The Office of Inspector General (OIG) 2020 workplan includes residents who were receiving Medicaid nursing home care and then were hospitalized. The beneficiary then returned to the same facility and received Medicare covered post-hospital SNF care. In some cases, hospital physicians discharged beneficiaries to home rather than the SNF, yet nursing facility physicians certified that skilled care was needed. Because Medicare pays substantially more for SNF care than Medicaid for nursing home care, nursing home facilities have financial incentives to increase the level of skilled care. This will be the focus of OIG medical review.

 

What will the OIG use to determine if the post-hospital SNF care is dually eligible?

  • the SNF level of care was certified by a physician (e.g., a hospital or SNF physician) or a physician extender (i.e., a nurse practitioner, clinical nurse specialist, or physician assistant);
  • the condition treated at the SNF was a condition for which the beneficiary received inpatient hospital services or a condition that arose while the beneficiary was receiving care in a SNF for a condition for which the beneficiary received inpatient hospital services;
  • daily skilled care was required
  • the services delivered were reasonable and necessary for the treatment of a beneficiary’s illness or injury; and
  • improper Medicare payments were made on the claims we review. We will also determine whether any of the hospital admissions we review were potentially avoidable

 

Prepare for the 2020 OIG Work Plan:

  • Develop policies and procedures related to admission and determination of appropriate level of care and individualize them for your facility.
  • Assure your process for attaining hospital records is timely. This is crucial for not only response to OIG review requests but also for timely PDPM processes including identifying NTA components.
  • Review your facility’s communication for medical review. Did you know HTS partners with a third-party company to complete medical reviews on your behalf? Ask us about our Denials Management Processes today!

 

Bottom Line: There is a very short timeframe for response.

  • Hospital discharge records requested within 7 days and remaining documents within 15 days
  • Specific policies and procedures must be submitted for review as well as facility specific questions related to determining level of care:
    • Policies and procedures related to admission of patients into SNF care
    • Policies and procedures related to determination of appropriate level of care (unskilled/custodial care and skilled care)

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Winter and bitter cold temperatures pose danger for those with heart disease and especially for older adults. Understanding your personal heart attack risk is vitally important during winter months. It is also important to be aware of the threats cold weather can bring and take appropriate precautions to ensure your safety.

 

Safety Tips for Cold Weather:

  • Avoid alcohol as it gives you a false sense of warmth and can cause your heart to work harder.
  • Don’t overdo it, start your morning off slow. The cardiovascular system can adapt to slow, progressive change. Avoid sudden exertion like shoveling snow and take frequent breaks.
  • Prevent hypothermia by wearing a hat and layers of clothing to protect you from
    cold temperatures. Older adults have lower subcutaneous fat and are more prone to suffer from hypothermia.
  • Remain hydrated and drink water regularly to prevent overexertion and dehydration.
  • Breathe through your nose in cold weather; your nose has various defense mechanisms to prevent impurities and excessively cold air entering your body.

 

If you would like to learn more about a heart-healthy lifestyle, visit our therapy department. Physical and Occupational therapists can help you to develop a healthier lifestyle and reduce many of the risk factors that cause cardiac conditions. Cardiac rehabilitation programs are designed to help you control your symptoms and resume an active and productive life within the limits of your condition.

 

References: American Heart Association

As you get older, you may start to have trouble with everyday tasks such as bathing, picking up things off the floor, or even just getting around.  Assistive devices are products and tools that can make life easier. They might be new things you add to your home, or improvements to something you already have.  The first step is recognizing when and where you could use some extra help. Sometimes people adapt to changes in their ability level, giving up things they like to do without even recognizing it.

Here are some ideas that could help make your daily activities easier:

Getting Around:

  • A cane or crutch used on the opposite side of a painful knee or hip makes walking easier and helps the joint last longer.
  • Reachers are long rods with a grip handle on one end and a grabber on the other. They let you pick up small objects without having to bend over or reach uncomfortably.
  • Elevated chair legs make it easier to get in and out of your seat. The chairs you have can usually be fitted with extenders.

