What s New with the NYS OMIG Audit Process. NYSHFA Nurse Leadership Conference April 23, Disclosure

Size: px
Start display at page:

Download "What s New with the NYS OMIG Audit Process. NYSHFA Nurse Leadership Conference April 23, Disclosure"

Transcription

1 What s New with the NYS OMIG Audit Process NYSHFA Nurse Leadership Conference April 23, 2015 Disclosure Information contained in this program has been collected and collated by Zimmet Healthcare Services Group in consultation and conversation with diverse facilities in NY State and several NYS SNF Associations It is the attempt of the speaker to present objective information and provide resources that may be useful to facility staff when completing MDS assessments utilized for Resident Care and Reimbursement programs Individual SNF audit experiences and audit findings are welcome as part of the program. Conversations to improve processes for accurate Resident assessment, delivery of care and appropriateness of payment for services provided under Medicaid and Medicare programs are always appreciated! 2 ZIMMET HEALTHCARESERVICESGROUP 1

2 OMIG (Office of the Medicaid Inspector General) Established in 2006 as an independent integrity entity within the New York State Department of Health Their mission is to enhance the integrity of the New York State Medicaid program by preventing and detecting fraudulent, abusive and wasteful practices within the Medicaid program and recovering improperly expended Medicaid funds while promoting high quality patient care To insure it is paid correctly and appropriately specific to clinical and financial elements of the SNF reimbursement process 3 OMIG Mission Statement To educate, assist and assess Medicaid program providers in meeting their obligation to establish and operate effective compliance programs that will prevent or in the alternative detect and address fraud, waste and abusive practices within the Medicaid program. NYS Compliance regulations includes 8 elements for insuring payments for care, services or supplies have ongoing policies and procedures.. New York Codes, Rules and Regulations NYCRR ZIMMET HEALTHCARESERVICESGROUP 2

3 PRI to CMI Collections & OMIG Audits was the last PRI collection that was utilized for SNF payments thru the MDS CMI phase in utilizing MDS CMI scores Rates established from 2006 collections were heavily audited (years later) based on significant increase in PRI acuity scores OMIG audits & final appeals for 2006 now (almost) complete PRI had explicit rules and policies that provided parameters for auditing; however, there were multiple lawsuits specific to subjective interpretations of PRI language Many PRI items initially thrown out by OMIG nurses during early audits were successfully appealed and dismissed thru judicial reviews eg: Hemiplegia, Dementia Concern that OMIG nurses utilize PRI definitions for MDS audits eg: Rehab services, Physician Exams, Hemiplegia 5 ZHSG Benchmarks: January 28, 2009 Picture Date Simple average MA data from 63 SNFs enrolled 6 ZIMMET HEALTHCARESERVICESGROUP 3

4 ZHSG Benchmarks: July 2014 Picture Date Simple Average MA data from 125 SNFs ZHSG Avg. Top 25% Q2 Q3 Low 25% CMI Rehab + Extensive 4.0% 5.3% 5.0% 4.6% 1.8% Rehab 40.7% 66.9% 48.2% 31.7% 25.1% Extensive Services 4.4% 3.5% 3.8% 6.5% 3.9% Special Care 7.9% 6.0% 7.1% 11.0% 7.2% Clinically Complex 25.9% 11.1% 24.7% 30.8% 34.2% Impaired Cognition 4.7% 1.1% 4.4% 4.3% 9.0% Behavior 0.3% 0.1% 0.2% 0.7% 0.5% Physical Function 11.9% 6.0% 6.7% 10.1% 18.3% Restorative Nursing 14.3% 42.1% 15.9% 11.5% 8.4% CC w/ Depression 21.9% 20.3% 40.1% 13.9% 16.6% 7 Federal OIG Reports on MDS Accuracy Fuels Audits 272 claims in sample Premise: were 108 MDS reimbursement drivers consistent with medical record & documentation? 26% of RUGs were NOT supported 83% of these were upcoded ; 17% were downcoded These findings are inconsistent with ZHSG audits $542M+ in potential Medicare overpayments Sections P & G responsible for majority of errors The NY PRI audit results and the above Federal findings are driving NYS OMIG audits 8 ZIMMET HEALTHCARESERVICESGROUP 4

5 Where Are We Now? Minimal rules or clarifications specific to NYS RUG/CMI policies exist in writing Utilize RUG 54 for Medicaid payment acuity Most recently completed (non Medicare) MDS for all inhouse Medicaid residents on Picture Date Picture date for CMI is the last Weds in January and July MDS completion for CMI utilizes Federal manual guidelines and policies including definitions, supporting documentation and timeframes NYS Section S clarifications issued April What We Know DOH with School of Public Health conducted webinar training on New York s Common MDS Coding Errors in December & January It was supposed to highlight common MDS coding errors identified through audit by the OMIG and offer strategies for providers to improve accuracy It spent a significant amount of time on MDS coordinator job descriptions, reporting responsibilities, organizational diagrams, competencies and resource manuals It covered Sections S, C, D, E, G, I, J, K, O Utilized MDS manual references and clarifications and did not provide specific NYS OMIG findings MDS is not a source document for items and supportive information for all RUG drivers must have information in the clinical record Documentation references highlighted ARD and Care Planning requirements in addition to self facility auditing to improve documentation processes but not NYS OMIG findings 10 ZIMMET HEALTHCARESERVICESGROUP 5

6 What We Think We Know Using CMI reports run by DOH including targeting of: Facilities with more than 0.5 increases in CMI Facilities with high proportions of Rehab Services Residents being continued or renewed on Therapy services Facilities with high volume of Clinical Categories including Physician exams and orders to determine what type of Physicians and timing (looking at Podiatry and routine Dental in collection windows) Facilities with high (?) proportion of Residents receiving 2 person assist Are specialty units (Vents) to validate ADL and other services 11 What We Think We Know DOH and OMIG have not disclosed the amount of audits or financial concerns completed to date Initial audit of 2012 completed Statewide with no formal summary findings/reports issued How many facilities audited to date? Which collections? Several facilities have had back to back collections reviewed with same residents How many charts are audited in a day by individual reviewers? What is acceptable documentation? Are they reviewing entire chart or only explicit pieces of paper in folders as requested? What are the types, volume or significance of findings? Frequency of audits (and findings) for Facilities that have error rates? No error rates? For facilities with low CMI under 0.90? What about the draft (and some final) reports that have been issued with $ FINANCIAL PENALTIES noted 12 ZIMMET HEALTHCARESERVICESGROUP 6

