UPDATE Weekly

The following message was written by Mark Parkinson, President and CEO of the American Health Care Association (AHCA).

Over the past several days, we have all been watching and reading reports about the devastation caused by Hurricane Harvey in Texas and along the Gulf Coast. In these kinds of situations, we consistently hear of selfless acts by caregivers who prioritize their residents over their own families and personal property. We see our centers and communities step up to help in times of need, making space for residents who need to be evacuated. I am grateful for each and every one of our members and the way we come together in times of need.

The most recent report from Kevin Warren, the President and CEO of the Texas Health Care Association, is that more than 45 nursing facilities and 49 assisted living communities have been successfully evacuated. As flood waters continue to rise, rivers crest, and rain continues in many areas, there are potentially more at risk.

I have received messages from many of you asking how you can help. This week, the Texas Health Care Association is setting up a fund to accept donations that will help provider staff affected by Hurricane Harvey. When we have details about how to donate to the fund, we will share that with you. In the meantime, please continue to keep the providers, their staff, the families, and everyone responding to this crisis in your thoughts.

As more information is made available, NCHCFA will publish it in our weekly newsletter, UPDATE.

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As our members are aware, starting October 1, 2018, all Skilled Nursing Facility (SNF) Medicare Part A rates will be cut by 2 percent to fund an incentive payment pool. At that time, the Centers for Medicare & Medicaid Services (CMS) will adjust payments and return some amount to providers based on how well they do in managing hospital readmissions by meeting or exceeding performance standards. This CMS effort, the SNF Value Based Purchasing (VBP) Program, links financial outcomes to quality performance.

Providers may think they don’t have to focus on the SNF VBP program yet as it does not affect payment until 2018. But CMS is currently collecting rehospitalization data that will be used to determine how much centers earn back.

This week we are featuring Reducing Hospitalizations through Palliative Care, part seven of a 10-part resource series designed by the American Health Care Association to support members in reducing rehospitalizations.

Follow the journey of a facility that recognized the need to strengthen skill in palliative care and ended up reducing rehospitalizations.

Check out this resource here to learn more.

For more information about the SNF VBP program and to access additional resources and tools, visit the AHCA SNF VBP Web site here.

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The Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) rates will see a 1% market basket increase effective October 1, 2017. This market basket increase is to the base rate components. Not all providers will realize a 1% increase in their rates due to changes in the wage indexes used to calculate rates for each county. Onslow County facilities will see a 7.4% increase in their rates while facilities in Edgecombe and Nash counties will see a reduction of 2.36%. All other providers fall somewhere between these extremes.

The American Health Care Association has developed a Medicare SNF PPS rate calculator to assist members in examining and estimating the impact of payment changes to the SNF PPS rates. Using information on your distribution of Medicare Part A days by RUG category, the calculator will allow you to simulate and understand the impact of the final SNF PPS payment policy changes for FY 2018 on a facility.

To prepare the rate estimates, please take the following steps on the “Inputs and Results” tab of this Excel spreadsheet:

1. Select your facility location in the drop-down menu.
2. Enter the Medicare patient days by RUG category under the RUG-IV payment system.

The difference between the average Medicare rate for fiscal year 2018, effective October 1, 2017, and the average Medicare rate for fiscal year 2017, effective October 1, 2016, will be expressed in dollar and percentage amounts. You will be able to estimate the impact of the per diem payment changes effective October 1, 2017. For your information, the average Medicare rate for fiscal year 2017, effective October 1, 2016 is also provided.

The information contained in the “Inputs and Results” and “Rate Calculation” tabs may be printed.

To access the FY2018 Medicare SNF PPS Rate Calculator, click here.

Please note that the rates provided in this calculator are the same as those published in the Federal Register. It has been determined that discrepancies may exist between the rates in this calculator and the SNF PPS PC Pricer due to rounding.

Palmetto GBA has also posted their Excel rate file for the Medicare rates effective October 1, 2017. This file can be found by clicking here.

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Change Request (CR) 10163 provides updates to the lists of Healthcare Common Procedure Coding System (HCPCS) codes that are subject to the Consolidated Billing (CB) provision of the SNF Prospective Payment System (PPS). The CR corrects an error impacting certain claims with dates of service on or after January 1, 2015, that Medicare mistakenly denied rejected prior to implementation of CR10163. Make sure your billing staff is aware of these changes.

