UPDATE Weekly

Below is a listing of the 2014 Fabulous Fifty recipients. NCHCFA would like to thank all facilities that submitted nominations. We had a tremendous response to help recognize front-line staff for their contributions. Each of this year’s recipients will be honored at the Awards program in their district. The 14th Annual Fabulous Fifty Special Recognition Awards program will be at the following locations:

District I – October 15, 2013, Grand Bohemian Hotel, Asheville
District II – October 21, 2013, Hilton Charlotte University Place, Charlotte
District III – October 24, 2013, Grandover Resort, Greensboro
District IV – October 29, 2013, Mad Boar Restaurant, Wallace
District V – November 4, 2013, Renaissance North Hills Hotel, Raleigh

District I
Derf Donald – Pisgah Manor, Candler, NC
Debra Galmer – Cleveland Pines Nursing Center, Shelby, NC
Genease Hannon – Peak Resources-Shelby, Shelby, NC
Delores Jones – Skyland Care Center, Sylva, NC
Garnet McMillan – Macon Valley Nursing and Rehab, Franklin, NC
Patricia Moore – White Oak Manor-Tryon, Tryon, NC
Bob Oliphant – Madison Health and Rehab, Mars Hill, NC
Paula Oxentine – Glenbridge Health and Rehab, Boone, NC
Helix Tate – Grace Heights Health and Rehab, Morganton, NC
Steven Whiteside – White Oak Manor-Tryon, Tryon, NC

District II
Sherron Barnes – Trinity Oaks, Salisbury, NC
Rovonda Campbell – Hunter Woods Nursing and Rehab, Charlotte, NC
Bobbie Doster – Carrington Place, Matthews, NC
Jennifer Engelhaupt – The Oaks at Town Center, Harrisburg, NC
Noel Hathcock – Trinity Place, Albemarle, NC
Sharon Hash – Alleghany Center, Sparta, NC
Tiffany Johnson – Westwood Hills Nursing and Rehab, Wilkesboro, NC
Lisa Mickalowski – Bermuda Commons Nursing and Rehab, Advance, NC
Paulette Powell – Trinity Ridge, Hickory, NC
Lisa Talmage – Jesse Helms Nursing Center, Monroe, NC

District III
Elias Anchante – Oak Forest Health and Rehab, Winston-Salem, NC
Karen Boykins – Maple Grove Health and Rehab, Greensboro, NC
Veronica Cheek – Universal Health Care-Ramseur, Ramseur, NC
Dorothy Cottingham – Westwood Health and Rehab, Archdale, NC
Aileen Cranford – Clapp’s Convalescent Nursing Home, Asheboro, NC
Pam Flinchum – Clapp’s Nursing Center, Pleasant Garden, NC
Belinda Gallimore – Universal Health Care-Ramseur, Ramseur, NC
Glenn Gillis – Peak Resources-Treyburn, Durham, NC
Wanda Hairston – Walnut Cove Health and Rehab, Walnut Cove, NC
Wilhemina Thompson – Peak Resources-Alamance, Graham, NC

District IV
Brandi Goodchild – Harnett Woods Nursing and Rehab, Dunn, NC
Joyce Holloway – Brian Center Health and Rehab-Goldsboro, Goldsboro, NC
Annie Leggett – Peak Resources-Pinelake, Carthage, NC
Vivian Packer – Liberty Commons-Columbus County, Whiteville, NC
Nellie Phynon – Bayview Nursing and Rehab, New Bern, NC
Cathy Smith – Golden Years Nursing Home, Falcon, NC
Cleophas Smith – Cherry Point Bay Nursing and Rehab, Havelock, NC
Johnnie Lou Smith – Trinity Grove, Wilmington, NC
Stephanie Smith – Southwood Nursing and Rehab, Clinton, NC
Dyane Michelle Thompson – Highland Acres Nursing and Rehab, Lumberton, NC

District V
Clara Alston – Universal Healthcare-Oxford, Oxford, NC
Annette Badgett – Wellington Rehab and Healthcare, Knightdale, NC
Donald Daugherty – Roanoke River Nursing and Rehab, Williamston, NC
Carol Dickens – Longleaf Neuro-Medical Treatment Center, Wilson, NC
Andre Gaston – UniHealth Post-Acute Care-Raleigh, Raleigh, NC
Katina Harris – Universal Healthcare-Greenville, Greenville, NC
Robert Lockey – WilMed Nursing Care Center, Wilson, NC
Janet Pankey – Golden Living Center-Greenville, Greenville, NC
Sidney Richardson – South Village, Rocky Mount, NC
Elizabeth Tyner – Rex Rehab and Healthcare of Apex, Apex, NC

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The following summary reports the most recent updates to the NCTracks issues being experienced by most nursing home providers. Please make sure that the appropriate billing staff receives this information.

