UPDATE Weekly

According to what AHCA is hearing in DC, the Centers for Medicare & Medicaid Services (CMS) plans to more aggressively review ICD-10-CM code sets for claims payments, making accurate ICD-10-CM implementation critical to our membership. As you know, the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code set will soon replace the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code set used to report medical diagnoses and inpatient procedures through the Health Insurance Portability and Accountability Act (HIPAA) standard transactions. Any provider covered by the Health Insurance Portability Accountability Act (HIPAA), including most long term and post acute care organizations must implement ICD-10-CM by October 1, 2015. After that date, providers will not be able to use ICD-9-CM codes.

According to CMS, the new ICD-10-CM code set implementation will affect long term and post acute care providers in a number of ways:

• Nursing facility (NF) providers will need to align with the federal CMS guidelines for Minimum Data Set (MDS) submission.
• LTC providers will be required to submit ICD-10-CM diagnosis codes on all claims.
• Primary diagnosis codes will be required on the Long Term Care Medicaid Information (LTCMI) section of the MDS submitted on the LTC Online Portal.
• Community Services providers must be prepared to submit the Medical Necessity and Level of Care (MN/LOC) Assessment using the new ICD-10-CM diagnosis codes.

As the implementation date gets closer, AHCA encourages long term and post acute care providers to start now to educate and train staff; make the required software changes to submit accurate assessments or claims with ICD-10 CM code sets; and monitor any state Medicaid policy changes that may be required by ICD-10-CM code sets. Although CMS has provided numerous tools and resources for certain health care providers, it has not very successfully provided tools for long term and post-acute care providers. AHCA is currently planning its own series of Webinars especially for our sector (mark your calendars for Dec. 5th and 11th), which will be advertised shortly. In the meantime, to obtain more general information regarding ICD-10 implementation information go to:

• Video: ICD-10: Getting From Here to There — Navigating the Road Ahead
• Video: ICD-10 and Clinical Documentation
• Expert Column: Preparing for ICD-10: Now Is the Time
• View the ICD-10 Introduction fact sheet and FAQs for an overview of ICD-10.
• Find official resources designed to help providers, payers, vendors, and non-covered entities with the transition to ICD-10.

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The North Carolina Health Care Facilities Association is turning 60 in 2015! All members are invited to join in the celebration at the NCHCFA Diamond Jubilee, February 15-18, 2015 at the Sheraton Four Seasons Hotel/Koury Convention Center in Greensboro, NC. Are you ready to reminisce? Join us as we take a look back in time to when it all began. NCHCFA will be honoring all members from the past and present. Brochures outlining specific program information will be available in December.

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The Intent to Apply deadline is Thursday, November 13, 2014 at 8 p.m. ET. The AHCA/NCAL National Quality Award Program provides a pathway for providers of long term and post-acute care services to journey towards performance excellence. The program is based on the core values and criteria of the Baldrige Performance Excellence Program. Member centers may apply for three progressive levels of awards: Bronze—Commitment to Quality, Silver—Achievement in Quality, or Gold—Excellence in Quality. Each level has its own distinct rigors and requirements for quality and performance excellence.

Applicants for the 2015 National Quality Award Program are strongly encouraged to submit the $75 Intent to Apply payment prior to the deadline. This is not mandatory; however, there are a number of benefits associated with submitting an Intent to Apply:

• The overall application fee is reduced by $200; and
• Applicants who submit the Intent to Apply will receive regular communications from Quality Award staff with deadline reminders, tips on applying for the award, and links to educational webinars.

For more information and to apply click on this link National Quality Award Program to go to the AHCA/NCAL Web site.

Please note that the Intent to Apply fee is non-refundable. Late payments will not be accepted.

Click here to start the process.

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Palmetto GBA performed service-specific prepayment targeted medical review on Skilled Nursing Facility (SNF) claims, for the 14 Lower Resource Utilization Group (RUG) Codes. This edit was set in North Carolina, South Carolina, Virginia and West Virginia.

In North Carolina, 304 claims were reviewed with 162 of the claims either completely or partially denied. The total dollars reviewed was $610,222.56, out of which $285,554.35 were denied, resulting in a charge denial rate of 46.8 percent. The top denial reasons identified, based on dollars denied, were:

For additional information as well as the results from the other states reviewed, click here.

