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

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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.

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