McKnight's Long Term Care News

Ask the payment expert ... about the observation stay loophole

By Patricia Boyer May 01, 2013

We've had problems with residents being caught in the hospital "observation stay loophole." What can we do to ensure they qualify for coverage at our facility?

Ask the payment expert ... about matching diagnoses codes

By Patricia Boyer April 01, 2013

How important is it that diagnoses coded in Section I of the MDS match what is being billed on the UB-04?

Ask the payment expert: Why do we have so many A's in our ADL coding?

By Patricia Boyer January 01, 2013

The new RUGs-IV scoring methodology has a strong tendency to score your ADLs lower.

Ask the payment expert: How can I make sure that my Medicare claims are correct?

By Patricia Boyer December 01, 2012

I recommend every facility that gets reimbursement from Medicare complete a Medicare audit annually. You want to look at yourself the same way the government does.

Ask the payment expert: Why should I be concerned about hospitals being penalized for rehospitalizations?

By Patricia Boyer November 01, 2012

Rehospitalization is another way that the Centers for Medicare & Medicaid Services is looking to cut Medicare costs.

Ask the payment expert: How well are the new MDS rules working?

By Patricia Boyer October 01, 2012

Now that we are a few months after the April MDS assessment changes, how are rules working for facilities?

Ask the Payment Expert: Are staffing adjustments necessary to deal with MDS changes?

By Patricia Boyer September 01, 2012

I believe the most effective way to meet resident needs is for nurse managers to be involved in all OBRA assessments because those are the assessments that "drive" care.

Ask the payment expert: What's the best way to maximize Medicaid and Medicare reimbursement?

By Patricia Boyer August 01, 2012

It depends on which state you are in as to which Medicaid reimbursement program you are managed under. For the RUGs III Medicaid reimbursed states, you need to remember your RUGs III grouper and what qualifies in which category. It will be the same as the old (pre-October 2010) Medicare system.

Ask the payment expert: How will our new e-charting system influence our reimbursement?

By Patricia Boyer July 05, 2012

We are getting a new electronic charting system. Is there anything we should be aware of with the change?

What's the best way to prevent Immediate Jeopardy citations?

By Patricia Boyer May 01, 2012

We've been assisting facilities in several states with Immediate Jeopardy (IJ) resolutions. One of the big changes we are seeing is that when an IJ situation is cited, multiple tags are affected and so multiple IJs are identified.

Ask the payment expert: How will the RAC audit process affect nursing homes?

By Patricia Boyer April 02, 2012

They already are. We were recently involved in a RAC audit appeal process. Nursing facilities should be prepared to know what a RAC review can result in.

Ask the payment expert: What are some tips for completing a Change of Therapy OMRA accurately?

March 01, 2012

Nursing and therapy need to be monitoring the therapy level on a continual basis. Therapy staff need to look forward seven days to make sure they planned the appropriate days and minutes of care and look back to make sure it was given as planned.

Ask the payment expert: How do I know if I need to complete a Change of Therapy OMRA?

By Patricia Boyer February 01, 2012

The Change of Therapy (COT) OMRA means that each therapy resident is always in a "look back" period. When an assessment is completed, either a scheduled assessment or an EOT-R assessment, it sets a new seven-day observation period.