CMS announced the MDS 3.0 RAI Manual v1.17.1 which will take effect on October 1, 2019 is now available. 
This version of the RAI manual provides clarification to existing coding and transmission policy.

Click here to download the manual.

Exclusive PDPM Training For HTS Partners

We are committed to supporting our partners by offering exclusive PDPM webinar and live trainings in critical areas to foster success as we “Power through PDPM.”

Moving From RUG-IV to PDPM:  The Transitional IPA

Wednesday, September 25, 10:00 a.m. – 11:00 a.m.

Join us for the 1st High Impact PDPM Workshop where we will review how to successfully navigate the upcoming transition from RUG-IV to PDPM. This webinar will focus on completion of the required transitional Interim Payment Assessment (IPA) for current Medicare Part A beneficiaries including gathering quality assessment data and considerations for ARD scheduling.

Presented by: Eleisha Wilkes, RN, RAC-CT

 

PDPM Billing Processes

Wednesday, October 23, 10:00 a.m. – 11:00 a.m.

The importance of billing accuracy becomes more important than ever under the PDPM (Patient-Driven Payment Model) effective October 1, 2019. This session will focus on tools and strategies to establish a robust Triple Check process that providers cannot afford to overlook.

Presented by: Stacy Baker, OTR/L, CHC, RAC-CT

 

Please contact us to register. Not a partner? Contact us to learn how we’re providing even more value to our partners.

Have you recently experienced a fall? If so, you are not alone. Each year, one in three adults 65+ experience a fall that requires medical attention. Falls can lead to hip fractures and other serious injuries. Falls are not a normal part of aging and most falls can be prevented.

Outdoor Hazards & Safety

▶ Use a walker or cane for added stability.
▶ Wear warms boots with rubber soles for added traction.
▶ If sidewalks look slippery, walk on the grass for better traction.
▶ Carry a small bag of rock salt or kosher salt and sprinkle on slick surfaces.
▶ Beware of highly polished marble or tile floor surfaces in public buildings. Stay on carpet runners whenever possible.
▶ Allow for extra commute time to ensure safe travel.

Home Safety Tips

▶ Keep all rooms free from clutter, especially on the floors.
▶ Wear supportive, low-heeled shoes even at home.
▶ Remove rugs or use double-sided tape to secure rugs so they won’t slip.
▶ Put a non-slip rubber mat or self-stick strips on the floor of the shower or tub.
▶ Install easy-to-reach grab bars in the bathroom.
▶ Use a shower chair or transfer bench.
▶ Place a lamp close to the bed where it’s easy to reach.

How Can Physical & Occupational Therapy Help?

Maintaining proper balance and sense of body position is critical to preventing falls. A physical therapist can help you prevent falls by designing an individualized program of exercises and activities with an emphasis on strength, flexibility, and proper gait. Occupational therapists can review your home environment for hazards and assess any individual limitations. By identifying these factors that contribute to falls, the occupational therapist can recommend strategies to safely perform daily tasks, modify the home environment, and change activity patterns and behaviors.

Talk to your doctor about your fall risk and ask if physical or occupational therapy could help. Be sure to have your doctor or pharmacist to review you prescriptions regularly.

The transition to PDPM will be on October 1, 2019 resulting in a “hard stop” of RUG-IV on September 30, 2019. Strategies for a successful transition include:

  • Development of a plan for data collection for IPA look-back periods which may creep back into September dates of service.
  • Completion of a triple check process to assure COTs are accurate and completed (missed COT will be provider liable).
  • Assuring no principal diagnoses map to “return to provider”.
  • Collection of section GG interim performance data.
  • Completion of resident interviews on or before the transitional IPA ARD.
  • Optimization of processes to code diagnoses for Nursing, NTA, and SLP components accurately.

A transitional IPA will be required for each Medicare A resident present in the facility on October 1, 2019. Transitional IPAs are not to be confused with an IPA. See below for key differences:

Click here for the Variable Per Diem Adjustment Factor Fact Sheet.

