Looking back from 2020, the start of this New Year has been more reflective than most. As an organization, fully “seeing 20/20” in 2021 has been made possible by the clarity gained through the experiences and challenges we all faced last year. In 2020, we relied more on our clinical knowledge than ever before to develop creative solutions for staffing, in-room treatments and utilizing tele technology–all while emphasizing the patient-centered delivery model. Although it is likely that 2021 will bring similar challenges as those from last year, as an industry we know what we are capable of accomplishing. We are also now better equipped to overcome COVID-19 related obstacles with the use of exponentially expanded partner and therapist toolkits, policies, and procedures.

We at HTS have identified the top 5 therapy clinical outcome focus areas for 2021 to improve processes and clinical delivery across the IDT.


This month’s clinical focus area is:

Workflow Process Improvement

Optimizing processes for workflow improvement allows organizations to work smarter and more efficiently. This can be as simple as reducing redundant information sharing to using static agendas and communication tools.

HTS supports our valued partners with a “best practice” workflow system analysis. Our HTS management team is uniquely positioned to facilitate workflow processes to allow more efficient identification for educational and training opportunities. These action items are then used to drive process improvement with the facility’s interdisciplinary team.

Check out the top 3 ways your building can enhance processes for maximum efficiency and coding accuracy. Use of these HTS tools and resources are available exclusively for HTS partners.

1.  Use of the HTS Preadmission Screening Tool

The HTS PDPM Pre-Admission Evaluation Tool is a 3-page screening document that assists care coordinators in capturing clinically indicated patient characteristics to attain a projected PDPM clinical category and per diem rate (available via a rate estimator). This is a great guiding tool for admissions and clinical liaisons to use while gathering information from the hospital record. This tool also assures accuracy with coding. Our interdisciplinary teams have found this tool to be especially useful when capturing NTA comorbidities and CMG classification.

2.  Formalized Meeting Guides

PDPM implementation required system adaptation and modification for success. The PDPM Initial Medicare Assessment Meeting Tool is highly recommended to bring the team together for a guided, patient-specific clinical discussion. Suggested medical record items for interdisciplinary meeting discussion are recommended and a template for documentation of communicated action items is also provided.

Buildings that have implemented use of this specific tool have observed a marked improvement in the quality of communication. Additionally, they specifically saw an increase in timeliness when querying the physician and an improved ability to capture NTA comorbidities. Providing a standardized and formalized platform to determine usual performance for Section GG has also streamlined consistency across the record. Our partners agree this is definitely a “must have” for PDPM meetings.

We also recommend use of a weekly Medicare Meeting Form to provide a more structured, formal discussion of patient specific clinical complexities. The HTS Medicare Meeting Form which was revised in 2020 paired with use of the Medicare Meeting Discussion Guide ensures all attendees are present, timely, and prepared to stimulate discussion with the team.

3.  Optimization of IDT Communication to Achieve Consistency Across the Medical Record

“Consistency across the record” is one big component all providers strive to achieve. This consistency is primarily accomplished by effective interdisciplinary communication. MDS coding lacking supportive documentation puts a claim at risk for medical review, which could negatively impact reimbursement.

Rate setting, captured by coding on the MDS, involves a team approach to integrate systems in order to achieve reimbursement appropriate for the patient’s clinical complexities. For example, Section GG requires multiple disciplines between days 1-3 to determine the usual functional performance. Simply attaining function scores from one discipline, such as only nursing or only therapy, puts the claim at risk for medical review. Furthermore, coding that is not supported by documentation within the chart is another risk factor for medical review.

Since Section GG contributes to 3 of the 5 components of the PDPM rate, effective GG function score procedures are imperative for success under PDPM. Some great solutions are available within the Section GG Workflow Resources section of our PartnerHQ portal. Tools such as the Function Score Quick Tips are also available to optimize processes in your building to minimize medical review risk and achieve consistency across the medical record.

Need a Powerful Therapy Partner? Contact Amanda Green, Executive Director of Strategic Development amanda@htstherapy.com for information about our contract therapy partnerships.

HTS has identified the top 5 therapy clinical outcome focus areas for 2021 based on our experiences from 2020 which makes us better equipped to overcome COVID-19 related obstacles. Furthermore, after attending a 15-hour training and certification process, HTS management staff have all become “PDPM Masters.” These additional “feathers in our cap” allow us to uniquely champion process improvement initiatives alongside your interdisciplinary team. As HTS continues to identify opportunities for clinical growth, a key process improvement area will be discussed each month.


