MDS Language Impacts CAHs
|
|
- Collin Randall
- 5 years ago
- Views:
Transcription
1 MDS Language Impacts CAHs April 2014 Kerry Dunning, MHA, MSH, CPAR, RAC-CT Sr VP, Long Term Care Division GPS Healthcare Consultants
2 Objectives To Sufficiently Understand: Medicare intent for documentation Medicare definitions CAH responsibilities in complying with Medicare required paperwork Update to the Medicare Manual or SNFs as a result of the Jimmo vs. Sebelius Settlement Agreement 2) 2
3 Swing Bed Medicare benefits allow a patient to remain in a Swing Bed as long as he/she continues to meet all criteria and has benefit days available Once the patient no longer meets criteria, Medicare will not reimburse for the services What needs to be documented? 3
4 Jimmo vs. Sebelius Intended to clarify that when skilled nursing or skilled therapy services are required in order to provide care that is reasonable and necessary to prevent or slow further deterioration Medicare skilled coverage cannot be denied based on the absence of potential for improvement or restoration Conversely, coverage in this context would not be available when the beneficiary s care needs can be met safely and effectively through the use of nonskilled personnel The Agreement does not modify, contract, or expand the existing eligibility requirements for receiving Medicare coverage 4
5 Documentation Even though appropriate documentation is not an element of the definition of a skilled service, appropriate documentation serves as the means by which a provider would be able to confirm that skilled care is needed and received. 5
6 Three Qualifying Midnights Medicare beneficiaries must receive acute care as a hospital or CAH inpatient for a medically necessary stay of at least three consecutive calendar days to qualify for coverage of SNFlevel services. 6
7 Regulatory Critical Access Hospitals, Statutory Citation, 2254A, Chapter 2, State Operations Manual (updated 9/27/13) The Conditions of Participation (CoPs) for Critical Access Hospitals are found in the Code of Federal Regulations at 42 CFR Part 485 subpart F Compliance with the specific CAH SNF requirements specified by 42 CFR (d) must be met for swing beds 7
8 Residents rights Be in Compliance with 42 CFR (d)(1-9) Admission, transfer, and discharge rights Resident behavior and facility practices Patient activities (with exceptions for director of services) Social services Comprehensive assessment, comprehensive care plan, and discharge planning (with some exceptions) Specialized rehabilitative services Dental services Nutrition
9 RAI Manual The Resident Assessment Instrument (RAI) helps facility staff to gather definitive information on a resident s strengths and needs, which must be addressed in an individualized care plan It also assists staff to evaluate goal achievement and revise care plans accordingly by enabling the facility to track changes in the resident s status Interdisciplinary use of the RAI promotes emphasis on quality of care and quality of life Provides resource for increased clarity of documentation 9
10 Where do YOU Begin? 10
11 Most Common Use of SBs Need was for physical and occupational therapy for orthopedic patients Patients needing strengthening following their hospital stay Patients requiring wound care Patients getting intravenous antibiotics were also common among the swing bed population. 11
12 Admission Guidelines Milliman Care McKesson InterQual for Subacute Medicare Fiscal Intermediary Manual, Part 3, Chapter 2 BUT Plan of Care establishes need for skilled services AND documentation should be closely linked to POC Must project team approach to care 12
13 Other Documentation: Labs, X-Rays, MRIs, CAT scans or supporting diagnostic reports Diagnosis supporting rehabilitation, skilled services or therapies Discharge summaries from the qualifying hospital stay Evaluations, treatment plans, or POCs signed by a physician 13
14 Colorado Rural Health Center Manual for CAHs Forms Certification/Recertification Patient Tracking Form Patient Transfer to CAH Swing Bed Assessment Swing Bed Care Plan Swing Bed Team Meeting Care Plan Update Swing Bed Patient Activity Plan 14
15 Swing Bed Requirements CMS clarified that CAHs are required to complete a resident assessment and a comprehensive care plan for each Swing Bed patient Documenting: significantly high probability that complications would arise without skilled supervision of the treatment plan by a licensed nurse (and therapist) 15
16 Start with Assessment Use of Nasal Cannula Use of a cannula or the need for respiratory therapy services does not alone qualify a patient for skilled care Must be daily documentation of the patient s progress and/or complications Need for skilled management should be reevaluated at least once weekly Precise delivery of oxygen concentration, e.g., titration of O2 for Ventimasks. Oxygen delivery by nasal cannula is usually not eligible for RT visits. 16
17 RAI Manual: Nebulizers Respiratory therapy services include coughing, deep breathing, heated nebulizers, aerosol treatments, assessing breath sounds and mechanical ventilation, etc., which must be provided by a respiratory therapist or trained respiratory nurse Does not include hand-held medication dispensers Not a skilled service if patient can selfmedicate 17
