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.

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

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.

On October 23, 2019, a new consumer alert icon will be present on the Nursing Home Compare website next to facilities that have had:

  1. Abuse that led to harm of a resident within the past year; and/or

  2. Abuse that could have potentially led to harm of a resident in each of the last two years.

The icon and CMS inspection results will be updated monthly. This is a welcome change when compared to the quarterly updates the site was receiving. Seema Verma, CMS Administrator, stated the information is “for incentivizing nursing homes to compete on cost and quality.”

In April 2019, CMS announced its plan for more transparency which will be done through a five-part approach to maximize safety and quality in nursing homes. The initiative emphasizes five pillars:

  • Strengthening Oversight
  • Enhancing Enforcement
  • Increasing Transparency
  • Improving Quality
  • Putting Patients over Paperwork

Click here to read more about this five-part approach.

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.

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

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

The Quality Improvement Organization (QIO) Program originated with the Peer Review Improvement Act of 1982 and is authorized by Title XI Part B and Title XVIII the Act. The goal of the QIO program is to improve the quality of care for Medicare beneficiaries, including beneficiary complaints, skilled service termination appeals, and Immediate Advocacy to protect the Medicare Trust Fund. The QIO program is to achieve this goal through performance of various case review directives promulgated by CMS in the QIO Contract.

As of June 8th, important updates apply to the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QI) in Indiana and Kentucky. Providers should review documents and publications noted below with references to KEPRO. The following actions should take place:

Indiana:

  • Remove KEPRO (effective June 8, 2019) and replace with Livanta information

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.

by Shelly Maffia, Director of Regulatory Services, Proactive Medical Review

CMS released upcoming improvements to Nursing Home Compare and the Five Star Rating system that will go into effect in April 2019. Key changes that will take place in April include:

Health Inspection Rating:

  • The freeze on the Health Inspection rating will end.
  • Surveys occurring after Nov. 28, 2017 will now be included in the rating.
  • Ratings will again be based on 3 cycles of inspections (3 most recent standard inspections and any complaint inspections occurring within the past 3 years).
  • Cycles will return to pre-“freeze” weightings, with the most recent period (cycle 1) assigned a weighting factor of 1/2, the previous period (cycle 2) with a weighting factor of 1/3, and the third period (cycle 3) having a weighting factor of 1/6 of the health inspection score.
  • Star ratings will not be displayed for Special Focus Facilities.

Quality Measure Rating:

  • Separate Quality Measure ratings created for short-and long-stay measures.
  • Each facility will continue to have an overall QM rating, which will be used to calculate the overall nursing home star rating.
  • Overall QM rating will be equally based on the short-stay and long-stay quality ratings.
  • Increased thresholds for ratings, based on the rate of improvement on QM scores since the last revision in February 2015.
  • Every six months, QM thresholds will be increased by 50% of the average rate of improvement in QM scores to incentivize continuous quality improvement.
    • Individual QMs will be weighted and scored differently.
      High and medium weighting levels established.
    • Total number of points available for QMs with high weighting will be 150 points and medium weighing will be 100 points each.
    • Points for QMs weighted “high” will be awarded by thresholds established at each decile, whereas points for QMs weighted “medium” will be awarded by thresholds established at each quintile.
  • Adding the long-stay hospitalization measure and a measure of long-stay emergency department transfers to the QM rating.
  • Short-stay pressure ulcers and successful discharge to community measures are being replaced by the similar measures from the SNF Quality Reporting Program (QRP).
  • Removing long-stay physical restraint measure from QM rating’s calculation, but will continue to report the measure on Nursing Home Compare.

Staffing Rating:

  • Adjusted thresholds for staffing ratings to increase the weight registered nurse staffing has on the staffing rating.
  • Four days (instead of seven days) without RN onsite will trigger automatic downgrade to one-star Staffing Rating.

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.

by Skilled Nursing News
Starting October 1, skilled nursing facility operators will have no choice but to become proficient with a specific type of medical coding that previously had no bearing on reimbursements — and leading industry voices say there are multiple paths to getting there.

ICD-10 codes, specific diagnosis identifications long used by hospitals, will play a key role in the new Patient-Driven Payment Model (PDPM), and facilities only have a few more months to get staffers up to speed.

Click here to continue reading this article.

Exclusive PDPM Training For HTS Partners

Generate Powerful ICD.10 Coding
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.”

These sessions will review ICD-10-CM coding conventions and official guidelines for coding/reporting to gain knowledge on appropriately assigning ICD-10 codes, a focus on the diagnosis codes that impact reimbursement under the Patient Driven Payment Model (PDPM). Please contact us to register. Not a partner? Contact us to learn how we’re providing even more value to our partners.

Tuesday, April 9 – Evansville
Wednesday, April 10 – Louisville
Wednesday, May 29 – Fort Wayne
Thursday, May 30 – Indianapolis

Improve Brain Health & Memory FREE Community Workshops

We’re excited to sponsor FREE Community Workshops focusing on Solutions to Improve Your Mental Fitness & Overall Brain Health. Check out the schedule below to find the workshop in your area. Each workshop will provide you with:

  • Tips To Engage Your Brain For Maximum Mental Fitness
  • Learn What Foods Can Improve Your Memory
  • Benefits of Exercise For Your Brain
  • How Outpatient Therapy Can Help You Regain Your Daily Independence
  • Take Home A Free Brain Health Workout

Light Refreshments will be provided. There is no cost to attend, FREE and open to the public.

 

Workshop Schedule

Crestwood Village East

1123 N Edmondson Ave, Indianapolis, IN 46219, In the Ballroom
Tuesday, March 12th, 2:00 – 3:00 pm
If you have any questions about this workshop, call Madison: 317-351-1786 or Jason: 317-357-1100

Crestwood Village West

230 Welcome Way Blvd, Indianapolis, IN 46214, In the Ballroom
Thursday, March 14th, 2:00 – 3:00 pm
If you have any questions about this workshop, call David 317-273-8800

Crestwood Village South

8809 Madison Ave, Indianapolis, IN 46227, In the Ballroom
Tuesday, March 19th, 2:00 – 3:00 pm
If you have any questions about this workshop, call Jim 317-885-3461

Woodland Terrace Carmel

689 Pro Med Lane, Carmel, IN 46032, In the Inspiration Room
Wednesday, March 20th, 1:30 – 2:30 pm
If you have any questions about this workshop, call Dennis 317-564-0180

Woodland Terrace, New Palestine

4400 Terrace Drive, New Palestine, IN 46163, In the Fitness Center
Thursday, March 21st, 2:00 – 3:00 pm
If you have any questions about this workshop, call Bryan 317-623-5834

Crestwood Village North

9225 Garrison Dr, Indianapolis, IN 46240, Building #2
Thursday, March 28th, 2:00 – 3:00 pm
If you have any questions about this workshop, call Jill: 317-447-7430 or the office 317-844-9994