Ask the payment expert
It seems like Medicare always has so much information about us. How can we access that data?
Our referral hospital system is asking us what our cost of care is. How do I calculate that?
Can you explain the new Payroll-Based Journal system?
Can you explain the new MDS Section and assessment?
How do bundled payment initiatives affect my facility?
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?
he SNF Final Rule indicates that interoperability of data will be important. What do we need to do about this issue?
What is the new Quality Measure that will be included in the new SNF Value Based Purchasing program?
What are the Quality Measures that will be included in the new SNF Value Based Purchasing program?
The SNF Final PPS rule for fiscal 2016 talks about SNF Value Based Purchasing. Can you explain it?
Is it true that hospitals may be able to send patients to us following joint replacement surgery without a three-day hospital stay?
I keep hearing about MDS-focused surveys. What are they?
How important is it for department managers to understand financial information?
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.
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?
Can you demystify the ABNs and denial letters process?
We never downloaded our PEPPER report. How important is it?
We are going through culture change and wonder if surveyors will be more lenient with regulations if we do something that is resident choice?
What is the best nursing structure to support the MDS process?
What information is available so we can compare our nursing facility to others in the industry?
What guidelines should we use for a Medicare audit?
I thought the Recovery Audit Contractors (RACs) were on hold. Why did we still get a request for records?
What significant changes in Medicare occurred for us in 2014?
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.
We were told we didn't meet technical requirements for Medicare. What does that mean?
What are the financial benefits to implementing CMS's Quality Assurance Performance Improvement program?
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?
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?
With all the changes to the MDS on Oct. 1, 2013, how will payment be affected?
What can you tell us about PEPPER reports?
Most of our residents are covered under rehab services, so why do we need to worry about capturing clinical qualifiers?
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?
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?
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.
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.
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?
How important is it that diagnoses coded in Section I of the MDS match what is being billed on the UB-04?
The new RUGs-IV scoring methodology has a strong tendency to score your ADLs lower.
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?November 01, 2012
Rehospitalization is another way that the Centers for Medicare & Medicaid Services is looking to cut Medicare costs.
Now that we are a few months after the April MDS assessment changes, how are rules working for facilities?
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.
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.
We are getting a new electronic charting system. Is there anything we should be aware of with the change?
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.
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.
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.
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.
Patricia Boyer, MSM, NHA, RN, President, Boyer & Associates, LLC
Patricia Boyer, MSM, NHA, RN, President, Boyer & Associates, LLC