UPDATE Weekly

Due to the expiration of the current Sustainable Growth Rate (SGR) and the therapy caps exceptions process, nursing facility providers may want to delay billing April Part B claims and issue Advance Beneficiary Notices to their residents needing Part B therapy beyond the $1,940 threshold in April. Please continue reading for further details on this issue.

Last week, the Senate completed its work regarding the budget, yet realized it lacked enough procedural time to take up the historic permanent Sustainable Growth Rate (SGR) repeal passed by the House. The so-called “vote-o-rama” concluded around 3:30 a.m. Friday morning, and the Senate recessed for their Spring Break shortly thereafter. The Senate will address the bill again. Senate Majority Leader Mitch McConnell promised that the chamber would take up the permanent repeal very soon after Senators return April 13.

Facility operators are entering a period of operational uncertainty and risk related to Medicare Part B services due to the U.S. Senate’s not voting on a new Sustainable Growth Rate (SGR) bill – also known as the Doc Fix – prior to the March 31 expiration of the current SGR and therapy cap exceptions process. There are two major issues that we want to alert you to and provide preliminary recommendations, as there is no current guidance from the Centers for Medicare and Medicaid Services (CMS).

These recommendations, as well as the content provided in the detailed FAQ document, are based upon current available information and have been reviewed and commented on by the AHCA Finance Committee’s Billing and Operations Subcommittee and the Therapy Policy Advisory Group. We encourage SNF operators to review and consider these recommendations within the context of their current operational policies.

First Issue

Technically, a -21.2 percent adjustment would apply to the Part B fee schedule effective April 1. However, if the SGR bill is enacted when the Senate returns from recess, this will not apply and there will be a 0.0 percent adjustment from April 1 – June 30. CMS will most likely hold processing of Part B claims for up to 14 days to avoid changing its billing systems while Congress acts.

To mitigate this risk, AHCA recommends that SNF operators hold any Part B claims with dates of services on or after April 1 until it is clearer what will happen in the Senate. Most SNF operators typically bill on a monthly basis so that April dates of service would not be billed until May. We believe this will be sufficient time to let the legislative process proceed so that care centers will not have to change charge masters or resubmit claims, assuming the SGR bill is enacted after the Senate returns from recess in two weeks.

Second Issue

Technically, the therapy caps exceptions process expires on March 31 and there will be a hard $1,940 therapy cap with no exceptions. However, if the SGR bill is enacted when the Senate returns from recess, this will not apply. The problem is that until Congress acts, any therapy services furnished over the $1,940 threshold during this period of uncertainty could pose payment liability risks.

To mitigate this risk, AHCA recommends that SNF operators issue Advance Beneficiary Notices (ABNs) to beneficiaries needing Part B therapy services beyond the $1,940 threshold as of April 1, 2015. This notice will provide necessary beneficiary and provider payment liability protections depending on the resolution of the current SGR vote delay in the Senate.

For a more detailed explanation of these risks, please review the SGR Delay Impact on SNF Operations FAQ and share within your billing, therapy and other affected operational personnel.

The delay leaves us time to coordinate our advocacy efforts and reach out to Senators. We are hearing that the Senate has enough votes to pass a permanent repeal. But the Senate leaders could not move the House measure through the necessary parliamentary hoops because such a move required unanimous consent from all 100 Senators.

However, we must make the most of this time while the Senate is in recess. We must continue our push for the bill to be passed.

Action Steps

We need you to continue reaching out to your Senators if you have strong relationships with them. Even though this was not delayed because of lack of support, we need to show the Senate we are serious about a permanent fix, and there is no better messenger than their own constituents to tell them that. To view a complete list of Senators and their offices, both in Washington and their respective states, click here.

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The NC Department of Health and Human Services will soon launch a pilot initiative that provides a collective learning opportunity for professionals who assist individuals with long-term care needs to transition from facility settings to their homes and communities.

The NC Community Transitions Institute (“The Institute”) will create a learning community among participating transition coordinators, care managers, care coordinators, discharge planners, options counselors and others in order to collectively deepen the skills and approaches necessary to best ensure a quality transition.

If the Institute pilot proves to be an effective, scalable method for supporting the learning of professionals involved in transition work, the Department will develop a strategy for the Institute’s long-term sustainability.

Click here, for the outline of the Institute’s purpose and information about participation and application.

Please note that the deadline for the application is Monday, April 6th.

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Join the North Carolina Culture Change Coalition for a symposium that features an Interactive Theater performance on unnecessary wheelchair use in nursing homes. This event is open to medical directors, administrators, nursing, therapy, restorative aides, nurse aides, state surveyors and Ombudsmen.