7 What We Think We Know Facilities getting a call and letter upwards of a month Schedule not flexible after established Lists of specific residents being sent upwards of 2 weeks ahead Teams of OMIG Nurses going to facilities with more conversation with facility staff and peer reviews Inconsistency among OMIG nurses about accepted standards of practice Who documents ADLs in building (CNA vs LPN vs RN vs MDS) Review (or lack of review) of Care Plans 13 What We Think We Know If it isn't documented, it doesn t count! Allowance for facilities to submit missing information within hours Advising facilities to prepare RUG folders as they complete MDS assessments with all supporting documentation available Handwritten findings issued during audit and given to facility as informal findings not necessarily upheld off site Audit findings being reviewed by DOH before Draft Audit Report issued 14 ZIMMET HEALTHCARESERVICESGROUP 7

8 OMIG Comments & Findings to Date Activities of Daily Living Most significantly, OMIG is looking for an initial nurse assessment to evaluate the level of functioning and the need for assistance Requires completed CNA documentation Flow sheets/accountability records of care provided during prior 7 days with no missing shifts ( down coding for missing information and care plans not accepted) Utilizing the rule of 3 for higher scores Looking for documentation to support utilizing 2 person assist Making clinical & critical thinking Documentation by nursing must be detailed Q shift for the 4 ADL RUG drivers Discrepancies' in CNA and Nursing ADLs must be documented with examples for over rides and changes 15 OMIG Comments & Findings to Date Specific episodic documentation about Behaviors must include frequency and type of Behavior, causal factors, staff interventions and results of interventions. Care Plan alone not enough Dementia add-on requires MD Dx in past 60 days, active Care Plan identifying specific care concerns related to Resident Dementia, Nurses notes in prior 7 days stating how the Dementia drives/affects daily care issues Hemiplegia, CP, MS and other RUG driven Dx require MD Dx in past 60 days, active Care Plan identifying specific care concerns related to Dx and Nurses notes in prior 7 days stating how the Dx drives/affects daily care issues Weights that influence BMI payments must be exactly within the prior 30 days of ARD 16 ZIMMET HEALTHCARESERVICESGROUP 8

9 OMIG Comments & Findings to Date Looking for specific ADL changes, Significant Change assessments and/or detailed supportive nursing documentation to initiate Rehab Therapy programs OMIG nurses mentioning significant improvements when on Rehab Therapy programs eg: PRI language OMIG nurses commenting that returns from hospital are deconditioned and weak and usually not appropriate for formal Rehab Therapy services OMIG nurses commenting that Resident showed improvement from Rehab Therapy program but prior declines and other conditions were not documented to consider Therapy services appropriate OMIG nurses commenting that Residents with severe cognitive loss not good candidates for formal Rehab Therapy services no improvement is possible OMIG nurses commenting that specific Resident on Speech & Cognitive Therapy program is too confused and would not benefit from interventions contrary to Speech Therapy note OMIG nurses commenting that Rehab Therapy programs for pain management are not reasonable because medication management and alternatives should have been given and documented first OMIG nurses stating that the Rehab Therapy programs are not appropriate despite being audited by Medicare Part B as appropriate 17 OMIG Comments & Findings to Date OMIG nurses commenting that Physician orders should not be counted as there was no mention of new problems or conditions and these orders were considered routine and/or follow up to old problems OMIG nurses stating that changes in Coumadin medications are considered similar to Insulin orders and do not count. Stating reference information was from MDS manual when it was a privately written /personal opinion newsletter 18 ZIMMET HEALTHCARESERVICESGROUP 9

10 Reports to Facilities Being Issued Letters with Draft Audit Report being sent now for findings of 2012 audits Findings identified during the OMIG review include adjustments to CMI score based on cases specific cases denied. Facility CMI score re-calculated and Medicaid $ dollar overpayments included in the Draft Audit Report. Facilities given 30 days to respond in writing to findings with supporting documentation submitted for additional reviews A Final Audit Report will be issued and Facility will have 60 days to request a Hearing specific to the items raised in the response to findings identified in the Draft Audit Report 19 Make Sure Facility Policies Include Strict adherence to Part B Rehab Therapy requirements including: Documented referral to Rehab that indicates area of functional decline, Nursing documentation (CNA flow sheets, nurses notes) that identifies specific ADL or other functional changes and problems, MD orders that clearly state the reasons for Rehab Therapy services, frequency and duration, Documentation of Therapy evaluation and written Plan of Care with short and long term goals, Accurate Therapy logs including days and minutes of service provided Detailed Rehab Therapy progress notes, appropriate Care Plan documentation, supportive nursing documentation 20 ZIMMET HEALTHCARESERVICESGROUP 10

11 Things to Remember Everything requires documentation within ARD timeframes specific to MDS manual individual item definitions and clarifications Surgical Wound care requires documentation of orders treatments and care, observation of wound areas does not count as a treatment Restorative Nursing Programs requires Nursing assessment of problem, formal program with detailed plan & instructions, care plan and signed log of days and time care program Respiratory Therapy programs include training of responsible staff, MD orders, facility P & P, treatment logs with minutes RUG drivers eg: O2, Chemo, Hemodialysis, Fever, Tubes, etc...require documentation, flow sheets and more 21 Final Thoughts This is a work in progress with much more to come NYSHFA and other Associations are meeting with the DOH specific to OMIG auditing protocols, facility findings and targeted review areas. Including requests for documentation of Frequently Asked Questions with clarifications and explicit RUG & CMI policies Facilities are responsible to have written clinical team assessment and documentation policies specific to MDS completion, Care Plan and reimbursement guidelines Under NYS Mandatory Compliance Rules & Regulations, facilities must have written compliance policies, education and training programs for employees, on going identification with self & external auditing programs, disciplinary policies, self reporting of non compliant matters and good faith participation. 22 ZIMMET HEALTHCARESERVICESGROUP 11

12 Resources cms.gov/mds30raimanual.htm Thank You 23 ZIMMET HEALTHCARESERVICESGROUP 12

OMIG s Compliance Certification Process for Mandatory Compliance Programs:

OMIG s Compliance Certification Process for Mandatory Compliance Programs: OMIG s Compliance Certification Process for Mandatory Compliance Programs: Enrolling Provider or Revalidating Provider Webinar # 25 January 27, 2015 January 27, 2015 2 Welcome OMIG appreciates your interest

More information

What OMIG Looks for in a Compliance Program Review Compliance Program Review Guidance of October 26, 2016

