Ask the payment expert

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

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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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What can you tell us about PEPPER reports?

Ask the payment expert ... about clinical qualifiers

Ask the payment expert ... about clinical qualifiers

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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

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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

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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

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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

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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

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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

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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?

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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?

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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?

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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?

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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?

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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?

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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?

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

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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?

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

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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?

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

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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?

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

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?

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

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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.

Ask the payment expert...Should we add more MDS staff to meet new regulations?

Ask the payment expert...Should we add more MDS staff to meet new regulations?

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Patricia Boyer, MSM, NHA, RN, President, Boyer & Associates, LLC

Ask the payment expert: How to maintain solvency under increased Medicare scrutiny (Part III)

Patricia Boyer, MSM, NHA, RN, President, Boyer & Associates, LLC

Ask the payment expert: Coping with RUG payment reductions, Part II

Ask the payment expert: Coping with RUG payment reductions, Part II

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Patricia Boyer, MSM, NHA, RN, President, Boyer & Associates, LLC

Ask the payment expert: How can facilities remain financially solvent with potential RUG reductions?

Ask the payment expert: How can facilities remain financially solvent with potential RUG reductions?

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Patricia Boyer, MSM, NHA, RN, President, Boyer & Associates, LLC

Ask the payment expert: Can facilities remain financially solvent with possible RUG reductions looming?

Ask the payment expert: Can facilities remain financially solvent with possible RUG reductions looming?

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Patricia Boyer, MSM, NHA, RN, President, Boyer & Associates, LLC

Ask the payment expert: Can a facility bill a higher RUG rate for two residents in isolation?

Ask the payment expert: Can a facility bill a higher RUG rate for two residents in isolation?

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Patricia Boyer, MSM, NHA, RN, President, Boyer & Associates, LLC

Why so many A's in our RUG-IV categories?

Why so many A's in our RUG-IV categories?

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Patricia Boyer, MSM, NHA, RN, President, Boyer & Associates, LLC

Ask the payment expert: Is 'look back' documentation still required

Ask the payment expert: Is 'look back' documentation still required

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Patricia Boyer, MSM, NHA, RN, President, Boyer & Associates, LLC

Billing correctly using MDS/RUGs system

Billing correctly using MDS/RUGs system

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Patricia Boyer, MSM, NHA, RN, President, Boyer & Associates, LLC

Ask the payment expert: Measuring the impact of resident interviews and MDS 3.0

Ask the payment expert: Measuring the impact of resident interviews and MDS 3.0

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Patricia Boyer, MSM, NHA, RN, President, Boyer & Associates, LLC

Legislation would increase surveyor influence, training

Legislation would increase surveyor influence, training

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Legislation recently introduced by Rep. Lucille Roybal-Allard (D-CA) would strengthen nursing home surveyor training programs, and extend whistleblower protections to surveyors.

Ask the payment expert: What should we do about our therapy services to fully capitalize on MDS 3.0 and RUG-IV?

Ask the payment expert: What should we do about our therapy services to fully capitalize on MDS 3.0 and RUG-IV?

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Patricia Boyer, MSM, NHA, RN, President, Boyer & Associates, LLC

Ask the payment expert: What is the impact of Section I of the new MDS 3.0?

Ask the payment expert: What is the impact of Section I of the new MDS 3.0?

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Patricia Boyer, MSM, NHA, RN, President, Boyer & Associates, LLC

Ask the payment expert: explaining the changes in the new Section Q of the MDS

Ask the payment expert: explaining the changes in the new Section Q of the MDS

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Patricia Boyer, MSM, NHA, RN, President, Boyer & Associates, LLC

Ask the payment expert: Will we need more staff to complete the new MDS 3.0?

Ask the payment expert: Will we need more staff to complete the new MDS 3.0?

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Patricia Boyer, MSM, NHA, RN, President, Boyer & Associates, LLC

Ask the payment expert: the efect of a RUGs-IV delay, info on the Quality Indicator Survey process

Ask the payment expert: the efect of a RUGs-IV delay, info on the Quality Indicator Survey process

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Patricia Boyer, MSM, NHA, RN, President, Boyer & Associates, LLC

Ask the payment expert: When will we see the new Care Area Assessment?

Ask the payment expert: When will we see the new Care Area Assessment?

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Patricia Boyer, MSM, NHA, RN, President, Boyer & Associates, LLC

Ask the payment expert: payment trends related to medical review

Ask the payment expert: payment trends related to medical review

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Patricia Boyer, MSM, NHA, RN, President, Boyer & Associates, LLC

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