MACRA now in its first year of implementation in 2017, has established a new framework for physician payment focused on quality and value using two distinct payment paths. The Centers for Medicare & Medicaid Services (CMS) Quality Payment Program (QPP) includes the following pathways: the Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Model (APM) Incentive program. MACRA replaced the Sustainable Growth Rate (SGR) formula that gave the ability to determine Medicare … [Read more...] about Major Health Groups Chime in on Medicare Access and CHIP Reauthorization Act (MACRA) Payment System
Failure to Deliver PASRR Services – Level I Screening and Level II Evaluation Assessments
Provider Letter No. 17-15 - DAD'S latest provider letter addressing Nursing Facilities reports on clarification that the role of the nursing facility (NF) is to coordinate completion of the Level I screening and Level II evaluation assessments with appropriate entities. The letter reports:Nursing Facilities must comply with both state and federal requirements related to Preadmission Screening and Resident Review (PASRR). This includes coordinating with appropriate entities to ensure completion … [Read more...] about Failure to Deliver PASRR Services – Level I Screening and Level II Evaluation Assessments
Status on Pre-Dispute Arbitration Agreement
A coalition of states has joined together to oppose the Administration proposal to end the ban on pre-dispute arbitration agreements used by nursing homes. This band arises from a final rule promulgated in October of 2016. Meanwhile, though the American Health Care Association supports ending the ban, it also opposes other provisions seeking to impose more regulation on the agreements themselves and submitted those in comments to the proposed new rule. … [Read more...] about Status on Pre-Dispute Arbitration Agreement
Texas Health and Human Services Commission Notice: Removal of Service Codes for Habilitation and Residential Habilitation
The latest Information Letter No. 17-15 - As of July 10th, some services codes associated with habilitation have been removed by Texas Health and Human Services Commission. CLASS DSA, DBMD program provider, or FMSA are no longer able to submit a service claim that includes any of these service codes described below: ? service codes 10, 10A, and 10V associated with CLASS habilitation; and? service codes 17 and 17V associated with DBMD residential habilitation.A CLASS DSA or DBMD program provider … [Read more...] about Texas Health and Human Services Commission Notice: Removal of Service Codes for Habilitation and Residential Habilitation
Challenges Continue for LTC Regarding Change of Therapy Documentation
Nursing facilities continue to battle Medicare denials because of documentation issues:Untimely certifications, missed or incorrectly billed Change of Therapy documentation, and lack of documentation supporting a signed physician order for skilled therapy are among the top reasons facilities are battling Medicare claims denials, an expert said in late April.Check your systems for communication between your MDS people and the therapy providers. … [Read more...] about Challenges Continue for LTC Regarding Change of Therapy Documentation
New Rules for Nursing Facilities Regarding License Revocation
On March 27, 2017, DADS issued a Provider Letter announcing new rules in the TAC regarding Revocation of Licenses for Nursing Facilities and regarding staying the license revocation. DADS explains:If you received a violation on or after September 1, 2016 that was related to abuse or neglect and cited at the immediate threat level, you also received a letter at the time of the exit conference that serves as your notice that the survey team identified a violation related to abuse or neglect that … [Read more...] about New Rules for Nursing Facilities Regarding License Revocation
HHSC – Learning Collaborative Summit
HHSC has posted information on the August 27th - 28th Statewide Learning Collaborative Summit, including the livestream link and agenda, on the Dates and Deadlines page. Visit us at Garlo Ward, PC … [Read more...] about HHSC – Learning Collaborative Summit
Certification and Recertification by Physicians for Extended Care Services
In skilled nursing facilities, in accordance with CMS manual guidance, CMS will only make payment for covered post-hospital extended care services if a physician makes the required certification and, where applicable, the required re-certification regarding the services furnished. Skilled nursing facilities are responsible for obtaining the required physician certification and recertification statements. Such certification must clearly note that that post-hospital inpatient extended … [Read more...] about Certification and Recertification by Physicians for Extended Care Services
Common Nursing Facility Survey Deficiencies
McKnights Long Term Care News offers a free webinar entitled "2012 Survey Update: The Least You Need to Know" on common nursing facility deficiencies. Linda Elizaitis, president of CMS Compliance Group and one of the speakers, stated the most common nursing home citations have to do with kitchen sanitation, infection control, management of resident care plans and medication dispensing procedures. Elizaitis noted that state surveyors have also honed in on matters of resident dignity, and … [Read more...] about Common Nursing Facility Survey Deficiencies
Non-payment for “Never Events”: Coming to a Long-Term Care Provider Near You
Since October 2008, the Centers for Medicare and Medicaid Services ("CMS") have not paid hospitals for certain hospital-acquired conditions. That is, CMS will not pay for certain conditions that were not present in the patient upon admission. The conditions are, as designated by CMS, conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been … [Read more...] about Non-payment for “Never Events”: Coming to a Long-Term Care Provider Near You