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.

Study shows disconnect between CMS infection control surveys and COVID outbreaks

A recent study of data from the Centers for Medicare & Medicaid Services (CMS) by the Center for Medicare Advocacy (CMA) has shown a disconnect between the results of CMS infection control surveys and outbreaks of COVID-19 within skilled nursing facilities.

Infection control citations

In mid-March, CMS announced that inspections would focus on infection control programs – in addition to cases of immediate resident danger – to help suppress the spread of COVID-19 within SNFs. A review of CMS inspection data by CMA showed that a very small portion of infection control surveys resulted in citations. Out of 5,724 infection control surveys performed from the March announcement through June 24, only 99 resulted in citations.1

Of the citations, 93 were marked as having minimal harm or potential for minimal harm, and three were marked as having a potential for minimal harm. The remaining three were marked as putting residents’ health and safety in immediate jeopardy. Thirty-five of the citations resulted in fines.

The disconnect between citations and infections

The concern raised by CMA has been raised by officials in many states, as well as by families of afflicted nursing home residents: With the high rate of COVID-19 cases in nursing homes, the low amount of citations – which translates to 2.4 percent of surveys – seems “implausible,” according to CMA officials. Through the end of June, more than 40 percent of COVID-19 deaths in the United States were related to skilled nursing facilities.2

The CMA’s review showed that several of the CMS infection control surveys that did not result in citations took place even as SNFs were in the middle of COVID-19 outbreaks. Three days after a passing survey at one California facility, there were 68 diagnosed COVID-19 cases documented. The staff refused to return to work over concerns for their safety, and members of the California National Guard were deployed to care for residents.3

Those eyeing the survey results give different causes for the disconnect between passing surveys and COVID-19 infections. Some say SNFs lacked access to the personal protective equipment needed to keep staff and residents safe. Others called out a lack of regular testing among residents and staff. One CMS administrator said the disparity between survey results and infection rates likely shows that SNF staff demonstrated compliance during surveys but failed to follow protocols when they were not under scrutiny.

Maintaining infection control programs

Amidst the COVID-19 pandemic, maintaining infection control protocol has become more important than ever in keeping residents and staff safe. The number of SNF deaths due to the pandemic and the results of the CMA’s data review could lead to further scrutiny of infection control programs or more stringent infection control program requirements.

SNFs can stay on top of regulations, infection control protocol and patient data with ABILITY INFECTIONWATCH. The application allows for easy tracking of McGeer criteria, infection reports and infection control measures. SNFs can tighten their vigilance against infections by customizing infection thresholds; when those thresholds are reached, an alert appears on the ABILITY INFECTIONWATCH dashboard so staff won’t miss the signs of an outbreak.

 

Sources:

1. “Special Report Additional Infection Control Surveys at Nursing Facilities Show Same Results: Few Deficiencies, Most Called ‘No Harm’; Poor Ratings on Nursing Home Compare,” Miriam Edelman, July 9, 2020, https://medicareadvocacy.org/wp-content/uploads/2020/07/Report-Coronavirus-Infection-Controls-Second-Batch-.pdf?emci=0f6236c7-f5c1-ea11-9b05-00155d03bda0&emdi=526f3f5a-0dc2-ea11-9b05-00155d03bda0&ceid=7801066.

2 “More than 40 Percent of U.S. Coronavirus Deaths are to Nursing Homes,” The New York Times, July 23, 2020, https://www.nytimes.com/interactive/2020/us/coronavirus-nursing-homes.html.

3 “As Coronavirus Raged Through Nursing Homes, Inspectors Found Nothing Wrong,” Jack Dolan & Brittny Mejia, June 28, 2020, https://www.latimes.com/california/story/2020-06-28/coronavirus-nursing-homes-state-inspector-covid-19.

 

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

CMS issues millions in infection control penalties to SNFs

The Centers for Medicare & Medicaid Services (CMS) has imposed more than $15 million in penalties on 3,400 skilled nursing facilities for failure to comply with infection control regulations in the midst of the COVID-19 pandemic. The announcement of the penalties comes with a warning to SNFs to stay vigilant in monitoring their infection control programs.

“Now more than ever, nursing homes must be vigilant in adhering to federal guidelines related to infection control to prevent the spread of infection disease, including COVID-19,” said CMS Administrator Seema Verma. “We will continue to hold nursing homes accountable and work with state and local leaders to protect the vulnerable population residing in America’s nursing homes.”1

Avoid CMS penalties

ABILITY INFECTIONWATCH can help your facility avoid costly CMS penalties with better infection control monitoring. This valuable application makes it easier for your facility to meet all CMS Requirements of Participation, and it allows you to quickly pull reports to meet the requests of surveyors. Using built-in national infection criteria, infection control administrators align facility data with reporting requirements consistently and efficiently.