 

Transition to PDPM Example

Admission Date: 9/22/19  |  5 Day ARD: 9/29/19  |  Transitional IPA ARD: 10/4/19

Source: McGill J., (Producer). (2019). Strategies for PDPM transition and IPAs [Video Webinar].
Retrieved from www.aanac.org

  • RUG-IV will be used for payment for admission of 9/22 through 9/30.
  • Payment for the transitional IPA begins 10/1 and continues through the end of the Medicare stay unless another IPA is done.
  • The Transitional IPA ARD window is October 1-7. The provider may select any of these 7 days.
  • For this example, the transitional IPA will be 10/4.
  • The variable per diem begins 10/1.
  • The NTA is adjusted by 3.0 for Oct 1-3.
  • PT/OT component will not decrease by 2% until Oct 21.

Successful transition to PDPM will undoubtedly involve optimization of efficiency in providing care and improving patient outcomes. It’s never too late to reassess and tweak your facility’s operational strategies to get ready for the transition. Don’t know where to start or stuck on a process change solution? Contact your HTS Regional Director or the HTS Director of Clinical Outcomes today!

 

We had a Great Time at the MCHS Back-to-School Bash

Thanks for including us, Metcalfe Health Care Center, at the Back to School Bash. We are proud to be your partner in therapy!

“Starting the School Year off Strong! We had a great time at the MCHS Back to School Bash last Thursday. Amy Neighbors and our therapy department conducted grip strength testing for both adults and kids and made it a bit of healthy competition. We are proud to provide outpatient therapy services for all ages. Just another way we serve our entire community. Here’s to a great 2019-2020 school year. Go Hornets!”

Follow along with our Facebook page to see how we’re helping communities just like yours!

1. Start Date: October 1, 2019

2. Applies only to traditional Medicare Part A Skilled Nursing Patients

3. PDPM is a site-neutral reimbursement structure for post-acute care.

4. May impact SNF episodic spending

5. May create opportunities for SNF to increase their clinical scope to accept higher acuity patients

6. Increase of information needed from the hospitals transfer documentation to justify all active conditions:

  • History
  • Physical
  • Medication List
  • Labs
  • Therapy progress notes
  • Chest X-ray
  • Immunizations

Additional requested information under PDPM

  • ICD.10 codes with specificity
  • All active diagnoses
  • Post-Operative Reports
  • Any physician consults

7. PDPM should NOT affect the timeliness in which patients are accepted by Skilled Nursing Facilities

8. PDPM should not drastically reduce the amount of therapies provided or weekend availability

9. This is the largest change to SNF reimbursement in 20 years

10. There is opportunity to improve processes and care collaboration between hospitals and SNFs for optimal success under PDPM

Every year, the National Rehabilitation Awareness Foundation designates a week in September to educate people about the benefits and impact of rehabilitation.

Physical Therapy ◆ Occupational Therapy ◆ Speech Therapy

The goal of rehabilitation is to help an individual heal and achieve their highest level of independence possible. Physical Therapists (PT), Occupational Therapists (OT), and Speech-Language Pathologists (SLP) all work together to help individuals overcome obstacles and accomplish normal tasks of daily living. These therapists work on an individual level, which is beneficial for a range of conditions/diseases, ages and abilities.

Physical Therapy are experts in the examination and treatment of musculoskeletal and neuromuscular problems that affect peoples’ abilities to move the way they want and function as well as they want in their daily lives. Treatment is aimed to reduce pain and improve range of motion, flexibility, strength, endurance, and mobility.

Occupational Therapy uses goal-directed activity in the evaluation and treatment of persons whose ability to function is impaired by normal aging, illness, injury or developmental disability. Treatment goals in occupational therapy include the promotion of functional independence and prevention of disability.

Speech-Language Pathology (Speech Therapy) is the study, diagnosis, and treatment of defects and disorders of the voice and of spoken and written communication. Speech therapy also evaluates and treats neurological and physical disorders and conditions caused by an injury or illness.

When Can Therapy Help?

  • Joint Replacements
  • Post-Orthopedic Surgeries
  • Balance & Gait Training
  • Arthritis
  • Fractures
  • C.V.A (Stroke)
  • Lymphedema
  • Cardiac Conditions
  • Pain Management
  • Back & Neck Pain
  • Parkinson’s
  • Neurological Conditions
  • Swallowing Disorders
  • Language & Cognitive Function
  • Generalized Weakness, or Decrease in Strength

Article by Skilled Nursing News

The federal government on Tuesday finalized a predicted funding increase for nursing homes, while also formalizing changes to several key quality programs — with an eye toward clarifying some parts of the new Medicare payment model for skilled nursing facilities.