What OMIG Looks for in a Compliance Program Review Compliance Program Review Guidance of October 26, 2016 What OMIG Looks for in a Compliance Program Review Compliance Program Review Guidance of October 26, 2016 March 8, 2017 Latham, NY LeadingAge New York March 8, 2017 2 The Fine Print OMIG acknowledges that

More information

Using SNF Data to Manage Federal & State Audit Initiatives

Using SNF Data to Manage Federal & State Audit Initiatives Using SNF Data to Manage Federal & State Audit Initiatives 2012 OIG & GAO Reports In 2009 OIG estimated that 47% of claims had misreported information on the MDS that caused significant errors in Billing

More information

Office of the Medicaid Inspector General (OMIG) Investigations and More

Office of the Medicaid Inspector General (OMIG) Investigations and More Office of the Medicaid Inspector General (OMIG) Investigations and More June 28, 2017 Speaker: Richard A. Marchese, Jr., Esq. Woods Oviatt Gilman LLP ERIE INSTITUTE OF LAW RICHARD A. MARCHESE, ESQ. Partner,

More information

What Will Be Covered:

What Will Be Covered: A View From New York: Compliance Mandates You May See in Your State Health Care Compliance Association (HCCA) April 23, 2013 National Harbor, Maryland Carol Booth, Compliance Specialist NYS Office of Medicaid

More information

OFFICE OF INSPECTOR GENERAL TEXAS HEALTH & HUMAN SERVICES COMMISSION

OFFICE OF INSPECTOR GENERAL TEXAS HEALTH & HUMAN SERVICES COMMISSION OFFICE OF INSPECTOR GENERAL TEXAS HEALTH & HUMAN SERVICES COMMISSION HOSTED BY Health and Human Services Commission Office of Inspector General Texas Department of Aging and Disability Services ATTENDEES

More information

CMS s RAI Version 3.0 Manual October 2016

CMS s RAI Version 3.0 Manual October 2016 Presented by: CMS s RAI Version 3.0 Manual October 2016 RAI SOM CAAs MDS Resident Assessment Instrument Utilization Guidelines from the State Operations Manual Care Area Assessments Minimum Data Set Affinity

More information

MDS Accuracy and Compliance: Where There s Smoke

MDS Accuracy and Compliance: Where There s Smoke MDS Accuracy and Compliance: Where There s Smoke November 2014 1 Objectives List the current trends in the Long Term Care industry that are driving scrutiny into the MDS assessment process Identify the

More information

Successfully Avoiding Denied Claims

Successfully Avoiding Denied Claims Harmony Healthcare I N T E R N AT I O N A L... A COMPLETE GUIDE TO... Successfully Avoiding Denied Claims During these times of reduced census, it is important Harmony Healthcare to keep a clear focus

More information

Medicare Part A SNF Payment System Reform: Introduction to Resident Classification System - I

Medicare Part A SNF Payment System Reform: Introduction to Resident Classification System - I Medicare Part A SNF Payment System Reform: Introduction to Resident Classification System - I Introduction to the Resident Classification System - I Concepts Structure Implications RCS is NOT the Unified

More information

Delivery System Reform Incentive Payment Program ( DSRIP ) NewYork-Presbyterian Performing Provider System

Delivery System Reform Incentive Payment Program ( DSRIP ) NewYork-Presbyterian Performing Provider System Delivery System Reform Incentive Payment Program ( DSRIP ) NewYork-Presbyterian Performing Provider System Overview of DSRIP Program What is the Delivery System Reform Incentive Payment Program ( DSRIP

More information

Uniform Assessment System for New York Assisted Living Program Frequently Asked Questions April 11, 2014

Uniform Assessment System for New York Assisted Living Program Frequently Asked Questions April 11, 2014 Uniform Assessment System for New York Assisted Living Program Frequently Asked Questions April 11, 2014 UAS-NY Questions 1. When using the UAS-NY, many scores initially seem to be increasing slightly,

More information

Patient Driven Payment Model (PDPM) and the MDS: A Total Evolution of the SNF Payment Model

Patient Driven Payment Model (PDPM) and the MDS: A Total Evolution of the SNF Payment Model Patient Driven Payment Model (PDPM) and the MDS: A Total Evolution of the SNF Payment Model By Devin Kassi, PT, DPT, and Melissa Keiter, RN, RAC-CT, DNS-CT, DON Centers for Medicare & Medicaid Services

More information

Preventing Fraud and Abuse in Health Care

Preventing Fraud and Abuse in Health Care Preventing Fraud and Abuse in Health Care Corporate Compliance what is it? Corporate Compliance is about the effort to fight healthcare fraud and abuse by making it a state and federal criminal offense

More information

Maggie Turner RN RAC-CT Kara Schilling RN RAC-CT Lisa Gourley RN RAC-CT

Maggie Turner RN RAC-CT Kara Schilling RN RAC-CT Lisa Gourley RN RAC-CT Maggie Turner RN RAC-CT Kara Schilling RN RAC-CT Lisa Gourley RN RAC-CT We do not have any financial relationships to disclose We do not have any conflicts of interest to disclose We will not promote any

More information

Florida Health Care Association 2013 Annual Conference

Florida Health Care Association 2013 Annual Conference Florida Health Care Association 2013 Annual Conference The Westin Diplomat Resort & Spa Session #21 Compliance = Confidence! Tuesday, August 6 2:30 to 4:30 p.m. Diplomat 1 & 2 Upon completion of this presentation,

More information

OMIG AUDIT PROTOCOL ASSISTED LIVING PROGRAM (ALP) Effective 11/22/13

OMIG AUDIT PROTOCOL ASSISTED LIVING PROGRAM (ALP) Effective 11/22/13 STATE OF NEW YORK OFFICE OF THE MEDICAID INSPECTOR GENERAL 800 North Pearl Street Albany, New York 12204 ANDREW M. CUOMO GOVERNOR JAMES C. COX MEDICAID INSPECTOR GENERAL OMIG AUDIT PROTOCOL Audit protocols

More information

Medicare Part A SNF Payment System Reform: Introduction to Resident Classification System - I ZIMMET HEALTHCARE 2018

Medicare Part A SNF Payment System Reform: Introduction to Resident Classification System - I ZIMMET HEALTHCARE 2018 Medicare Part A SNF Payment System Reform: Introduction to Resident Classification System - I Introduction to the Resident Classification System - I Concepts Structure Implications RCS is NOT the Unified

More information

OBQI for Improvement in Pain Interfering with Activity

OBQI for Improvement in Pain Interfering with Activity CASE SUMMARY OBQI for Improvement in Pain Interfering with Activity Following is the story of one home health agency that used the outcome-based quality improvement (OBQI) process to enhance outcomes for