Accurately track symptoms and infections

As COVID-19 continues to spread throughout the U.S., ABILITY INFECTIONWATCH helps you to protect against outbreaks utilizing your facility’s data. Monitor symptoms, track and report infections, oversee facility visitors and identify the sources of infections through the application. The convenient dashboard allows you to customize alerts so you are notified when your preset data points are reached.

Protect your facility

COVID-19 poses a real danger to SNF residents and staff. And never before have facilities been placed under such scrutiny. ABILITY INFECTIONWATCH provides the tools you need to protect your facility from a coronavirus outbreak. It also allows you to track, access and report the data required by CMS to reduce the risk of survey deficiencies and costly penalties.

Protect your facility from a potential outbreak – and potential financial penalties. Learn more about ABILITY INFECTIONWATCH now.

 

1. “Trump Administration Has Issued More Than $15 Million in Fines to Nursing Homes During COVID-19 Pandemic,” Centers for Medicare & Medicaid Services, August 14, 2020, https://www.cms.gov/newsroom/press-releases/trump-administration-has-issued-more-15-million-fines-nursing-homes-during-covid-19-pandemic

 

ABILITY and design®, ABILITY® and ABILITY INFECTIONWATCH® 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.

Three tips for better nurse engagement that drives quality care

Nurses are the heart of every healthcare organization. Not only are they passionate about providing expert care, they are also educators, counselors and their patients’ strongest advocates.

While caring for nursing home residents can be rewarding, it is also quite challenging. Working long demanding shifts in a high-stress environment can lead to burnout and high turnover, which can quickly result in sub-optimal care and increased medical errors. In fact, a research report from the University of California San Francisco found that the median turnover rate for nurses at long-term care facilities is 44%, which is significantly higher than the average for the healthcare industry.

Nursing engagement is key to preventing complications and reducing medical errors and mortality rates, according to research by Gallup. Engaged nurses are more responsive to their residents’ needs, more efficient and effective when providing care and less likely to experience burnout or leave their place of employment.

So how can your skilled nursing facility improve nursing engagement? Here are three tips:

1. Encourage and value nursing input

Include and involve nurses throughout improvement initiatives and allow them to be active participants in decision making that impacts the organization, patient care and their nursing role. Nurses will be more engaged if they know their input matters.

2. Ensure accessibility and responsiveness

Nurses need to know they have a committed leadership team behind them. Take steps to make leaders accessible to nurses and responsive to their needs. This builds a trusting relationship, which will drive greater levels of engagement and commitment to your organization.

3. Recognize nursing contributions

Honest and meaningful recognition of a job well done increases loyalty and engagement. Find ways to recognize the many contributions nurses make to their residents and your facility.

Whether done in a public forum or through personal, one-on-one communication, showing appreciation improves nursing morale and instills a sense of pride.

Want to learn more? Discover how ABILITY CAREWATCH can keep your nursing team on the right track with quality initiatives.

 

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

Skilled nursing facilities to receive break on reporting staffing data

The Centers for Medicare & Medicaid Services (CMS) has extended timeline requirements for reporting direct staffing data in skilled nursing facilities. The extension is part of a series of blanket waivers to CMS requirements that is designed to relieve bureaucratic stress on SNF staff as they implement infection control programs to combat the COVID-19 outbreak and protect residents.

Under CMS regulations, skilled nursing facilities are normally required to report information on direct staff – anyone responsible for the hands-on care of residents – to the CMS in a uniform format at least quarterly. The waiver applies to data pulled and submitted electronically to CMS through the Payroll-Based Journal (PBJ) system.

The reporting requirements whose timelines are being waived include:

  • The work category for each direct-care staff member
  • Resident census data
  • Staff tenure and turnover
  • The number of care hours performed by each staff member per day
  • Designation of direct-care staff as facility employee, agency worker or independent contractor

Skilled nursing facilities that are overwhelmed by their response to COVID-19 infection or prevention do not have to submit paperwork to take advantaged of the relaxed timeline for reporting direct staffing data. Because the timeline extension was part of a blanket waiver by the agency, it automatically goes into effect for all skilled nursing facilities. The measure, which was announced on April 24, is good for 60 days. That timeframe could be extended based on the ongoing impact of the COVID-19 pandemic.

The extended deadlines for reporting staffing numbers do not apply to data that was due to CMS for its April reports. That data should have been collected before a public health emergency was declared on Jan. 31.

The timeline extension was part of a large series of blanket waivers issued by CMS to help skilled nursing facilities better address and cope with the COVID-19 crisis.

 

Source:

Director, CMS Quality Safety & Oversight Group, April 24, 2020,  memorandum to State Survey Agency Directors. https://www.cms.gov/files/document/qso-20-28-nh.pdf

 

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

CMS temporarily lifts MDS reporting timeline

Skilled nursing facilities will see the timeline requirements for reporting the Minimum Data Set (MDS) to the Centers for Medicare & Medicaid Services (CMS) extended as they work to keep residents safe during the COVID-19 pandemic. CMS announced at the end of April that it would provide a blanket waiver for MDS reporting timeline so facilities could focus their energy on infection control programs that could help slow the spread of COVID-19.