This symposium is funded through CMP funds and FREE to four members of your certified nursing home to register. At least one of the attendees must be a certified nursing assistant. CEU credits may be provided for Administrators and nurses. Any additional registrants will be considered based on availability.

To secure a spot for this career-enhancing workshop, click here.

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Each month, the Division of Medical Assistance publishes the Medicaid Bulletin and posts it on-line. The current issue contains articles on NCTracks updates, changes in payments of Medicare crossover claims, record retention requirements, personal care services changes and trainings, and many others subjects. The current issue, as well as past issues, can be found by clicking here.

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LTC Trend Tracker is a central place to access key data to improve performance, including all the information CMS collects on skilled nursing centers. AHCA members can find exclusive, in-house measures to help gain insight on hospital readmissions and discharges to the community. To ensure members get the most from this web-based resource, AHCA continues to make updates and improve LTC Trend Tracker. The Five Star reports and the Five Star Rating predictor feature have been updated in LTC Trend Tracker to reflect the recent CMS changes. The Rating Predictor features allow users to see how potential changes can impact a center’s Five Star QM Rating and Staffing Rating. AHCA has also recently added the new Length of Stay (LOS) metric. The new feature calculates the median LOS for all new admissions from a hospital, as well as the percentage of new admissions who have stays of seven, 14, 20 and 45 days or fewer. For details on these reports and how they can serve your organization’s needs. Click here for more information.

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CSC has Regional Provider Relations Representatives, serving all regions of the state of North Carolina. Provider site visits can be requested online using the NCTracks Provider Portal. Click on the Contact Us link, found at the bottom of every NCTracks Web page, complete the form, select the Subject “Request a Site Visit” from the drop down box, and click on the “Send” button. A Provider Relations Representative will be in contact to schedule a site visit.

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On Tuesday, the US Supreme Court decided that private health care providers cannot sue State Medicaid agencies over low reimbursement rates. To read more of this story from Modern Healthcare, click here.

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“Bring on the Fiesta!” is this year’s theme for National Nursing Home Week! Speak the language of Familia, Vida and Amor during National Nursing Home Week 2015! Imagine an event that brings the long-term care (LTC) community of residents, rehab patients, families and care center staff together for a weeklong festival in 2015. Think of all the fun your LTC community can have, which is precisely why the American Health Care Association (AHCA) will designate National Nursing Home Week (NNHW) as “Bring on the Fiesta!” week. Visit AHCA’s on-line store to view the colorful and fun product line for this special week! (Don’t wait until the last minute! National Nursing Home Week products are very popular and will sell out quickly!) National Nursing Home Week is May 10-17, 2015!

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The NC State Board of Examiners for Nursing Home Administrators will offer the 2015 Preceptor Seminars on April 20-21, 2015 and April 21-22, 2015 at the Kingston Plantation, Myrtle Beach, SC. You will need to choose the first seminar dates for Renewal Preceptor certification and the second seminar dates for Initial Preceptor Certification and Continuing Education Only. The seminars will be open to all nursing home administrators seeking continuing education credits and/or preceptor certification. This is the only Preceptor Seminar being planned for 2015 by the NC State Board of Examiners for Nursing Home Administrators.

Click here to download more information along with the registration form.

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ICD-10 coding will be implemented in just months. Is your facility ready for the transition? Nationally recognized coding expert Karen Fabrizio, RHIA, CHTS-CP, CPRA, AHIMA Approved ICD-10-CM/PCS Trainer, will help you train with her new, comprehensive ICD-10 coding training manual. Specific to long-term care, this manual gives detailed coding training and how-to guidance for the top diagnoses in the long-term care setting. ICD-10 is a complex new coding set, so it is crucial your facility is prepared.

This book provides:

• In-depth coding how-to for the most commonly documented diagnoses in the long-term care setting
• Guidance on how to properly document and code in ICD-10 to ensure appropriate coding on claims
• Quiz questions, examples, and sample scenarios to help train staff
• A detailed understanding of how long-term care providers in particular can best conquer ICD-10 complexities
• “How to” chapters that focus on each diagnostic area

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

Product #8347
AHCA MEMBERS $149.00

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Important information for residents and families… This brochure outlines what physical restraints are, when they should be used, rules and regulations concerning restraints, and making decisions about using them. To order, e-mail your request to Karen Lennon at karenl@nchcfa.org.

• NCHCFA Member: $30.00 per 100 brochures plus tax and shipping
• Non-Members: $60.00 per 100 brochures plus tax and shipping

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Most Alzheimer’s patients not given diagnosis by their doctors.

http://www.cnn.com/2015/03/25/health/alzheimers-diagnosis/index.html

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The Eiffel Tower is the most visited, paid monument in the world, 6.98 million people in 2011.

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