More information

4/20/2015. NE Home Care & Hospice Conference: Strategic Preparation for Medicare Audits & Appeals. Today s Objectives. Background

4/20/2015. NE Home Care & Hospice Conference: Strategic Preparation for Medicare Audits & Appeals. Today s Objectives. Background NE Home Care & Hospice Conference: Strategic Preparation for Medicare Audits & Appeals Cheryl Leslie, RN, MPH Director of Consulting Services Pamela Meliso, JD, MPH Director of Consulting Services Today

More information

Stark, False Claims and Anti- Kickback Laws: Easy Ways to Stay Compliant with the Big Three in Healthcare

Stark, False Claims and Anti- Kickback Laws: Easy Ways to Stay Compliant with the Big Three in Healthcare Stark, False Claims and Anti- Kickback Laws: Easy Ways to Stay Compliant with the Big Three in Healthcare In health care, we are blessed with an abundance of rules, policies, standards and laws. In Health

More information

What Did Your PEPPER Tell CMS?

What Did Your PEPPER Tell CMS? What Did Your PEPPER Tell CMS? HARMONY UNIVERSITY The Provider Unit of Harmony Healthcare International, Inc. (HHI) Presented by: Matthew P. McGarvey, MBA Director of Business Development Speaker Bio:

More information

Quality Outcomes and Data Collection

Quality Outcomes and Data Collection Quality Outcomes and Data Collection Presented By: Joanne Jones Director, Clinical Consulting Services August 30, 2016 Quality Measurement in LTC CMS Nursing Home Compare 5 Star Rating System New measures

More information

Getting Started with OIG Compliance

Getting Started with OIG Compliance Getting Started with OIG Compliance Kathy Mills Chang, MCS-P CCPC Do You Feel Like This? Or This? Does Your Business Deserve the Same Focus Your Patients Do? How This Training Will Protect You! Stay within

More information

SNF Compliance: What s at Stake?

SNF Compliance: What s at Stake? SNF Compliance: What s at Stake? HARMONY UNIVERSITY The Provider Unit of Harmony Healthcare International, Inc. (HHI) Presented by: Elisa Bovee, MS OTR/L Vice President of Operations About Elisa Elisa

More information

Private Duty Nursing. May 2017

Private Duty Nursing. May 2017 Private Duty Nursing May 2017 Overview Provider Enrollment Member Eligibility Private Duty Nursing Services Specialized Private Duty Nursing Services Billing Additional Information 2 Provider Enrollment

More information

Compliance Program Updated August 2017

Compliance Program Updated August 2017 Compliance Program Updated August 2017 Table of Contents Section I. Purpose of the Compliance Program... 3 Section II. Elements of an Effective Compliance Program... 4 A. Written Policies and Procedures...

More information

OFFICE OF INSPECTOR GENERAL TEXAS HEALTH & HUMAN SERVICES COMMISSION

OFFICE OF INSPECTOR GENERAL TEXAS HEALTH & HUMAN SERVICES COMMISSION OFFICE OF INSPECTOR GENERAL TEXAS HEALTH & HUMAN SERVICES COMMISSION NURSING FACILITY UTILIZATION REVIEW QUARTERLY STAKEHOLDERS MEETINGS HOSTED BY Health and Human Services Commission Office of Inspector

More information

New York State Office of the Medicaid Inspector General Carol Booth, R.N./Auditor, Managed Care Cathy McCulskey, B.S./Data Systems Analysis

New York State Office of the Medicaid Inspector General Carol Booth, R.N./Auditor, Managed Care Cathy McCulskey, B.S./Data Systems Analysis New York State Office of the Medicaid Inspector General Carol Booth, R.N./Auditor, Managed Care Cathy McCulskey, B.S./Data Systems Analysis Official Disclaimer The opinions expressed during this presentation

More information

A Nurse Leader s guide to a successful Restorative Nursing Program PRESENTER: AMY FRANKLIN RN, DNS MT, QCP MT, RAC MT

A Nurse Leader s guide to a successful Restorative Nursing Program PRESENTER: AMY FRANKLIN RN, DNS MT, QCP MT, RAC MT A Nurse Leader s guide to a successful Restorative Nursing Program PRESENTER: AMY FRANKLIN RN, DNS MT, QCP MT, RAC MT Requirements for Successful Completion 1. 2.0 contact hours will be awarded for this

More information

Clinical Compliance Program

Clinical Compliance Program Clinical Compliance Program The University at Buffalo School of Dental Medicine, Daniel Squire Diagnostic and Treatment Center (UBSDM) has always been and remains committed to conducting its business in

More information

December 8, Howard A. Zucker, M.D., J.D. Commissioner Department of Health Corning Tower Empire State Plaza Albany, NY 12237

December 8, Howard A. Zucker, M.D., J.D. Commissioner Department of Health Corning Tower Empire State Plaza Albany, NY 12237 December 8, 2015 Howard A. Zucker, M.D., J.D. Commissioner Department of Health Corning Tower Empire State Plaza Albany, NY 12237 Re: Medicaid Overpayments for Inpatient Transfer Claims Among Merged or

More information

2/20/2018. Resident Classification System RCS-1. CMS Proposal

2/20/2018. Resident Classification System RCS-1. CMS Proposal Resident Classification System RCS-1 CMS Proposal Resident Classification System I (RCS-I) Complete overhaul of the Medicare A payment system (replacing RUGs-IV) On April 27, 2017 CMS released an Advance

More information

RAC Audits and Denials Management WHCA Fall Conference September 9, 2014

RAC Audits and Denials Management WHCA Fall Conference September 9, 2014 JoLynn Munro, MS,OTR/L, Regional Vice President Infinity Rehab Carolyn Staples, CCC/SLP, Area Rehab Director Infinity Rehab RAC Audits and Denials Management WHCA Fall Conference September 9, 2014 Objectives

More information

Articles of Importance to Read: AmeriChoice Tennessee s Provider University. Spring 2010

Articles of Importance to Read: AmeriChoice Tennessee s Provider University. Spring 2010 Important information for physicians and other health care professionals and facilities serving AmeriChoice members Spring 2010 AmeriChoice Tennessee s Provider University AmeriChoice Tennessee s Provider

More information

Changes to the RAI manual effective October 1, 2013

Changes to the RAI manual effective October 1, 2013 Changes to the RAI manual effective October 1, 2013 CMS released on Friday, September 27 an updated version of the RAI manual that became effective October 1, 2013. The manual is found here> http://www.cms.gov/medicare/quality-initiatives-patient-assessment-

More information

HMM BillTAG (Billing Transition Action Group)

HMM BillTAG (Billing Transition Action Group) Complimentary webinar sponsored by: HMM BillTAG (Billing Transition Action Group) Session 2 Admissions, CMI, FIDA update and FAQ Review May 29, 2015 Presented by: Veronica M. Bencivenga, CPA Director HMM

More information

Goodbye PPS: Hello RCS!