Certain radiation therapy codes are included as services that are not subject to SNF CB. These codes can be submitted globally (no modifier), professional component only (modifier 26), or technical component only (modifier TC).

When the codes listed below are submitted globally or just for the technical component, the claims are being rejected by Medicare’s Common Working File (CWF). In other words, they are not allowed to pay separately outside of the consolidated payment that is made to the SNF.

When submitted with the 26 modifier for just the professional component, the claims have been allowed to pay. The following are the allowable HCPCS codes: 77014, 77750, 77761, 77762, 77763, 77776, 77777, 77778, 77785, 77786, 77787, 77789, 77790, 77799, 79005, 79101, and 79445.

This error is occurring because the codes were not added by CMS to the appropriate coding lists with the 2015, 2016, and 2017 SNF CB Annual Updates. CR10163 corrects this error.

Therefore, when brought to their attention, your MAC will reprocess claims with dates of service on or after January 1, 2015, that were erroneously denied/rejected.

To see the instructions that CMS sent to the Medicare Administrative Contractor to address this issue, click here.

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Looking for information about the Jimmo Settlement Agreement? Visit the new Jimmo Settlement Agreement Webpage for background on the settlement, links to resources, and Frequently Asked Questions (FAQs).

CMS reminds the Medicare community of the Jimmo Settlement Agreement (January 2013), which clarified that the Medicare program covers skilled nursing care and skilled therapy services under Medicare’s skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met). Specifically, the Jimmo Settlement required manual revisions to restate a “maintenance coverage standard” for both skilled nursing and therapy services under these benefits:

Skilled nursing services would be covered where such skilled nursing services are necessary to maintain the patient’s current condition or prevent or slow further deterioration so long as the beneficiary requires skilled care for the services to be safely and effectively provided.

Skilled therapy services are covered when an individualized assessment of the patient’s clinical condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist (“skilled care”) are necessary for the performance of a safe and effective maintenance program. Such a maintenance program to maintain the patient’s current condition or to prevent or slow further deterioration is covered so long as the beneficiary requires skilled care for the safe and effective performance of the program.

The Jimmo Settlement may reflect a change in practice for those providers, adjudicators, and contractors who may have erroneously believed that the Medicare program covers nursing and therapy services under these benefits only when a beneficiary is expected to improve. The Settlement is consistent with the Medicare program’s regulations governing maintenance nursing and therapy in skilled nursing facilities, home health services, and outpatient therapy (physical, occupational, and speech) and nursing and therapy in inpatient rehabilitation hospitals for beneficiaries who need the level of care that such hospitals provide.

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Back by popular demand, Judy Wilhide Brandt will be presenting a full day seminar on the following topics in Greensboro, NC on September 26th, 2017.

• Review SNF Quality Reporting Program (QRP), Section GG Coding
• Discuss the purpose of Post-Acute QRP and the role of SNF-QRP
• Understand which MDS items are used for MDS based QRP measures and how to avoid a 2% APU reduction
• List the current QRP claims and MDS based measures with overview of how they are calculated
• Discuss the new MDS items for QRP and new QRP measures to begin collection October 2018 as finalized in the FY18 SNF Final Rule
• Discuss implications of accurate coding for Section GG, to include assessment periods, timing and value in health information exchange for transitions
• Review 5 star quality measures and accurate coding
• Discuss administrative oversight of the MDS department to ensure compliance with accurate coding and transmission for all QMs that are MDS based
• Understand how MDS coding affects risk adjustment for claims based measures
• Review Requirements and Interpretative Guidelines for baseline care planning
• Discuss authentic ways to engage the physician and CNAs in care planning as required by Phase 2 ROP

About the Presenter

Judy Wilhide Brandt is one of the nation’s leading experts on skilled nursing facility (SNF) clinical Medicare compliance, Five Star Rating System, Quality Measures and the MDS/RAI process. Judy brings over thirty-five years of combined experience to the long term care industry, with over twenty years in positions of increasing responsibility in nursing facilities as a nurse manager, executive, and consultant. She is the principle for Wilhide Consulting, Inc. and serves as an advisor, auditor, and trainer for multiple providers from stand-alone communities to multi-state chains across the country. Her services are in high demand as she can be counted on for accurate, current information in the ever-changing SNF regulatory landscape.

CLICK HERE TO REGISTER NOW!
CLICK HERE TO DOWNLOAD AND PRINT THE BROCHURE WITH THE REGISTRATION FORM!

