Ask the payment expert

Ask The Payment Expert: Patricia Boyer

Ask The Payment Expert: Patricia Boyer

Can you clear up confusion over quality measures and how long people remain on the report?

Ask the Payment Expert about ... competency-based staffing

Ask the Payment Expert about ... competency-based staffing

By

What do new requirements mean about competency-based staffing?

Ask the Payment Expert about ... preparing for the new requirements and surveys

Ask the Payment Expert about ... preparing for the new requirements and surveys

By

What do we need to do to prepare for the new regulations and survey process?

Ask the Payment Expert about ... keeping finances in order for 2017

Ask the Payment Expert about ... keeping finances in order for 2017

By

With the first month of 2017 already behind us, what are some recommendations to keep your "financial house in order" the rest of the year?

Ask the Payment Expert about ... acuity-based staffing

Ask the Payment Expert about ... acuity-based staffing

By

What is acuity-based staffing and how do we know what our acuity is?

Ask the Payment Expert about ... SNF Value Based Purchasing Program

Ask the Payment Expert about ... SNF Value Based Purchasing Program

By

How does the new Skilled Nursing Facility Value Based Program relate to our Medicare payments?

Ask the Payment Expert about ... new CMS initiatives

Ask the Payment Expert about ... new CMS initiatives

By

There are so many new programs coming out from the Centers for Medicare & Medicaid Services recently that it's hard to understand. Is the criteria the same for them all?

Ask the Payment Expert about ... Medicare data

Ask the Payment Expert about ... Medicare data

By

It seems like Medicare always has so much information about us. How can we access that data?

Ask the Payment Expert about ... how to calculate cost of care

Ask the Payment Expert about ... how to calculate cost of care

Our referral hospital system is asking us what our cost of care is. How do I calculate that?

Ask the Payment Expert about ... the new Payroll-Based Journal system

Ask the Payment Expert about ... the new Payroll-Based Journal system

By

Can you explain the new Payroll-Based Journal system?

Ask the Payment Expert about ... the new MDS Section

Ask the Payment Expert about ... the new MDS Section

By

Can you explain the new MDS Section and assessment?

Ask the Payment Expert about ... bundled payment initiatives

Ask the Payment Expert about ... bundled payment initiatives

By

How do bundled payment initiatives affect my facility?

Ask the Payment Expert about ... bundled payments in rural areas

Ask the Payment Expert about ... bundled payments in rural areas

By

We are in a rural area and we've tried to talk to our hospital about bundled payment but they don't seem to know what we are talking about. What can we do?

Ask the Payment Expert about... data interoperability

Ask the Payment Expert about... data interoperability

By

he SNF Final Rule indicates that interoperability of data will be important. What do we need to do about this issue?

Ask the Payment Expert about... new quality measures

Ask the Payment Expert about... new quality measures

By

What is the new Quality Measure that will be included in the new SNF Value Based Purchasing program?

Ask the Payment Expert about... Quality Measures

Ask the Payment Expert about... Quality Measures

By

What are the Quality Measures that will be included in the new SNF Value Based Purchasing program?

Ask the Payment Expert about... SNF Final PPS rule

Ask the Payment Expert about... SNF Final PPS rule

By

The SNF Final PPS rule for fiscal 2016 talks about SNF Value Based Purchasing. Can you explain it?

Ask the Payment Expert about... bundled payments

Ask the Payment Expert about... bundled payments

By

Is it true that hospitals may be able to send patients to us following joint replacement surgery without a three-day hospital stay?

Ask the Payment Expert ... about MDS-focused surveys

Ask the Payment Expert ... about MDS-focused surveys

By

I keep hearing about MDS-focused surveys. What are they?

Ask the payment expert ... about administrative financial knowledge

Ask the payment expert ... about administrative financial knowledge

By

How important is it for department managers to understand financial information?

Ask the payment expert ... about quality metrics

Ask the payment expert ... about quality metrics

By

A metric is a measurement of some sort of factor. For a quality metric, we are measuring quality in your facility. Companies measure performance against quality standards to determine whether they're meeting expectations. This measurement may be compared to benchmarks by labor market, by state or by national prevalence.

Ask the payment expert ... about long-term compliance

Ask the payment expert ... about long-term compliance

By

Sometimes we feel like we're spinning our wheels in correcting problem areas in our facility. What can we do to ensure ongoing compliance in problem areas?