Goodbye PPS: Hello RCS! Disclosure of Commercial Interests I consult for the following organizations: Celtic Consulting LLC President, CEO Celtic Consulting is a Long-Term Care advisory firm, focused on providing one-on-one oversight

More information

NYSHFA ADVANCED TRAINING INITIATIVE & July 30, 2015

NYSHFA ADVANCED TRAINING INITIATIVE & July 30, 2015 1 NYSHFA ADVANCED TRAINING INITIATIVE & COST REPORT PREP July 30, 2015 Introductions 2 Kathie Angelone, Director Shauna Seeley, Supervisor Division of EFP Rotenberg, LLP Agenda 3 RHCF-4 Cost Report Filing

More information

As promised in the 2006 statute1 and accompanying

As promised in the 2006 statute1 and accompanying New York Issues Compliance Guidance for Hospitals A Look at How the Guidance Stacks Up to OIG Recommendations Jack Wenik / Matthew McKennan Jack Wenik is a member er of the firm Sills, Cummis mis & Gross

More information

Understanding the New OMIG Audit Protocol for Assisted Living Programs

Understanding the New OMIG Audit Protocol for Assisted Living Programs Understanding the New OMIG Audit Protocol for Assisted Living Programs NYSCAL Audio Conference January 23, 2014 David R. Ross, Esq. O Connell and Aronowitz, Attorneys at Law (518) 462-5601 dross@oalaw.com

More information

Indiana Medicaid Reimbursement Update Tysen Adams, CPA Deborah Lake, RN, RAC-CT Senior Managing Consultants BKD, LLP

Indiana Medicaid Reimbursement Update Tysen Adams, CPA Deborah Lake, RN, RAC-CT Senior Managing Consultants BKD, LLP Indiana Medicaid Reimbursement Update Tysen Adams, CPA Deborah Lake, RN, RAC-CT Senior Managing Consultants BKD, LLP Agenda 5 To 8 Year Long-Term Care Plan Value Based Purchasing Issues Proposed Report

More information

Data Stewardship: Essential Skills for Long Term Care Facility Managers

Data Stewardship: Essential Skills for Long Term Care Facility Managers Data Stewardship: Essential Skills for Long Term Care Facility Managers PRESENTED BY LEAH KLUSCH EXECUTIVE DIRECTOR THE ALLIANCE TRAINING CENTER ALLIANCE, OHIO 330-821-7616 leahklusch@sbcglobal.net Data

More information

Clinical Documentation Improvement (CDI) Programs: What Role Should Compliance Play?

Clinical Documentation Improvement (CDI) Programs: What Role Should Compliance Play? Clinical Documentation Improvement (CDI) Programs: What Role Should Compliance Play? June 17, 2016 Agenda Clinical Documentation Improvement (CDI) Perspective An Effective CDI Program Core Focus: Compliance

More information

Riding Herd on Fraud, Waste and Abuse

Riding Herd on Fraud, Waste and Abuse Riding Herd on Fraud, Waste and Abuse Dan McCullough Judi McCabe Juanita Henry Kim Hrehor 1 Taking Stock: Surveying the Landscape of Fraud, Waste and Abuse 2 How Big is the Problem? The simple truth is

More information

PEPPER for Home Health Agencies and Skilled Nursing Facilities: Practical Applications for Compliance

PEPPER for Home Health Agencies and Skilled Nursing Facilities: Practical Applications for Compliance PEPPER for Home Health Agencies and Skilled Nursing Facilities: Practical Applications for Compliance April 19, 2016 Victor Kintz, Polaris Group and Kimberly Hrehor, TMF Agenda What is PEPPER? Focus: HHA

More information

UNIVERSITY OF ROCHESTER MEDICAL CENTER BILLING COMPLIANCE PLAN

UNIVERSITY OF ROCHESTER MEDICAL CENTER BILLING COMPLIANCE PLAN UNIVERSITY OF ROCHESTER MEDICAL CENTER BILLING COMPLIANCE PLAN Revised December 31, 1998 INTRODUCTION This plan is an integral part of the University s ongoing efforts to achieve compliance with federal

More information

The Shift is ON! Goodbye PPS, Hello RCS

The Shift is ON! Goodbye PPS, Hello RCS The Shift is ON! Goodbye PPS, Hello RCS Presented By Maureen McCarthy, RN, BS, RAC-MT, QCP-MT President/CEO Maureen McCarthy, RN, BS, RAC-MT, QCP-MT Maureen is the President of Celtic Consulting, LLC and

More information

MDS 3.0/RUG IV OVERVIEW

MDS 3.0/RUG IV OVERVIEW MDS 3.0/RUG IV Distance Learning Series January - May 2016 OVERVIEW In keeping with the success of their previous highly-rated distance learning education offerings, LeadingAge state affiliates and Plante

More information

DEPARTMENT OF HEALTH HELEN HAYES HOSPITAL SELECTED FINANCIAL MANAGEMENT PRACTICES. Report 2006-S-49 OFFICE OF THE NEW YORK STATE COMPTROLLER

DEPARTMENT OF HEALTH HELEN HAYES HOSPITAL SELECTED FINANCIAL MANAGEMENT PRACTICES. Report 2006-S-49 OFFICE OF THE NEW YORK STATE COMPTROLLER Thomas P. DiNapoli COMPTROLLER OFFICE OF THE NEW YORK STATE COMPTROLLER DIVISION OF STATE GOVERNMENT ACCOUNTABILITY Audit Objectives... 2 Audit Results - Summary... 2 DEPARTMENT OF HEALTH Background...