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The “Skilled Nursing Facility Prospective Payment System” Fact Sheet (ICN 006821) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the Skilled Nursing Facility Prospective Payment System (SNF PPS).

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The “Updated LEIE” database file reflects all OIG exclusion and reinstatement actions up to, and including, those taken in October 2014. This new, “Updated LEIE” (List of Excluded Individuals and Entities) is a complete database file containing all exclusions currently in effect. Individuals and entities that have been reinstated to the federal health care programs are not included in this file.

All the updated files are posted at http://oig.hhs.gov/exclusions/exclusions_list.asp.

Instructional videos explaining how to use the online database and the downloadable files are available:

• On-line Database Video: http://oig.hhs.gov/exclusions/online.asp
• Downloadable Database Video: http://oig.hhs.gov/exclusions/download.asp

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The US Supreme Court has agreed to review the legal challenge in King v Burwell (most likely hearing the case in March 2015) and to decide whether or not the Obama Administration is improperly providing tax subsidies to consumers who purchase insurance through the Federal Exchanges (in more than 30 states). This will mark the third time that the US Supreme Court will hear litigation focusing on the Affordable Care Act (ACA), and casts a cloud on the tax subsidies issues as the second round of open enrollment for insurance through the Exchanges is set to begin. In 2012, the US Supreme Court upheld the constitutionality of the ACA; but also found the Medicaid expansion provision unconstitutionally coercive to the states, leaving Medicaid expansion optional for the states. Then earlier this year, the Court carved out an exception for providing contraceptive coverage for employers who object for religious reasons. Now, in agreeing to hear King v Burwell, the US Supreme Court will review the lower court (US Court of Appeals for the Fourth Circuit) decision that upheld the subsidies for the Federal Exchanges. Recall that on the same day that the Fourth Circuit released its decision, a panel of the US Court of Appeals for the District of Columbia (DC) Circuit struck down the subsidies. The full DC Circuit was poised to reconsider this matter in December; but now pending the US Supreme Court review, this action is on hold. Depending on how the US Supreme Court rules on this matter, their final decision could seriously dismantle the ACA.

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Information on upcoming Skilled Nursing Facility (SNF) open door forums, hosted by the Centers for Medicare & Medicaid Services (CMS) may be found by clicking here. The next call will be held on November 13th.

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This book will teach directors of nursing, charge nurses, and staff educators proven strategies to empower staff members to take more ownership and responsibility in their jobs. Quantifying an intangible concept such as accountability can be difficult, but the author reveals the successful six-step plan that she uses with her own staff to achieve measurable results. This manual provides helpful tools to set expectations for behavior and standards of practice. A key training resource for both new and experienced managers, it is perfect for directors, administrators, managers, and staff educators. Clinical Accountability in Long-Term Care will help you:

• Set expectations to hold staff accountable in a variety of situations
• Practice accountability individually and within multidisciplinary work relationships
• Use active listening and assertive speaking
• Recognize and change no commitments to commitments
• Differentiate between the terms “responsibility” and “accountability”
• Assess the level of accountability of managers and supervisors

To order, visit http://www.AHCApublications.org or call (800) 321-0343.

Product #6746
AHCA MEMBERS $129.00

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This DVD, Mobility and Safe Movement of the Elderly, Improving Your Skills to Prevent Injuries and Reduce Falls, by Teepa Snow, MS, OTR/L., FOTA, Dementia Care & Training Specialist, was developed in conjunction with Wake Allied Health Education Center, Durham Technical Community College and the University of North Carolina School of Medicine, Office of Information Systems. The content is formatted in separate segments in order to customize the delivery of content to your learning objective. Handouts developed by Teepa accompany each video and may be reproduced. To order, e-mail your request to Jan Williams at janw@nchcfa.org. The price is $35.00 (tax and shipping included).

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Exercise and Depression

http://abcnews.go.com/Health/Depression/story?id=117946

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During the fall, in response to colder temperatures and less light, leaves stop producing chlorophyll, the green pigment that helps capture sunlight to power photosynthesis. As the green fades, the leave’s other pigments shine through, such as orange and yellow carotenoids and vibrant red anthocyanin.

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