1. Double collection of the June 2013 personal monthly liability: For the month of June 2013, the monthly patient liability was collected by both HP and NCTracks. According to NCTracks representatives, a resolution to this issue has been put in place. NCTracks is instructing providers to refile the impacted claims. The claims should re-process with the proper monthly liability amount on the claim.
2. FL-2 approval issues: The processing of FL-2s still poses an issue with many providers. NCTracks is now starting to mail letters to providers with information on some of the submitted FL-2s. Unfortunately, NCTracks suggests that providers still having FL-2 processing issues contact the NCTracks call center for assistance. NCTracks representatives feel that most of the FL-2 errors are due to improper submission and are developing a training webinar to educate providers.
3. Code 0094, bill other insurance: Claims are being denied with code 0094 – Bill other insurance, even though the recipient has no other insurance coverage in effect. Under HP, providers had billed these claims with an occurrence code 24. To fix this denial issue, the State needs to override the suspected third party liability. This can be done by contacting Marilyn Vail at marilyn.vail@dhhs.nc.gov. Providers should include their NPI and Recipient ID, Name and Admission Date. When sending personal health information by e-mail, the file containing the PHI should be password protected or encrypted. Alternatively, you can fax the requested information to Marilyn Vail at (919) 715-7133. Once the other insurance has been overridden, you should be able to resubmit these claims and get paid. The 24 occurrence code will not be needed.
4. Medicare bad debt: Currently, the RAs are not showing the proper information needed to support and claim the unpaid crossover balance on the Medicare bad debt log. NCTracks is currently addressing this issue and intends to furnish providers with credible support for the bad debt portion of the crossover claims. According to the bad debt section at Palmetto GBA, providers will be able to use information other than the Medicaid Remittance Advices, from an outside entity, to support their bad debt claims. In addition, providers do not need to have this documentation on hand as of the end of their Medicare cost reporting period. NCHCFA representatives will continue to work with NCTracks and Palmetto GBA to address this issue.
5. Medicare Part C crossover claims: NCTracks and NC DHHS are still working on a method to address the submission of current Medicare Advantage claims as well as the processing of the Medicare Advantage claims previously submitted to HP.

As more information comes available, it will be printed in our weekly newsletter, UPDATE.

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Palmetto GBA has announced an upcoming enhancement to their initial demand letter (overpayment letter) process. In order to assist providers with the routing of demand letters within their office/facility, Palmetto GBA will soon begin issuing initial demand letters using envelopes with a red strip on the top. Envelopes received from Palmetto GBA with a red strip will alert mailroom and other staff that the envelope contains a time sensitive overpayment demand letter which should be immediately routed to the proper area for action.

Watch for this new envelope alert mechanism and share with your appropriate staff.

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The Affordable Care Act (ACA) requires employers to provide all new hires and current employees with a written notice about the ACA’s health insurance exchanges (exchanges), effective Oct. 1, 2013.

Recently, the Department of Labor (DOL) issued frequently asked questions (FAQ) on the penalties for failing to provide an exchange notice. In this FAQ, the DOL stated that there is no fine or penalty under the ACA for failing to provide the notice.

The ACA requires all employers that are subject to the Fair Labor Standards Act (FLSA) to provide a written notice to their new and current employees about the exchanges.

The notice should inform employees:

• About the exchange;
• That they may be able to get lower-cost private insurance in the exchange; and
• That they may lose the employer contribution (if any) to their health benefits if they buy insurance through the exchange.

The DOL has issued two model notices to help employers comply. There is one model for employers that do not offer a health plan and another model for employers that offer a health plan for some or all employees:

• Model notice for employers that offer a health plan to some or all employees
• Model notice for employers that do not offer a health plan

Although this FAQ asserts that there will be no penalties for failing to provide an exchange notice, there are several reasons employers may still want to provide the notice.