More information

MAXIMUS Webinar Series

MAXIMUS Webinar Series MAXIMUS Webinar Series What the Provider Enrollment Rule Means Operationally for States and MCOs, Including Network Adequacy Continuing the Discussion on the CMS Rule for Medicaid & CHIP Managed Care June

More information

CAH PREPARATION ON-SITE VISIT

CAH PREPARATION ON-SITE VISIT CAH PREPARATION ON-SITE VISIT Illinois Department of Public Health, Center for Rural Health This day is yours and can be flexible to the timetable of hospital staff. An additional visit can also be arranged

More information

OMIG AUDIT PROTOCOL- CERTIFIED HOME HEALTH CARE (CHHA) - Effective XX/XX/XX

OMIG AUDIT PROTOCOL- CERTIFIED HOME HEALTH CARE (CHHA) - Effective XX/XX/XX STATE OF NEW YORK OFFICE OF THE MEDICAID INSPECTOR GENERAL 800 North Pearl Street Albany, New York 12204 ANDREW M. CUOMO GOVERNOR JAMES C. COX MEDICAID INSPECTOR GENERAL OMIG AUDIT PROTOCOL- - Audit protocols

More information

Dual eligible beneficiaries and care coordination. Mark E. Miller, Ph. D.

Dual eligible beneficiaries and care coordination. Mark E. Miller, Ph. D. Dual eligible beneficiaries and care coordination Mark E. Miller, Ph. D. Medicare Payment Advisory Commission Independent, nonpartisan Advise the Congress on Medicare issues Principles Ensure beneficiary

More information

MEDICAL REQUEST FOR HOME CARE

MEDICAL REQUEST FOR HOME CARE MEDICAL REQUEST FOR HOME CARE HCSP- M11Q 12/09/2014 Return Completed Form to: 1. CLIENT INFORMATION GSS District Office Address Zip Code Attn: Case Load No. Borough Tel. No. Date Returned to/received bygss

More information

7/1/2011 EVERYTHING YOU NEED TO KNOW TO SUCCEED WITH THIS NEW PROCESS ABOUT LEAH I FOCUS ON LEARNING, NOT TEACHING

7/1/2011 EVERYTHING YOU NEED TO KNOW TO SUCCEED WITH THIS NEW PROCESS ABOUT LEAH I FOCUS ON LEARNING, NOT TEACHING BIP-PITY BOB-PITY BOO!!!!!! MAKE THE MDS 3.0 WORK FOR YOU IT IS NOT MAGIC!!!!!! Leah Klusch, RN, BSN, FACHCA EVERYTHING YOU NEED TO KNOW TO SUCCEED WITH THIS NEW PROCESS ABOUT LEAH I FOCUS ON LEARNING,

More information

6/25/2013. Knowledge and Education. Objectives ZPIC, RAC and MAC Audits. After attending this presentation, the attendees will be able to :

6/25/2013. Knowledge and Education. Objectives ZPIC, RAC and MAC Audits. After attending this presentation, the attendees will be able to : Objectives ZPIC, RAC and MAC Audits Approach After attending this presentation, the attendees will be able to : 1. Understand the different types of audits related to reimbursement: ZPIC, RAC, and MAC

More information

Thank you for joining us!

Thank you for joining us! Thank you for joining us! We will start at 1 p.m. CT. You will hear silence until the session begins. Handout: Available at PEPPERresources.org in the SNF Training and Resources section. A recording of

More information

ABOUT FLORIDA MEDICAID

ABOUT FLORIDA MEDICAID Section I Introduction About eqhealth Solutions ABOUT FLORIDA MEDICAID THE FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION The Florida Agency for Health Care Administration (AHCA or Agency) is the single

More information

Compliance Program Guidance for General Hospitals

Compliance Program Guidance for General Hospitals NEW YORK STATE DEPARTMENT OF HEALTH Office of the Medicaid Inspector General Compliance Program Guidance for General Hospitals James C. Cox, Medicaid Inspector General Issue Date: May 11, 2012 Compliance

More information

Q: From what service period do the patient days come from that are used in the calculation of the assessment?

Q: From what service period do the patient days come from that are used in the calculation of the assessment? FREQUENTLY ASKED QUESTIONS as of Sept. 12, 2014. Q:If a facility has Medicaid Trachs,special rate and Medicaid Vents, are they included in the acuity calculation? The acuity calculation is made using data

More information

DEFINING LINES OF COMPLIANCE. April 2004 By: Angela Miller Compliance Officer Home Care Supply

DEFINING LINES OF COMPLIANCE. April 2004 By: Angela Miller Compliance Officer Home Care Supply DEFINING LINES OF COMPLIANCE April By: Angela Miller Compliance Officer Home Care Supply OUTLINE Broad brush on Audit Responses Finer Policy Points Education: The Vicious Circle A Private Showing: Attorney

More information

Provider Network Newsletter

Provider Network Newsletter NETWORK NEWSLETTER Fall/Winter 2016 Provider Network Newsletter NETWORK DEVELOPMENT DEPARTMENT: LEFT TO RIGHT: TESSY KOSHY, MARIA PERALTA, WILLIAM GUEVARA, SARAH RAMDHANI, AND DENISE MCLACHLAN Products

More information

THE MONTEFIORE ACO CODE OF CONDUCT

THE MONTEFIORE ACO CODE OF CONDUCT THE MONTEFIORE ACO CODE OF CONDUCT 2017 Approved by the Board of Directors on March 10, 2017 Our Commitment to Compliance As a central part of its Compliance Program, the Bronx Accountable Healthcare Network

More information

AN OPPORTUNITY TO INTEGRATE NUTRITION SERVICES IN YOUR LOCAL HEALTHCARE SYSTEM

AN OPPORTUNITY TO INTEGRATE NUTRITION SERVICES IN YOUR LOCAL HEALTHCARE SYSTEM AN OPPORTUNITY TO INTEGRATE NUTRITION SERVICES IN YOUR LOCAL HEALTHCARE SYSTEM KIMBERLY K. DELP, RN BSN January 26, 2017 AN OPPORTUNITY TO INTEGRATE NUTRITION SERVICES IN YOUR LOCAL HEALTHCARE SYSTEM 1

More information

What To Do When the OMIG Investigates Your Health Center

What To Do When the OMIG Investigates Your Health Center What To Do When the OMIG Investigates Your Health Center Presentation to Community Health Care Association of New York State October 26, 2008 Presented by: Helen Pfister Manatt, Phelps & Phillips LLP 7

More information

Medicare Part A Update

Medicare Part A Update Medicare Part A Update Jennifer Bogenrief, JD Manager, Regulatory Affairs AOTA AOTA Specialty Conference: Effective Documentation Friday, September 12, 2014 1 Topics Medicare Therapy Documentation Requirements

More information

Regulatory Compliance Risks. September 2009

Regulatory Compliance Risks. September 2009 Rehabilitation Regulatory Compliance Risks September 2009 1 Agenda - Rehabilitation Compliance Risks Understand the basic requirements for Inpatient Rehabilitation Facilities (IRFs) and Outpatient Rehabilitation