Ask the payment expert ... about ABNs and denial letters

Ask the payment expert ... about ABNs and denial letters

By

Can you demystify the ABNs and denial letters process?

Ask the payment expert ... about PEPPER reports

Ask the payment expert ... about PEPPER reports

By

We never downloaded our PEPPER report. How important is it?

Ask the payment expert ... about regs vs. resident choice

Ask the payment expert ... about regs vs. resident choice

By

We are going through culture change and wonder if surveyors will be more lenient with regulations if we do something that is resident choice?

Ask the payment expert ... about supporting MDS completion

Ask the payment expert ... about supporting MDS completion

By

What is the best nursing structure to support the MDS process?

Ask the payment expert ... about facility comparisons

Ask the payment expert ... about facility comparisons

By

What information is available so we can compare our nursing facility to others in the industry?

Ask the payment expert ... about Medicare audit guidelines

Ask the payment expert ... about Medicare audit guidelines

By

What guidelines should we use for a Medicare audit?

Ask the payment expert ... about continuing RAC requests

Ask the payment expert ... about continuing RAC requests

By

I thought the Recovery Audit Contractors (RACs) were on hold. Why did we still get a request for records?

Ask the payment expert ... about Medicare changes

Ask the payment expert ... about Medicare changes

By

What significant changes in Medicare occurred for us in 2014?

Ask the payment expert ... about quality of care and reimbursements

Ask the payment expert ... about quality of care and reimbursements

By

Many states are at the forefront of pay for performance initiatives. These tie payment incentives to quality measurements and outcomes. These programs are encouraged by the Centers for Medicare & Medicaid Services' value-based purchasing "Pay for Performance" initiative.

Ask the payment expert ... about Medicare technical requirements

Ask the payment expert ... about Medicare technical requirements

By

We were told we didn't meet technical requirements for Medicare. What does that mean?

Ask the payment expert ... about the financial benefits of QAPI

Ask the payment expert ... about the financial benefits of QAPI

By

What are the financial benefits to implementing CMS's Quality Assurance Performance Improvement program?

Ask the payment expert ... about the Brief Interview for Mental Status

Ask the payment expert ... about the Brief Interview for Mental Status

By

Is there anything we should be doing with the results of the Brief Interview for Mental Status (BIMs) and PHQ-9 that we get from the MDS?

Ask the payment expert ... about changes related to Jimmo v. Sebelius

Ask the payment expert ... about changes related to Jimmo v. Sebelius

By

How come there are so many Medicare A denials when Jimmo v. Sebelius stated we could keep residents on Medicare A even if they are not improving?

Ask the payment expert ... about MDS changes and payment

Ask the payment expert ... about MDS changes and payment

By

With all the changes to the MDS on Oct. 1, 2013, how will payment be affected?

Ask the payment expert ... about PEPPER reports

Ask the payment expert ... about PEPPER reports

By

What can you tell us about PEPPER reports?

Ask the payment expert ... about clinical qualifiers

Ask the payment expert ... about clinical qualifiers

By

Most of our residents are covered under rehab services, so why do we need to worry about capturing clinical qualifiers?

Ask the payment expert ... about MDS staffing

Ask the payment expert ... about MDS staffing

By

We recently lost our MDS nurse and didn't know what to do, as no one else knew how to do MDSs. What should we do differently now?

Ask the payment expert ... about RAC nursing home audits

Ask the payment expert ... about RAC nursing home audits

By

We keep hearing about RACs in skilled nursing homes but we haven't seen any in our state, so why should we worry about them?

Ask the payment expert ... about monitoring therapy services

Ask the payment expert ... about monitoring therapy services

By

Q: What should an administrator do to monitor therapy services in his or her facility? A: The main fact to remember is that you are responsible for what happens in your therapy department, even if you have a contract company.

Ask the payment expert ... about quality and reimbursement correlations

Ask the payment expert ... about quality and reimbursement correlations

By

How can the Centers for Medicare & Medicaid Services correlate quality of care and reimbursement? You always need to remember that Medicare is an insurance plan. As such, Medicare has rules, just like your insurance company. Two of those rules are that we must provide care according to an individualized care plan for each resident and that we provide appropriate discharge planning.

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

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

By

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

Ask the payment expert ... about matching diagnoses codes

By

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?

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

By

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?

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

By

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?

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

By

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?

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

By

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?

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

By

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?

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

By

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.