This month’s clinical outcome focus area is:

Medicaid CMI

HTS has made it our goal to partner with our clients in every facet of the skilled nursing facility – not just within the walls of the therapy gym. Through business review meetings and discussions with HTS therapists and regional directors, we have become aware of the need for a more detailed look at Medicaid CMI. The HTS team immediately went to work to create a deep-dive analysis program. Now, HTS management is able to apply operational, clinical, and strategic insight to provide solutions to help our clients efficiently assign a dollar value to the treatment of Medicaid patients that is consistent with medical needs. HTS is here to serve you as a facilitator of opportunity and process improvement initiatives through a Medicaid CMI Deep-Dive. Medicaid CMI success is achieved through a three-pronged approach:

Medicaid CMI Deep-Dive Services currently available to HTS Clients

HTS management completes report interpretation at the site level by analyzing data provided within the Time-Weighted CMI Resident Roster Report. A summary of potential vulnerabilities and opportunity areas are identified and reported to the interdisciplinary team. Opportunities are then discussed and assigned to a process improvement champion. Timeframes are designated to keep the team on track with system development. CMI information is then tracked on a quarterly basis to show benchmarking and trends. This value-add service comes with a standard rate of $500. However, for HTS clients, this proprietary deep-dive is offered as a complimentary service.

See below for additional step-by-step details of the deep-dive process:

  1. The Time-Weighted CMI Resident Roster Report for the last 4 quarters are requested.
  2. Reports are interpreted and analyzed by the HTS Management Team
  3. A site-specific, customized presentation of Medicaid CMI data analysis is provided. Opportunities for Medicaid CMI improvement are identified and discussed.
  4. Medicaid CMI data tracking continues as reports are received.
  5. HTS Regional Directors are your “boots on the ground” to facilitate process improvement initiatives.

Need a Powerful Therapy Partner? Contact Amanda Green, Executive Director of Strategic Development amanda@htstherapy.com for information about our contract therapy partnerships.

HTS has identified the top 5 therapy clinical outcome focus areas for 2021 based on our experiences from 2020 which makes us better equipped to overcome COVID-19 related obstacles. Furthermore, after attending a 15-hour training and certification process, HTS management staff have all become “PDPM Masters.” These additional “feathers in our cap” allow us to uniquely champion process improvement initiatives alongside your interdisciplinary team. As HTS continues to identify opportunities for clinical growth, a key process improvement area will be discussed each month.


This month’s clinical outcome focus area is:

PDPM Case Mix

“It’s not enough to be providing excellent patient care anymore. Under PDPM, if you don’t code correctly on the MDS, you’re not going to get credit for it.” – Sheena Mattingly M.S., CCC-SLP, RAC-CT, HTS Director of Clinical Outcomes.

HTS has identified 5 areas of opportunity to improve PDPM Case Mix. Let’s take a deeper-dive by discussing the 5 areas of attack to optimize PDPM case mix classification coding.

1.  Assure good communication and collaboration of the function score (Section GG) which drives the nursing, and PT/OT CMG classification.

At this point we are all aware of Section GG’s impact on Medicare reimbursement under PDPM, but odds are we still need some fine tuning. Review current processes for attaining Section GG coding to assure IDT collaboration of usual performance is documented and available within the medical record. Section GG is of utmost importance not only for PDPM reimbursement but also for Quality Measures, SNF QRP, and 5-Star Rating.

2.  Review your facility’s process for querying the physician to capture any coding opportunities. HTS recommends use of our Initial Medicare Meeting Tool.

Imagine this all too familiar scenario, the speech-language pathologist (SLP) in your building identifies a newly admitted patient has aphasia. This SLP then brings this information to the Initial Medicare Meeting and presents her findings. The IDT agrees and proceeds to query the physician for a diagnosis so that the aphasia is considered active within the 7-day lookback period and can be coded in section I4300 of the MDS. This example of excellent communication results in a more accurately coded MDS that is reflective of the patient’s clinical needs. More specifically, the coding opportunity identified is counted as a SLP-Related Condition in the SLP PDPM “bucket” which is directly tied to PDPM reimbursement.

3.  Use the HTS IMA SLP Component Communication Tool.

This tool is to be assigned to be completed by a SLP or an OT. It is designed to be used to identify potential coding opportunities from the SLP’s or OT’s skilled perspective. The opportunity can then be presented to the IDT for discussion. Prior to PDPM, components such as Section K of the MDS or coding of a mechanically altered diet did not correlate to a rate setting. Now, we do get “credit” for these types of clinically indicated coding opportunities which means communication is key.

4.  Use the HTS Nursing Case-Mix Classification Quick Tip Handouts which is available to HTS Partners on the PartnerHQ Web Portal.

Each nursing component Quick Tip Handout is paired with a HTS High Impact Webinar available on demand on the PartnerHQ Web Portal. For example, when reviewing the Special Care High Quick Tip Handout, you will see that a commonly overlooked classification item may be a patient with COPD. If this patient has shortness of breath while lying flat and this is documented within the medical record, this patient would classify as Special Care High versus Physical Functioning. There are several Quick Tip Handouts. They are a one-page resource that aide in familiarizing yourself with the details of the components for each nursing classification.

