RUGs

Are your Ultra High RUGs putting you at risk?

Are your Ultra High RUGs putting you at risk?

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The 2016 Office of Inspector General work plan calls for increased scrutiny of the Ultra High therapy billing category because the amount of this therapy delivered has increased over time, despite resident characteristics not having changed. This work plan is a reminder that providers need to have all of their processes in order.

Ask the payment expert ... about MDS

Ask the payment expert ... about MDS

The state may be using the MDS data and RUG levels to determine the "expected staffing" that compares the staffing levels to the RUGs levels.

Entitlement or over utilization?

Entitlement or over utilization?

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Many of our therapy patients are medically complex and we, unfortunately, are not able to predict the future, as it sometimes seems that regulators want us to do.

No more Rehab Medium RUG defaults

No more Rehab Medium RUG defaults

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Well, Oct. 1 has passed, and we're all still hanging in. The biggest changes we saw to rehab were the addition of reporting co-treatment minutes on our billing logs and Section O on the MDS. And, the new question of "how many DISTINCT calendar days" were received between SLP, OT, and PT.

What's on Your PEPPER Report?

What's on Your PEPPER Report?

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Have you received your provider-specific PEPPER report yet? The Program for Evaluating Payment Patterns Electronic Report (PEPPER) were mailed on August 30 and have been slowly arriving at skilled nursing facilities throughout the country.

Are you prepared? 5 questions you need to know the answers to

Are you prepared? 5 questions you need to know the answers to

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With all the recent regulatory changes that have come down the line, or are about to, we developed a simple five-question survey that each provider had to ask every therapy employee. If you can develop strong policies and procedures based on these questions, you will have a good offensive game plan in place.

The three C's are the key!

The three C's are the key!

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How do you justify the reason for rehab, length of stay and intensity of treatment? You turn to the 3 C's.

Changes to MDS 3.0, RUGs the focus of free Sept. 11 Super Tuesday webcast

Changes to MDS 3.0, RUGs the focus of free Sept. 11 Super Tuesday webcast

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The MDS 3.0 now plays central payment role in long-term care. But new rules and regulations are constantly emerging — and the stakes for providers have never been higher. An informative, live, one-hour webcast will help sort things out on Sept. 11. Leading the presentation will be Leah Klusch, RN, BSN, FACHA, executive director of The Alliance Training Center. Participants on the day of the webcast can earn continuing education credit, which also comes at no cost.

Rehab reimbursement and audits the focus of July Super Tuesday webcast

Rehab reimbursement and audits the focus of July Super Tuesday webcast

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Nursing home administrators who can't back up every minute of rehab therapy delivered in their building leave themselves open to auditing, warns an MDS 3.0 expert during the July 10 McKnight's Super Tuesday webcast. Every skilled nursing facility billing minutes to rehab services must be able to verify that he or she has read all of the updates to the RAI Manual, as well as all of the changes that took effect April 1, adds Leah Klusch, RN, BSN, FACHA. That and much more was discussed during the free webcast, which remains available for viewing in an online archive for a year.

OIG report: Correct nursing home Medicare pay 'immediately'

OIG report: Correct nursing home Medicare pay 'immediately'

Medicare payments to skilled nursing facilities increased unexpectedly by $2.1 billion (16%) during the first six months of fiscal 2011, according to a new report issued by the Office of the Inspector General. The OIG has asked Centers for Medicare & Medicaid Services Administrator Donald Berwick to take "immediate action" to correct this overpayment.

Future of healthcare reform still remains cloudy for Democrats

Future of healthcare reform still remains cloudy for Democrats

After narrowly passing a healthcare stopgap bill that included a therapy caps extension package, Democrats in Congress are finding it difficult to bring their major reform proposal across the finish line, according to recent reports.

Medicare case-mix likely to become more clinically complex, NIC panel asserts

Medicare case-mix likely to become more clinically complex, NIC panel asserts

The looming Medicare payment system will encourage nursing home operators to embrace more clinically complex care, according to panelists who spoke Tuesday at the 2010 National Skilled Nursing Investment Forum. A favorable reimbursement level will push this case-mix shift, they noted.

New CMS rule to eliminate section of MDS, revise RUGs

New CMS rule to eliminate section of MDS, revise RUGs

A controversial new rule from the Centers for Medicare & Medicaid rule will recalibrate Medicare case mixes under the Resource Utilization Group (RUG) system. Specifically, it will eliminate a section of the Minimum Data Set (MDS) and change the RUG classification process for short-stay residents.

CMS to cut Medicare funding to skilled nursing facilities by $360 million in fiscal year 2010

CMS to cut Medicare funding to skilled nursing facilities by $360 million in fiscal year 2010

The Centers for Medicare & Medicaid Services late Friday issued a rule that will cut $360 million in Medicare payments to skilled nursing facilities for fiscal year 2010.