In the Kitchen & Bedroom:

  • Rearrange your kitchen so that the things you use most often are the easiest to reach.
  • Use lamps activated by touch or by your voice.
  • Getting dressed could be easier if you switch to big buttons, button hooks, or velcro closures.
  • Find sock aids and zipper pulls. A sock aid can help you pull up your socks without bending your legs. A zipper pull makes zippers easier to grab and zip.

In the Bathroom:

  • A tub bench or shower seat lets you bathe more comfortably and reduces the chance of falls.
  • Grab bars make it easier to get in and out of the bath and on and off the toilet.
  • A raised toilet seat with side rails reduces the strain of getting on and off.
  • Long-handled sponges help you to wash your legs and feet without bending.

 

Occupational Therapists specialize in helping older adults to safely perform activities and do the things they want to do.  Being able to perform basic self-care activities is very important for older adults to safely live independently. They may have other ideas for assistive devices or home modifications that could make a world of difference.  If you are having trouble with completing day-to-day activities, talk with your doctor about physical and occupational therapy to restore your mobility and function as soon as possible.

Expect More When You Use HTS for Contract Therapy.

As health care continues to evolve, we know your therapy team needs to walk beside you — and even a little ahead of you — to bring solutions, navigate change and anticipate needs. Our dedicated experts keep you well informed and ahead of changes effecting our industry.

Partnering with HTS Means You’ll Receive 

  • Custom Marketing Solutions
  • Commitment to Compliance
  • Clinical Expertise

Click here to learn more about our Contract Therapy Services.

Article by James M. Berklan, www.mcknights.com

Journalists are supposed to be “words” men and women, but to be honest, I love a good set of numbers as much as anything. Especially when they’re tied to a pertinent analysis.

That’s why I find this period of transition with the Patient Driven Payment Model intoxicating. There’s mystery (Will providers fare well under the drastic overhaul?), cunning (How might providers get the best bang for their buck?) and suspense (What will regulators yank back if they don’t like what they’re seeing?).

And numbers. Lots and lots of numbers.

Wednesday I got a chance to talk initial PDPM numbers with three of the biggest LTC numbers crunchers around, Marc Zimmet, Vince Fedele and Steven Littlehale. We talked about Zimmet Healthcare Services Group’s initial PDPM reimbursement analysis of October Medicare claims.

The overall impression coming out of it? You’re going to be alright, providers. Just as many had predicted, those who did their homework — and vow to keep getting better — should be just fine.

In fact, as colleague Danielle Brown writes in today’s top Daily Update news item, many providers who paid attention in their PDPM educational classes are making, on average, more than $50 more per patient day then they would have under the old RUGs-IV system. When adjusted for one-time exceptions, it’s about half that, but it’s still a big positive. In addition, Zimmet estimates that providers can gain another $40 per patient day more once they get better at coding and, well, simply remembering to claim what they have coming.

While OT and PT therapy pay rates won’t necessarily budge much, better can be had in speech language therapy, nursing and non-therapy ancillary services, Zimmet explained.

A big caveat here: The analysts were clear that theirs was not a random sample and should not be taken as an ironclad predictive argument. The sample included a lot of East Coast clients, and they tended to be on the larger size, but it was still significant and close to what others should be finding.

The biggest worry isn’t so much what PDPM will do to providers’ bottom lines, but, much as I predicted a few weeks ago after talking to a long time marketplace exec: What the Centers for Medicare & Medicaid Services will do to the flow of cash when it eventually recalibrates pay rates. Because we can assume with these kinds of cheery numbers Uncle Sam will want to get back what he feels is rightly his.

Zimmet predicted with “95% confidence” that a rate readjustment will be coming, eventually. Providers will know in “less than a quarter” how finances will shake out, but CMS will likely take about six months before it makes any pronouncements about rate readjustments.

Make no mistake: This is good. It means you’re not getting riffed right now, wondering how to make ends meet. The CMS policy is not going to be budget neutral — but in a good way.

And the best thing of all is, you can do even better at it once you get better at coding and stop leaving money on the table.

Click here to continue reading this blog.

Southfield Village Therapy Team Celebrates a Successful Recovery!

Patient, Brenda, enjoyed therapy so much that she dressed up for her last day at Southfield Village.

Pictured left to right are Derek Gokee PT, Brenda, and Brian Kemp PTA.