5.  Rely on the HTS therapy department for key performance indicator data analysis.

HTS Therapy Rehab Managers use a PDPM Analytic Business Intelligence Dashboard which is powered through Net Health Therapy (formally known as Optima). This report is pulled on a weekly basis to identify areas of opportunity. An action plan is then discussed with the therapy team and the HTS Regional Director is also consulted to drive process improvement. Key performance indicators analyzed include but are not limited to:

  • PDPM Covered Day Count and Patient Count
  • Case Mix Group Distribution
  • Treatment Minutes per Visit
  • PT/OT/ST B Units per Visit
  • Section GG Outcome Data

Need a Powerful Therapy Partner? Contact Amanda Green, Executive Director of Strategic Development amanda@htstherapy.com for information about our contract therapy partnerships.

In recognition of this week, we would like to take this opportunity to commend our partners and healthcare heroes for your unwavering commitment to improving the lives of those you serve.

To celebrate this week, HTS has created a fun activity for residents and staff.

HTS will present cash prizes of $200, $100 and $75 to the top three communities that show the best participation! Be sure to take photos and let us know how your community shined this week.

Sunshine Award

Get your residents and staff involved in this fun coloring activity to share sunshine and appreciation. Tell someone they brighten your day by presenting them a Sunshine Award.

Display your Sunshine Awards on resident doors, decorate the halls, promote/share on Facebook, and find other creative ways to get your community involved!

Choose from multiple awards to download, print, and distribute for residents and staff to color and share their appreciation. Click here to download yours today!

Throughout the health crisis, older adults have followed national health expert’s advice to stay home and socially distance. While social distancing has certainly been necessary, limited social interactions and lack of physical activity have created new health challenges for older adults. Staying indoors and isolated from family and friends, may leave you feeling lonely, depressed, and anxious. Also, many adults have greatly reduced their level of physical activity triggering issues with mobility, balance, and overall strength. Some people may not realize this can also impact your lung function, functional independence, and overall quality of life.

How Can Outpatient Therapy Help you?
As experts in movement and functional activity analysis, physical and occupational therapists play an important role in helping individuals who are at risk of functional decline. From strength training that aims to restore lost muscle strength to balance training that can greatly reduce your fall risk, our goal is to proactively address challenges you may be facing to ensure you maintain an independent and active lifestyle.

If you answer “YES” to any of the below questions, talk with your doctor about a prescription for outpatient therapy.

  • Is pain affecting your daily activities?
  • Have you recently fallen?
  • Are you unable to walk your usual distances?
  • Do you have difficulty getting out of bed?
  • Are you out of breath quicker when walking?
  • Do you have weakness that’s affecting your daily activities?
  • Have you noticed weight gain or loss?
  • Are you having difficulty with bathing, dressing, toileting, or preparing meals?
  • Are you recovering from COVID-19?
  • Are you experiencing memory issues or difficulty focusing?

Blog by: Stacy Baker, OTR/L, RAC-CT, CHC, Proactive Medical Review

Following a year of little to no medical review and extensive government spending, most experts forecast reimbursement compliance audits ramping up in 2021. Multiple areas are ripe for potential scrutiny, including, but not limited to PDPM coding and supportive documentation, the proper use of SNF waivers, and appropriate access to and accounting for Provider Relief Funds. Get the facts and ensure readiness with these insights into the current audit environment and the medical review entities that may rain on providers in the months ahead. CMS suspended audits between March 30 and August 3 of 2020 in order to reduce provider strain during the COVID-19 pandemic. This year, however, audits are resuming in full swing.

  • Under the new Biden administration, many industry leaders and healthcare attorneys predict an uptick in audits and healthcare prosecutions with “both government initiated litigation and qui tam suits…set for continued growth in 2021” according to Georgia Ravitz et. al (i) With Xavier Becerra, a former prosecutor, appointed secretary of HHS, the government is poised to advance fraud prevention efforts.
  • False Claims Act (FCA) recoveries in FY2020 were $2.2 billion, down from $3.1 billion in 2019 and lower than any year since 2008 at a time when spending has escalated throughout the pandemic. Healthcare made up 85% of FCA recoveries in 2020 and that trend is likely to continue through both standard channels and a focus on new risk areas such as telehealth billing fraud. ii
  • Recovery Audit Contractors are now authorized to review for Medical Necessity and Documentation Requirements specific to the Patient Driven Payment Model (PDPM), and the OIG has added new focus to the Work Plan to identify program integrity risks associated with Medicare telehealth services during the pandemic.