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LTC Trend Tracker is back in session – we’ve shared with you how to run reports and upload data into the tool, but what do you do next? How do you use reports to improve your organization’s performance? Join the LTC Trend Tracker team for their Back to School Webinar to find out more!

September 13, 2017
2:00 pm – 3:00 pm Eastern
Register Today!

During this Webinar, Holly Harmon, AHCA Senior Director of Clinical Services, and Lindsay Schwartz, NCAL Senior Director of Workforce and Quality Improvement, will discuss how to utilize your data in LTC Trend Tracker to provide better quality care.

Specifically, the Webinar will cover:

• How to access your data
• Example scenarios and how LTC Trend Tracker data can be helpful
• AHCA & NCAL Quality Initiative

LTC Trend Tracker is a powerful tool that can help your organization better meet its quality goals. You can monitor your progress on quality measures, Five-Star, AHCA/NCAL Quality Initiative goals, hospital readmission rates, and more. LTC Trend Tracker enables you to:

• Identify organizational areas for improvement and set your own performance targets.
• Quickly download reports with specific data that engages staff members and area providers.
• Use the Dashboard to evaluate your organization on key metrics in comparison with your peers.
• Benchmark yourself to those of your peers and keep your organization ahead of the curve.

Mark your calendars and register here now!

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It is time once again to acknowledge front line, unlicensed personnel who have demonstrated outstanding achievements in the long term care profession. This awards program honors individuals who are the backbone in our facilities because of the support they provide to our residents. A panel of judges from the Education and Programs Committee will select a Nurse Aide winner from each of NCHCFA’s five districts. In addition, one recipient in a non-nursing discipline will receive the Riley W. Clapp Outstanding Service Award. Each of the award recipients will be honored at the Annual Awards Gala during the Annual Convention and Expo on Tuesday, January 30, 2018 in Greensboro, NC.

To complete nominations on-line or to obtain additional forms, visit the Member Center of the Association Web site at http://www.NursingHomesNC.com. Click on “News & Updates”, select “2018 NCHCFA Annual Awards Packet” and choose “Survey Monkey”. If you have any questions about the Annual Awards, call the Association office at (919) 782-3827. Click here to download and print the brochure. Click here to print the nomination forms. Nominations received in the Association office after Friday, October 20, 2017 will not be considered.

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Summer is flying by and before you know it, fall will be settling in. Now is the time to register for this year’s AHCA/NCAL 68th Annual Convention & Expo, and make your plans to join AHCA in Las Vegas in October. AHCA/NCAL has so many exciting things planned. From education sessions and networking events to good food and entertainment, you will not want to miss a thing.

Experience one of the largest Expos, supporting the needs of long term and post-acute care. Attendees have exclusive access to meet one on one with the business community. These specialists stand ready to share solutions that drive efficiency without sacrificing quality.

If you have been too busy to submit your registration, or haven’t made up your mind on attending, do not wait any longer. Commit now and register today! When registering, make sure to get your tickets for the Gala Dinner & Show with Huey Lewis and the News. It will be a night you won’t forget!

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The book presents specific care strategies for all stages of dementia and emphasizes relatively simple interventions that nurses can incorporate into their care plans to prevent problems or address them before they escalate. The guide distinguishes between dementia and conditions that mimic dementia, discusses issues related to specific care settings, presents person-centered strategies for families and care partners, and covers the assessment and management of pain, safety concerns, communication strategies, and ethical and legal issues. It additionally provides numerous resources that nurses can offer to caregivers. Fast Facts for Dementia Care will serve as a daily companion for all clinical nurses who work with older patients in any setting, including the emergency room, medical-surgical unit, medical office, and community mental health settings.

Key Features:

• Easy to use and carry in all patient settings
• Provides communication techniques for different stages of dementia
• Describes numerous interventions for addressing issues such as pain, safety, behaviors, and ADLs
• Includes the “Fast Facts in a Nutshell” feature for quick reference
• Illustrates content with case vignettes

To order, visit http://www.AHCApublications.org or call (800) 321-0343. Fax orders may also be placed at (800) 869-5605.

Product #8293
AHCA MEMBERS $30.00

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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 Donna Snyder at donnas@nchcfa.org. The price is $35.00 (tax and shipping included).

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Calming fears of floods and other catastrophes

http://www.mcknights.com Article

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At any given time, there are 1,800 thunderstorms in progress over the earth’s atmosphere.

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