More information

5D QAPI from an Operational Approach. Christine M. Osterberg RN BSN Senior Nursing Consultant Pathway Health Pathway Health 2013

5D QAPI from an Operational Approach. Christine M. Osterberg RN BSN Senior Nursing Consultant Pathway Health Pathway Health 2013 5D QAPI from an Operational Approach Christine M. Osterberg RN BSN Senior Nursing Consultant Pathway Health Objectives Review the post-acute care data agenda. Explain QAPI principles Describe leadership

More information

Clinton County Corporate Compliance Plan

Clinton County Corporate Compliance Plan Prepared by: Nursing Home Administrator Director of Mental Health and Addiction Director of Public Health County Administrator Clinton County Corporate Compliance Plan Reviewed and updated: December, 2017

More information

MDS 3.0: What Leadership Needs to Know

MDS 3.0: What Leadership Needs to Know MDS 3.0: What Leadership Needs to Know especially prepared for CANPFA Ann Spenard RN, MSN History of the MDS and RAI Process The Resident Assessment Instrument (RAI) was part of a set of reforms enacted

More information

Annual Leadership Institute August 25, Triple Check: A Process for Preventing False Claims

Annual Leadership Institute August 25, Triple Check: A Process for Preventing False Claims Annual Leadership Institute August 25, 2016 Triple Check: A Process for Preventing False Claims 1 Your presenter today is: Sophie A. Campbell, MSN, RN, CRRN, RAC-CT, CNDLTC Director, Clinical Advisory

More information

5DAY = 1 AND

5DAY = 1 AND July 2008 Revision Table CH. Sect. Pg. July 2008 Revision NA Title Page NA Change the revised date to July 2008 CH 2 2.2 2-11 Revise as follows: Delete the second sentence of the second paragraph, The

More information

Medicaid RAC Audit Results

Medicaid RAC Audit Results Medicaid RAC Audit Results Clinical Audits: The RAC Clinical audit goal was to review supporting documentation for necessity of admission and continued stay in long term care for Medicaid residents. There

More information

Frequently Asked Questions

Frequently Asked Questions 450 Simmons Way #700, Kaysville, UT 84037 (801) 547-9947 unar@davistech.edu www.utahcna.com Frequently Asked Questions UNAR stands for the Utah Nursing Assistant Registry, the agency in charge of the registry

More information

Managing employees include: Organizational structures include: Note:

Managing employees include: Organizational structures include: Note: Nursing Home Transparency Provisions in the Patient Protection and Affordable Care Act Compiled by NCCNHR: The National Consumer Voice for Quality Long-Term Care, April 2010 Part I Improving Transparency

More information

Recover Health Training. Corporate Compliance Plan Code of Conduct Fraud & Abuse

Recover Health Training. Corporate Compliance Plan Code of Conduct Fraud & Abuse Recover Health Training Corporate Compliance Plan Code of Conduct Fraud & Abuse 1 The Course Objectives When you complete this course you will be able to: Understand Recover Health s reasons for implementing

More information

Special Issues in the Assisted Living Program

Special Issues in the Assisted Living Program Special Issues in the Assisted Living Program The Assisted Living Program: Today and Tomorrow March 7, 2017 Diane Darbyshire, senior policy analyst LeadingAge New York Agenda Highlight key issues that

More information

SNF REHOSPITALIZATIONS

SNF REHOSPITALIZATIONS SNF REHOSPITALIZATIONS David Gifford MD MPH SVP Quality & Regulatory Affairs National Readmission Summit Arlington VA Dec 6 th, 2013 Use of Long Term Care Services 19% 4 35% 2 20% 1 23% 1 20% 3 1. Mor

More information

Medication Management: Therapy Scope Versus Comfort Level

Medication Management: Therapy Scope Versus Comfort Level Medication Management: Therapy Scope Versus Comfort Level Presented By: Cindy Krafft MS PT President Home Health Section APTA Director of Rehabilitation Consulting Services August 17, 2011 243 King Street,

More information

Rehabilitative Care Alliance

Rehabilitative Care Alliance Rehabilitative Care Alliance Provincial Webinar January 10, 2018 12:00 1:00 p.m. For audio, you must call in by phone: (416) 764-8673 or Toll Free: 1-888-780-5892 Passcode: 7677451# Telephone lines open

More information

Compliance Program, Code of Conduct, and HIPAA

Compliance Program, Code of Conduct, and HIPAA Compliance Program, Code of Conduct, and HIPAA Agenda Introduction to Compliance The Compliance Program Code of Conduct Reporting Concerns HIPAA Why have a Compliance Program Procedures to follow applicable

More information

BOARD OF COOPERATIVE EDUCATIONAL SERVICES SOLE SUPERVISORY DISTRICT FRANKLIN-ESSEX-HAMILTON COUNTIES MEDICAID COMPLIANCE PROGRAM CODE OF CONDUCT

BOARD OF COOPERATIVE EDUCATIONAL SERVICES SOLE SUPERVISORY DISTRICT FRANKLIN-ESSEX-HAMILTON COUNTIES MEDICAID COMPLIANCE PROGRAM CODE OF CONDUCT BOARD OF COOPERATIVE EDUCATIONAL SERVICES SOLE SUPERVISORY DISTRICT FRANKLIN-ESSEX-HAMILTON COUNTIES MEDICAID COMPLIANCE PROGRAM CODE OF CONDUCT Adopted April 22, 2010 BOARD OF COOPERATIVE EDUCATIONAL

More information

CAH SWING BED BILLING, CODING AND DOCUMENTATION. Lisa Pando, Sr. Consultant GPS Healthcare Consultants

CAH SWING BED BILLING, CODING AND DOCUMENTATION. Lisa Pando, Sr. Consultant GPS Healthcare Consultants CAH SWING BED BILLING, CODING AND Lisa Pando, Sr. Consultant GPS Healthcare Consultants Learning Objectives: 1. Review Medical Necessity documentation specific to swing bed patients 2. Reasons to use the

More information

SNF Compliance Programs: What s at Stake?