Under the terms of the 2020 final rule for Medicare skilled nursing facilities, the Centers for Medicare & Medicaid Services (CMS) will increase payments to nursing homes by $851 million in the coming fiscal year, which begins October 1 of this year.

That figure represents a slight drop-off from the increase of $887 million projected in the proposed version of the rule, which CMS released back in April; the $851 million comes from a 2.8% increase to the Medicare market basket rate in the final rule, as opposed to a 3% rise in the proposal.

The Tuesday announcement also includes several clarifications related to the Patient-Driven Payment Model, also set to take effect October 1. CMS formally changed the definition of “group therapy” to any modality with two to six residents performing the same or similar activities. That change brings group therapy in SNFs more in line with other care settings, such as inpatient rehabilitation facilities, which use the same definition; CMS currently defines group therapy as activities with exactly four residents.

“As PDPM implementation takes place, CMS believes aligning the group therapy definition serves to improve the agency’s consistency in payment policies across PAC settings,” the agency wrote in a fact sheet about the changes.

Click here to continue reading this article.

The Centers for Medicare and Medicaid Services issued the FY 2020 Skilled Nursing Facility Prospective Payment System Final Rule which will take effect on October 1, 2019.  This rule finalizes payment policies for Medicare Part A in SNFs and updates the SNF Quality Reporting and Value-Based Purchasing Programs. Below are the highlights:

  • SNF market basket percentage is 2.4% or $851 million for FY 2020 (decreased from the proposed update of 2.5%).
  • The unadjusted urban and rural federal per diem rates will decrease slightly compared to the proposed rule rates.
  • Come October 1, 2019, group therapy will be defined as, “a qualified rehabilitation therapist or therapy assistant treating two to six patients at the same time who are preforming the same or similar activities.”
  • The sub-regulatory process for updating the ICD-10 codes used to classify patients under PDPM has been finalized for FY 2020.
  • Two new quality measures for the SNF QRP related to transfer of health information have been adopted.
  • Baseline nursing home residents will be excluded from the Discharge to Community Measure.
  • The quality measure for Drug Regimen Review Conducted with Follow-Up for Identified Issues will be publicly displayed.
  • The “5-Day Assessment” will be called “Initial Medicare Assessment.”
  • Clarification on the optional Interim Payment Assessment was provided stating, “…the SNF’s underlying responsibility to remain fully aware of (and respond appropriately to) any changes in its resident’s condition is in no way discretionary. Moreover, the discussion of the IPA in the FY 2019 SNF PPS final rule (83 FR 39233) clearly envisions a role for this assessment that is not strictly limited to payment alone: “We continue to believe that it is necessary for SNFs to continually monitor the clinical status of each and every patient in the facility regularly regardless of payment or assessment requirements and we believe that there should be a mechanism in place that would allow facilities to do this.” At the same time, in making the IPA optional, we recognized “. . . that providers may be best situated, as in the case of the Significant Change in Status Assessment, to determine when a change has occurred that should be reported through the IPA.”

 

For more information see  the CMS Press Release and Fact Sheet.


HTS is not only your partner in therapy – Power through PDPM with HTS’ strategies for success. HTS is able to provide comprehensive tools, policies, clinical pathways and education at all levels to ensure success under PDPM. Contact us today for more information on the HTS Partner Plus Program.

NASL Newsletter Feature: US Senator Mike Braun Visits HTS Therapy Office
On April 24, 2019, U.S. Senator, Mike Braun visited Healthcare Therapy Services (HTS) and one of HTS’ partner facilities in Indiana. NASL members were able to talk with the Senator about the hospital observation stays issue that was NASL’s top issue during the Winter Conference in February. The Senator spent about an hour visiting with staff, as well as interacting with residents.

Thank you NASL for featuring us in your latest newsletter!

Pictured: Senator Mike Braun; his wife, Maureen; Cassie Murray, HTS COO; and Keith Yoder, CEO with Hickory Creek Healthcare Corporation

Pictured: Healthcare Therapy Services representative Shaleen Bhatnagar, Regional Director; Stephen White, Rehab Manager; Cassie Murray, HTS COO; and Steve Chatham, President