Click here to continue reading this blog.


About Proactive Medical Review
HTS partners with Proactive Medical Review, a third party company who specializes in ensuring compliance with regulatory standards and promoting measurable care excellence. The team includes SNF experienced nurse, MDS, Health Facility Administrator, therapist and reimbursement specialists with experience serving in multi-site contract therapy operations, as corporate directors of quality, clinical program specialists, and Compliance Officers. Proactive is uniquely positioned to assist in managing the many changes and challenges facing providers partnered with HTS. Learn more about our commitment to compliance here.

Healthcare Therapy Services, Inc. has announced exciting changes in our executive leadership roles. Please see the message below from Barry Chatham.

The Chatham family is very pleased to announce that Cassie Murray, OTR, MBA, QCP has been promoted to be the President of HTS. Cassie has served HTS for 27 years in various roles from a front-line therapist, Regional Director for southern Indiana, and recently a dual role as the Chief Clinical Officer and Chief Operating Officer.

She will be responsible for operational leadership and will continue to ensure excellent care and support to the patients of our partners. Cassie has served HTS well, and her support and knowledge of healthcare and incredible work ethic are major reasons for our success.

Steve Chatham will take over as CEO and will help to support Cassie and the leadership team. Steve will continue to man the helm and provide strategic, financial and operational leadership for HTS and affiliate companies.

I am blessed to stay on as the Chairman of the Board and to be involved with our continued growth and new opportunities for HTS. These blessings continue as we remain focused on our mission and the core of why I created a Christian company. We will always stay very focused to live our mission statement based on Jeremiah 29:11 to provide a hope and a future.

Barry Chatham, Board Chairman
Healthcare Therapy Services, Inc.

Please join us in congratulating Cassie Murray, President of HTS.


Cassie Murray, OTR, MBA, QCP

President of HTS

Healthcare Therapy Services, Inc.

Experts in rehabilitation, HTS is committed to introducing new clinical programs and best practices that improve patient care delivery and outcomes. With falls being the leading cause of both fatal and nonfatal injuries for people 65 years of age and older, HTS has revitalized our Falls Prevention Program with evidence-based assessments, interventions, and resources. This new program, STEADY, provides the most advanced therapeutic interventions and treatment practices to adhere to the HTS commitment of perfecting rehabilitation.

Now introducing… STEADY:  A Comprehensive Therapy Approach to Fall Prevention.  STEADY is a therapy-driven fall prevention program designed to be utilized by Physical, Occupational and Speech Therapy.  The overall purpose of this program is to reduce the prevalence and risk of falls while improving the quality of life for our patients.

The HTS STEADY Program includes tools and resources on fall risk factors, evidence-based assessments and interventions, and educational handouts for patients and caregivers. The STEADY program provides a program protocol, fall prevention analysis tool and a falls tracking log to drive program efficacy.

This program will address many of the factors that lead to falls, such as:

  • Physical Inactivity
  • Fear of Falls
  • Low Vision
  • Balance & Mobility
  • Polypharmacy
  • Foot and Ankle Health
  • Cognitive Function
  • Urinary Incontinence
  • Sleep Health
  • Pain
  • Vestibular Dysfunction
  • Environmental Modifications

Patient and caregiver education is a vital component of this program.  For patients, STEADY provides essential health literacy tools to use at home such as: exercise handouts, home safety checklists, daily pain diary and more.  For caregivers, education is focused on environmental modifications, safe patient transfers, wheelchair and bed positioning safety, and instructions for getting up from a fall.

For more information about the HTS STEADY Program, please contact your HTS Regional Director.

Need a Powerful Therapy Partner? Contact Amanda Green, Executive Director of Strategic Development amanda@htstherapy.com for information about our contract therapy partnerships.

The fourth quarter fiscal year 2020 Program for Evaluating Payment Patterns Electronic Reports (PEPPER) are now available for skilled nursing facilities (SNFs) to download through the PEPPER Resources Portal. These reports summarize provider-specific data for Medicare services that may be at risk for improper payments. This data can be used to support internal auditing and monitoring activities.

To obtain your SNF PEPPER report, please follow the following steps:

  1. Visit the PEPPER Resources Portal
  2. Complete all the fields; and
  3. Download your PEPPER report

Click here to visit the PEPPER Resources Portal.

On April 12. 2021, the Indiana Department of Health, Division of LTC will resume federal and state health surveys for both nursing homes an residential care facilities. All surveyors have been updated with the Long-term Care Survey Process (LTCSP) Procedure Guide that was effective February 6, 2021. Surveyors will review facility information 12 months prior to the survey entrance date, unless there is a need related to complaint or other concerns that would require information past the 12-month time frame.

Click Here for More Details on Nursing Home Surveys.