SNF Compliance Programs: What s at Stake? SNF Compliance Programs: What s at Stake? HARMONY UNIVERSITY The Provider Unit of Harmony Healthcare International, Inc. (HHI) Presented by: Kris Mastrangelo, OTR/L, LNHA, MBA President and CEO About Kris

More information

NE Home Care Conference: Effective & Efficient Preparation for Medicare Audits & Appeals

NE Home Care Conference: Effective & Efficient Preparation for Medicare Audits & Appeals NE Home Care Conference: Effective & Efficient Preparation for Medicare Audits & Appeals Cheryl Leslie, RN, MPH Director of Home Care & Hospice Services Pamela Meliso, JD, MPH Director of Consulting &

More information

2014 AANAC 9_30_ AANA C AANA

2014 AANAC 9_30_ AANA C AANA 2013 2014 AANAC AANAC 9_30_14 Expert Advisory Panel Guests Deb Myhre, RN, RAC-MT, C-NE Mark McDavid, OTR, RAC-CT Requirements for Successful Completion 1 Contact hour will be awarded for this continuing

More information

The Moving Target of Successful Long Term Care Therapy Reimbursement: Audits, Denials, and Appeals 8/13/2018 OBJECTIVES

The Moving Target of Successful Long Term Care Therapy Reimbursement: Audits, Denials, and Appeals 8/13/2018 OBJECTIVES The Moving Target of Successful Long Term Care Therapy Reimbursement: Audits, Denials, and Appeals Becky Finni, DHS, OTR/L Kim Karr, BS, OTR/L Senior Appeal Specialists for RehabCare OBJECTIVES Understand

More information

11/23/2011. Proactive vs. Reactive Relationship

11/23/2011. Proactive vs. Reactive Relationship Overview Focus on Resident Voice Assessment Schedule EOT OMRA and New Resumption Items New PPS Assessment: COT OMRA CMS Clarifications Coding New Quality Measures Draft MDS and Care Planning as Risk Management

More information

Presented by: Arlene Maxim, RN-Founder A.D. Maxim Consulting, LLC.

Presented by: Arlene Maxim, RN-Founder A.D. Maxim Consulting, LLC. Presented by: Arlene Maxim, RN-Founder A.D. Maxim Consulting, LLC. On January 24, 2013, the U. S. District Court for the District of Vermont approved a settlement agreement in the case of Jimmo v. Sebelius,

More information

THE LEADERS GUIDE TO MDS 3.0 IMPLEMENTATION. Update on RUGs IV: The Problem. Update on RUGs IV: The Best Solution. Update on RUGs IV: The Default

THE LEADERS GUIDE TO MDS 3.0 IMPLEMENTATION. Update on RUGs IV: The Problem. Update on RUGs IV: The Best Solution. Update on RUGs IV: The Default THE LEADERS GUIDE TO MDS 3.0 IMPLEMENTATION June District Meetings, 2010 Update on RUGs IV: The Problem Current RUG-III based on MDS 2.0 RUG-IV based on MDS 3.0 Congress postponed most of RUG IV for 1

More information

Long Term Care Briefing Virginia Health Care Association August 2009

Long Term Care Briefing Virginia Health Care Association August 2009 Long Term Care Briefing Virginia Health Care Association August 2009 2112 West Laburnum Avenue Suite 206 Richmond, Virginia 23227 www.vhca.org The Economic Impact of Virginia Long Term Care Facilities

More information

11/18/2013 MDS 3.0 RAI MANUAL CHAPTER 1 RAI MANUAL CHAPTER 1 1.8, 1-16, 1-17, I-18

11/18/2013 MDS 3.0 RAI MANUAL CHAPTER 1 RAI MANUAL CHAPTER 1 1.8, 1-16, 1-17, I-18 MDS 3.0 CHANGES EFFECTIVE 10-1-2013 RAI MANUAL CHAPTER 1 1.8, 1-16, 1-17, I-18 Support Agency Contractors to assist in accomplishment of a CMS function. To assist another Federal or SA.for purposes of

More information

INPATIENT ACUTE REHABILITATION HOSPITAL LIMITATIONS, SCOPE AND INTENSITY OF CARE

INPATIENT ACUTE REHABILITATION HOSPITAL LIMITATIONS, SCOPE AND INTENSITY OF CARE INPATIENT ACUTE REHABILITATION HOSPITAL LIMITATIONS, SCOPE AND INTENSITY OF CARE Bacharach Institute for Rehabilitation offers a number of in and outpatient rehabilitation programs and services designed

More information

Find Your Purpose with the Phase 2 Regulations!

Find Your Purpose with the Phase 2 Regulations! Find Your Purpose with the Phase 2 Regulations! The New MegaRule! MONTANA HOSPITAL ASSOCIATION OVERVIEW OF PHASE 2 REQUIREMENTS WWW.PATHWAYHEALTH.COM Objectives Understand the new and revised final rule

More information

COMMONWEALTH OF KENTUCKY OFFICE OF INSPECTOR GENERAL AND MYERS AND STAUFFER LC PRESENT MDS CODING AND INTERPRETATION ANSWER SLIDES

COMMONWEALTH OF KENTUCKY OFFICE OF INSPECTOR GENERAL AND MYERS AND STAUFFER LC PRESENT MDS CODING AND INTERPRETATION ANSWER SLIDES COMMONWEALTH OF KENTUCKY OFFICE OF INSPECTOR GENERAL AND MYERS AND STAUFFER LC PRESENT MDS CODING AND INTERPRETATION ANSWER SLIDES WOULD YOU COMPLETE A SIGNIFICANT CHANGE IN STATUS ASSESSMENT? Example

More information

Maximizing the Power of Your Data. Peggy Connorton, MS, LNFA AHCA Director, Quality and LTC Trend Tracker

Maximizing the Power of Your Data. Peggy Connorton, MS, LNFA AHCA Director, Quality and LTC Trend Tracker Maximizing the Power of Your Data Peggy Connorton, MS, LNFA AHCA Director, Quality and LTC Trend Tracker Objectives Explore selected LTC Trend Tracker reports & features including: re-hospitalization,

More information

Five-Star Quality Rating System Technical Users Guide

Five-Star Quality Rating System Technical Users Guide Five-Star Quality Rating System Technical Users Guide Reginald M. Hislop III, PhD Maureen McCarthy, BS, RN, RAC-MT, QCP-MT The Five-Star Quality Rating System Technical Users Guide Reginald M. Hislop III,

More information

Certified Ophthalmic Executive (COE) Review Day

Certified Ophthalmic Executive (COE) Review Day Certified Ophthalmic Executive (COE) Review Day Compliance Plan & Chart Audits Financial Disclosure The instructor acknowledges a financial interest in the subject matter of this presentation. Presented

More information

Patient-Driven Payment Model

Patient-Driven Payment Model Patient-Driven Model Why a New System? Top 10 RUGs in 2015 Comprise 90% of SNF Days and 92% of SNF s RUG RUG Description Total Days 2015 Distinct Beneficiaries Per RUG Per Day Per Beneficiary Total Percent

More information