and 1 in 4 of them experienced a delay or nondelivery.”1 And patients aren’t the only ones impacted by lagging deliveries. Commercial and private mail services have been affected, creating concerns for small and medium-sized businesses that rely on mail delivery services.2

If your organization relies on paper claims submissions and patient statements, you could be facing longer A/R days and more work resubmitting lost claims. Likewise, with delivery delays, paper statements and bills may not reach patients in a timely manner, making it more difficult to capture patient payments.

Postmaster General Louis DeJoy has told the U.S. Senate that the Postal Service will not implement any changes in service until after the election.1 This could mean that more delays are on the horizon. Even if you have not yet experienced issues with lost or late mail, upcoming changes to U.S. Postal Service delivery programs may lead to more delivery issues in the coming months.

So, what can you do? Instead of bracing yourself for longer days in A/R, why not take advantage of this time to go paperless? With the right technology, you can:

  • Give patients the option to receive their statements online via email
  • Electronically upload claims attachments
  • Submit claims online instead of by mail

Want to learn more about applications that can help you accelerate A/R and avoid postal delays? Read about ABILITY CHOICE All-Payer Claims and ABILITY EASE All-Payer, or request a demo today.

 

Sources:

  1. “Postal Service Slowdowns Cause Dangerous Delays In Medication Delivery,” Paige Pfleger, NPR, August 25, 2020. Accessed September 10, 2020, https://www.npr.org/sections/health-shots/2020/08/25/905666119/postal-service-slowdowns-cause-dangerous-delays-in-medication-delivery
  2. “Are postal service delays hampering small business?” KTTN News, August 13, 2020. Accessed September 10, 2020, https://www.kttn.com/are-postal-service-delays-hampering-small-business/

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

The PBJ reporting waiver has ended: what you need to know

In a memorandum released on June 25, CMS announced the end of the COVID-19 emergency waiver for staffing data submissions.

Back in March, CMS had granted a series of blanket waivers to lessen administrative burden and allow nursing homes to focus on responding to the COVID-19 threat. Facilities now must resume submission of their staffing data through the payroll-based journal (PBJ) system as required by regulation.

Why it matters

A recent study published in the Journal of the American Geriatrics Society found that facilities with lower nurse staffing levels and lower scores on the Five-Star Quality Rating System before the pandemic had higher rates of COVID-19 infections and deaths. In fact, higher nurse staffing ratios were strongly correlated with fewer cases and deaths.

The authors of the study recommended that nursing home inspections should target facilities with lower RN staffing levels and quality ratings in addition to those located in areas with high infection rates.

On the heels of these findings, CMS made the announcement that nursing homes must recommence submission of their staffing data, stating that “we continue to emphasize the importance of staffing based on its relationship to quality.”

What this means for your facility

Here’s what you need to know about PBJ data submissions for 2020:

  • Staffing data for April-June is due by the usual deadline of August 14
  • You are not required to submit your staffing data for January-March
  • Nursing Home Compare is displaying the staffing star rating based on your October-December 2019 data
  • New Five-Star staffing ratings, based on your April-June data, will post at the end of October 2020
  • Facilities that received an automatic staffing downgrade to one star for the fourth quarter of 2019 will have their measures and rating temporarily suppressed and that one-star staffing rating downgrade removed

How ABILITY can help

While CMS is giving long-term care providers the opportunity to correct and improve their star rating, the agency plans to restart inspections “as soon as possible.” To protect your star ratings and ensure compliance with the PBJ reporting requirements, it is crucial to act soon. This is where ABILITY can help.

ABILITY CAREWATCH PBJ puts the right tools at your fingertips so you can efficiently collect, classify, validate and submit your facility’s direct care staffing data accurately and on-time.

To see firsthand how easy PBJ reporting can be, request a demo today.

 

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

Accountable Care Organizations

Savings from Accountable Care Organizations continue adding up

As Medicare continues its push toward directing 50 percent of reimbursements through alternative payment models (APMs) by 2018, recently released data shows the mounting savings generated by Accountable Care Organizations (ACOs). Last year, ACOs achieved savings of $466 million, according to a report issued by CMS. Read more

Will new star ratings for hospitals be an improvement?

Star ratings are now a way of life in many healthcare settings, but hospitals were recently given a short delay before the implementation of a new star system. Just one day before “overall hospital quality” ratings were set to launch in late April, CMS postponed the rollout in response to requests from Congress and the hospital industry. Read more

Medicare to roll out coverage for diabetes prevention

For the first time, a Medicare pilot program will soon be expanded nationwide without an act of Congress. The expansion, made possible by the Affordable Care Act (ACA), will provide coverage for diabetes prevention programs for seniors, after a multi-year pilot showed savings of more than $2,500 per patient. Read more

How will site-neutral payments impact your SNF?

The prospect of site-neutral reimbursement rates is one step closer, holding out the possibility that SNFs will no longer be paid less than inpatient rehab facilities for providing similar care. Read more

insurance open enrollment

CMS looks ahead to 2017 open enrollment

Healthcare leaders have now had a chance to evaluate the most recent open enrollment period and identify steps for improving next year’s processes. While the general trends show that consumers are getting the hang of using insurance exchanges, advocates continue to push for greater transparency and more features that will make it easier to comparison shop. Read more