The exchange notice can help employers answer employee questions about:

• What the exchange is;
• Whether the employer will still provide a plan once the exchanges are operational;
• How exchange plans are different from the employer’s plan; and
• Whether the employer’s plan is intended to be affordable and provide minimum value.

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The North Carolina Culture Change Coalition is accepting culture change grant applications from every certified nursing home.

The Coalition has made major changes to its grant program in accordance with new rules from CMS which took effect in 2012. Facilities will apply for grants using the updated RFA, which is available throughout the year. Once the coalition receives the proposal, trained members will review the application to make sure it meets CMS criteria. Each section of the application will be scored on the basis of incomplete, needs improvement, acceptable, or exceptional. Any section of the proposal receiving an incomplete or needs improvement will be sent back to the facility, and a trained coalition member will mentor the facility to help refine the section(s). Once all sections meet the acceptable or exceptional score, DHHS will help the facility convert the application into CMS’s required format and will then send the application to CMS for review. CMS has 45 days to make a determination on the application and may contact the facility for further information if necessary. Approval or denial is made by CMS and all decisions are final.

While this represents a major change in the method for reviewing grant proposals, the Coalition is willing to work with any eligible facility wishing to use CMP money to fund enhancement projects so they have the best chance of having their application approved by CMS. The revised RFA became available in early April and was sent to the administrators of all eligible North Carolina facilities. If you have any questions about the program, or need assistance with the application process, please contact Becky Wertz, becky.wertz@dhhs.nc.gov.

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The North Carolina Culture Change Coalition is offering one more free grant application workshop. This final workshop will be offered on October 9, 2013 at Davis Health Care Center, 1011 Porters Neck Road, Wilmington, NC 28411, either 9:00 AM – 12:00 Noon or 1:00 – 4:00 PM.

3.25 Administrator CEUs, drinks and snacks will be provided. To register, contact Patsy Rudolph at patsy.rudolph@kindred.com. Comments and questions can be directed to Becky Wertz, becky.wertz@dhhs.nc.gov or by visiting the NC Culture Change Coalition’s Web site at http://www.ltcenhance.com.

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Mark your calendar today for the North Carolina Health Care Facilities Association’s “Falls Prevention-Train the Trainer” with Sue Ann Guildermann! This comprehensive two-day program will cover Empira’s comprehensive fall prevention and reduction program in more detail. If you missed Sue Ann’s one-day seminar in March, you will NOT want to miss this two-day program!

This two-day course will be held November 13-14, 2013 in Greensboro, NC. Brochures will be mailed this fall! You must attend both days to receive credit.

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The May 2013 edition of the AHCA’s RAI/MDS User’s Manual, Version 3.0 is now available! The latest updates from CMS include revisions/updates to Chapters 2, 3, and 5. AHCA offers the RAI/MDS in two versions, a 3-ring binder with 49 tabs for easy reference or an e-book that is easy to navigate, and has excellent search capabilities.

The new May 2013 edition of the Long Term Care Survey has all the recent updates from CMS, including revisions to Appendix P on Dementia Care in Nursing Homes, and Appendix PP: F-Tag 309, Quality of Care, F-Tag 329, Unnecessary Drugs, as well as the earlier revisions to F-Tag 441 on Infection Control and F-Tag 155, Advanced Directives. New BONUS CD-ROM includes an electronic manual for convenient search of keywords and F-Tag numbers, exhibits/forms, and CMS transmittals. Order your copy today!

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

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NCHCFA is excited to offer this remake of our most popular educational tool, 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. This DVD 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 may be reproduced and accompany each video. To order, contact Jan Williams at janw@nchcfa.org.

The price is $35.00 (tax and shipping included).

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Thinking about death is frightening, but planning ahead is practical and leaves more room for peace of mind in our final days. In a solemn, thoughtful talk, Judy MacDonald Johnston shares 5 practices for planning for a good end of life.

http://www.ted.com/talks/judy_macdonald_johnston_prepare_for_a_good_end_of_life.html

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A contronym is a word that can be its own opposite, for example, “left” can mean to “depart” and “remain”.

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