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Everyone has heard the phrase “Stand Up Straight! Don’t Slouch!” Behind those long forgotten words lies a very valuable and surprisingly simple message: Good posture is important because it helps your body function at top speed. It promotes movement efficiency and endurance and contributes to an overall feeling of well-being.

Our bodies change as we age. If you have poor posture, your bones are not properly aligned, and your muscles, joint and ligaments take more strain than nature intended. These natural changes make it especially important for older adults to maintain good posture, strength, flexibility and balance. Good posture can decrease your risk of falls!

Poor Posture Can Cause:

  • Headaches & Fatigue
  • Back, Neck & Shoulder Pain
  • Breathing Problems

Tips for Maintaining Good Posture:

  1. Avoid staying in one position for long periods of time; inactivity causes muscle tension and weakness.
  2. Maintain a healthy weight; excess weight exerts a constant forward pull on the back muscles and weakens the abdomen.
  3. Sleep on a firm mattress and use a pillow under your head just big enough to maintain the normal cervical-neck-curve.
  4. Wear comfortable and well-supported shoes. Avoid high heeled or platform shoes, which distort the normal shape of the foot and throw the back’s natural curves out of alignment.
  5. Walk with good posture; keep head erect with chin parallel to the ground, allow arms to swing naturally, and keep feet pointed in the direction you are going.

For more exercise and posture tips, talk with your doctor about physical and occupational therapy. Therapy can help correct your bad posture and help alleviate chronic pain. No matter what age you are, every BODY will feel the benefits of better posture.

Update on CMS & MAC Claims Processing

Below is an update from AHCA on processing of Medicare claims under the Patient-Driven Payment Model. Please note particularly the part that suggests holding claims until Thursday, October 24.

On October 17th, CMS transmitted is quarterly update to all Medicare Administrative Contractors (MACs) as scheduled. CMS also indicated the MACs would need until October 24th to load, test, and launch the update.

Today, we have heard from several members about problems with claims submitted last Friday and yesterday. This likely is because the MACs require more time (e.g., until the targeted October 24th) to finish installation and testing.

Last evening, we informed CMS (both payment policy staff as well as MAC officers about the responses from MACs to-date (e.g., lower likely payments than billed). We will remain in contact with CMS in the coming days.

For now, we recommend holding submission of claims until October 24th – the date CMS indicated the MACs should be ready. On October 25th, COB, we will be in contact with membership about the result of claims submission. If problems persist, AHCA will escalate the issue quickly.

The final submission deadline for this quarter is November 14th, 2019. Only data successfully submitted by this time is used on the Nursing Home Compare website and in the five star rating calculations.

Tips:

  • Once information is uploaded, check your Final Validations Report which is accessed in the Certification and Survey Provider Enhanced Reporting (CASPER folder) to verify data was submitted successfully.
  • It may take up to 24 hours to receive the validation report.
  • QIES helpdesk is available for assistance help@qtso.com
  • Do not wait until just a few days before the deadline to submit PBJ data for the reasons above.

Click here to learn more.

According to the National Osteoporosis Foundation, one in two women and one in four men age 50 and older will suffer an osteoporosis-related fracture. Osteoporosis is a disease characterized by low bone mass and structural deterioration of bone tissue, leading to weak and brittle bones. Breaking a bone is serious, especially when you’re older and broken bones can cause severe pain.

How Can Therapy Help?

Physical therapy can help manage and prevent osteoporosis as well as reduce falls and injuries for those diagnosed with the disease. Based on a thorough assessment of your posture, balance, strength and flexibility, a physical therapist will work one-on-one with you to target your specific areas of weakness. Also, an occupational therapist will work with you to evaluate your lifestyle, home environment and activities of daily living to ensure you can safely do all the things that you want and need to do. 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.

Therapy Goals for Preventing & Treating Osteoporosis:

  • Maintain or Increase Bone Mass Density Using Exercise
  • Improve Muscle Strength, Balance, Posture, and Cardiovascular Fitness
  • Improve Psychological Well-being
  • Prevent Fractures
  • Reduce Falls
  • Provide Education

For more information, please contact the therapy department.


References: National Osteoporosis Foundation