Providers must be compliant with new nursing home payment rules or face rejection of claims, expert says

Share this article:

Nursing home administrators must be absolutely certain their billing department staff and MDS coordinators are up to speed on the newly implemented PPS rules for therapy, MDS expert Leah Klusch said Wednesday during a special McKnight's webcast.

With the tremendous changes that kicked in Saturday (Oct. 1), one of the shifts coding staff must be on top of is tracking changes in activities of daily living from assessment to assessment, emphasized Klusch, the executive director of the Alliance Training Center. Data that is “transmitted to MDS servers and billing must be pristine,” said Klusch.

“In the Federal Register, CMS doesn't recognize that ADLs have changed dramatically from MDS 2.0 to MDS 3.0,” Klusch said. “They are dead wrong. ADL scores changed significantly because we have a new calculator.”

If claims are submitted using the old rules, facilities can expect to face high rates of denials and rejections from the Centers for Medicare & Medicaid Services. The agency will be particularly watchful in processing therapy claims.

Klusch stressed that CMS will be looking at how therapy minutes are coded very carefully, searching for inconsistencies.

“You can never round up or down in documenting therapy minutes. If a resident received 26 minutes of therapy, do not round that to 25 or 30 minutes,” she warned.

Share this article:

More in News

Long-term care providers achieved 15% antipsychotic reduction goal, CMS announces

Long-term care providers achieved 15% antipsychotic reduction goal, ...

Long-term care facilities have reduced antipsychotic medication use by more than 15% through a large-scale initiative, according to a new report from the Centers for Medicare & Medicaid Services. That ...

Proposed Life Safety Code updates encourage more homelike environments

Updated fire safety regulations could encourage more home-like healthcare environments while increasing security to safeguard against wandering, according to a proposed rule announced Monday.

Visitor shot and killed on the grounds of an assisted living community ...

A woman visiting her mother at an assisted living facility in Kansas was gunned down in the parking lot Sunday, in what authorities are describing as a hate crime.