The timeline waiver applies specifically to regulations listed under 42 CFR 483.20. The MDS data under that code documents and monitors residents’ conditions by assessing cognitive patters, vision, communication, mood and behavior, psychological and social health, physical function, continence, diagnoses and condition, medication, treatments and procedures, activity and discharge planning.

Some of screenings affected by the timeline waiver include:

  • Pre-admission Level 1 and Level 2 screenings, which are typically required within the first 14 days of admittance
  • Quarterly review assessments, which are required at least once every three months
  • Annual assessments, which are required at least once every 12 months
  • Assessments that mark significant changes in a patient’s condition within 14 days of those changes

Under normal circumstances, all MDS data collected during resident assessments must be encoded within seven days and reported to CMS within 14 days.

Because the waivers were a blanket order issued by CMS, skilled nursing facilities do not have to file any additional paperwork if they will be delaying the reporting of the eligible MDS. The waiver does not apply to MDS required for CMS’s April 29 reports, as that data would have been collected before a public health emergency was declared on Jan. 31. The blanket waiver is in effect for 60 days, though there is a potential to extend the waiver.

 

Source:

Director, CMS Quality Safety & Oversight Group, April 24, 2020,  memorandum to State Survey Agency Directors. https://www.cms.gov/files/document/qso-20-28-nh.pdf

 

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

CMS waives hospitalization requirement for SNF patients

The Centers for Medicare & Medicaid Services (CMS) has announced it will waive several requirements for SNF residents impacted by COVID-19. The measures, which were announced at the end of April, are intended to help facilities adapt quickly to accommodate residents – and to help ensure residents are eligible for needed benefits – in light of the COVID-19 pandemic.

Some of the waivers related to SNF patients include:

Hospitalization requirements

With the blanket waiver, patients will be eligible for CMS coverage without the usual prerequisite of three days of prior hospitalization if they have been displaced or been affected by COVID-19.

Renewal of benefits

The provision also allows residents who have exhausted their long-term care benefits to renew their SNF benefits without having to begin a new benefit period if they were prevented from completing and renewing their previous benefits due to the coronavirus crisis. To be eligible, their benefits must have been renewable under normal circumstances.

Pre-admission screening and annual reviews

With the waivers, SNFs will be able to admit patients who have not yet had their Level 1 or Level 2 admissions screenings. Instead, facilities will have up to 30 days after admitting patients to perform the required screenings.

Resident transfers

To allow facilities to create cohorts to care for residents who have been diagnosed with COVID-19, CMS is waiving several transfer requirements, as long as a facility has agreed to receive a resident from another facility. Cohort agreements can allow for the transfer of residents with COVID-19 to allow stricken residents to be isolated in one facility, or residents who test negative for the illness can be transferred to other facilities to protect them from a COVID-19 outbreak within their current facility.

Blanket waivers automatically go into effect, so facilities do not need to submit applications when they take advantage of the waived requirements.

With these waivers, facilities must continue to track infections and infection control measures. Find out how ABILITY INFECTIONWATCH can help your staff track all of the necessary data.

 

Source:

Director, CMS Quality Safety & Oversight Group, April 24, 2020,  memorandum to State Survey Agency Directors. https://www.cms.gov/files/document/qso-20-28-nh.pdf

 

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

CMS places SNF inspection scores on temporary hold

To help protect skilled nursing facilities against COVID-19 outbreaks, the Centers for Medicare & Medicaid Services (CMS) began focusing inspections on infection control programs in March. With that change, many facilities are not being examined according to the usual schedule, potentially skewing the public quality rating system to negatively impact the ratings of facilities that are being inspected.1 To maintain the integrity of the system, CMS announced April 24 that it would place a temporary hold on the domain of the Nursing Home Five-Star Quality Rating System.

Through the duration of the hold:
• All SNF star ratings will remain consistent for the duration of the hold
• Results of inspections performed after March 4 will appear through a special link on the CMS Nursing Home Compare page
• CMS inspections will continue to focus on infection control programs and immediate threats to patient safety, based on complaints.

The hold will affect all inspections performed after March 4. Results of inspections performed after that date were posted to the public on April 29. Inspection results will continue to be posted as the data is able to be finalized and uploaded to the site. CMS did not reveal an end date for the hold of the rating system.

The announcement regarding the Five-Star Quality Rating System came along with other announcements about CMS requirements for skilled nursing facilities, including staffing data and the Minimum Data Set.

While ratings for skilled nursing facilities will remain unchanged for the foreseeable future, it is important for nursing facilities to diligently maintain their infection control programs to protect residents and staff, and to be prepared if an inspection does occur. ABILITY INFECTIONWATCH can help your facility track the data it needs to monitor its infection control program. Find out how.

 

Source:

1. Director, CMS Quality Safety & Oversight Group, April 24, 2020, memorandum to State Survey Agency Directors. https://www.cms.gov/files/document/qso-20-28-nh.pdf

 

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