18 Dehydration: At least 2... Resident takes in less than the recommended 1,500 ml of fluids daily (water or liquids in beverages and water in foods with high fluid content, such as gelatin and soups). The recommended intake level has been changed from 2,500 ml to 1,500 ml to reflect current practice standards. Resident has one or more potential clinical signs (indicators) of dehydration, including but not limited to dry mucous membranes, poor skin turgor, cracked lips, thirst, sunken eyes, dark urine, new onset or increased confusion, fever, or abnormal laboratory values (e.g., elevated hemoglobin and hematocrit, potassium chloride, sodium, albumin, blood urea nitrogen, or urine specific gravity). Resident s fluid loss exceeds the amount of fluids he or she takes in (e.g., loss from vomiting, fever, diarrhea that exceeds fluid replacement). 18
19 Wound Care Wound Care (including decubitus ulcers) care alone rarely requires a SNF setting A physician must order wound care The patient must require extensive wound care (e.g., packing, debridement, and/or irrigation) that cannot be accomplished by the patient, caregiver, or home health services Treatment of extensive decubitus ulcers or other widespread skin disorder Skilled observation and assessment of a wound must be documented daily and should reflect any changes in wound status to support the medical necessity for continued observation 19
20 Endotracheal Suctioning Deep tracheal suctioning must be required at least every 4 hours Suctioning daily or PRN less frequently than every 4 hours is not considered skilled Requires clear documentation that the patient is being suctioned at least every 4 hours 20
21 Urinary Catheters The presence of a stable indwelling or suprapubic catheter, the need for routine intermittent straight catheterization, catheter replacement or routine catheter irrigation does not quality a patient for SNF placement unless other skilled needs exist 21
22 Intermittent Catheterization Sterile insertion and removal of a catheter through the urethra for bladder drainage Do not include one time catheterization for urine specimen during look back period as intermittent catheterization 22
23 Isolation Only when the resident requires strict isolation or quarantine alone in a separate room because of active infection (i.e., symptomatic and/or have a positive test and are in the contagious stage) with a communicable disease, in an attempt to prevent spread of illness Do not code isolation if primarily consists of body/fluid precautions, because these types of precautions apply to everyone 23
24 Shortness of Breath SOB with exertion SOB when sitting at rest SOB when lying flat 24
25 Therapy The deciding factor in determining whether rehabilitation services are skilled is not the patient s potential for recovery, but whether the services require the skills of a therapist or non-skilled personnel What needs to be documented? Clear documentation of the patient's rehabilitative and restorative functional potential Documentation of the treatment plan, PT goals (including the approximate dates the goals will be met), as well as the anticipated length of treatment and discharge plan 25
26 Physical Therapy PT must relate to the restoration of lost function; e.g., gait, transfer, or stair training or bed mobility Unless a gait disturbance is present the following are not considered skilled PT: Progressive ambulation Repetitive exercises to improve ambulation and maintain strength and endurance, and Assisted walking of 100 feet or more 26
27 RAI Manual and Weight Bearing: Episodes of full staff performance are considered to be weight-bearing assistance When every episode is full staff performance, this is total dependence When there are three or more episodes of a combination of full staff performance and weight-bearing assistance Code extensive assistance When there are three or more episodes of a combination of full staff performance, weight-bearing assistance, and non-weight-bearing assistance Code limited assistance 27
28 RAI Manual: Rehab Potential Possible underlying problems that may affect function: Delirium Acute episode of chronic condition Change in cognitive status Mood decline Behavioral symptoms Use of physical restraints Pneumonia Fall Hip fracture Recent hospitalization Fluctuating ADLs Nutritional problems Pain Dizziness Communication issues Vision problems Abnormal Lab values (electrolytes, blood sugar, etc.) 28
29 RAI and ADLs Bed Mobility how a resident moves to and from lying position, turns side to side and positions body while in be or alternative sleeping furniture Transfer how resident moves between surfaces including to or from bed, chair, wheelchair, and standing position BUT excludes transfer to bath/toilet 29
30 Therapy Log Requires skilled services on a daily basis Shows length of service, thus allowing for necessity, duration and quantity documentation 30
31 Required Paperwork Physician Certification Admission Orders Practical Matter Notice of Medicare Non Coverage (NOMNC) 31
32 Regulatory Federal Public Law 42 CFR Part 485 Subpart F: [Conditions of Participation: Critical Access Hospitals (CAHs)] Section deals with the Conditions of Participation for Critical Access Hospitals. Section identifies special requirements for CAH providers of long term care services Public Law 42 CFR Part 409, Subpart C, Section ; and 42 CFR Part 409, Subpart D, Subpart D: (Includes requirements for coverage of post hospital SNF Care) Medicare State Operations Manual, Appendix W: Survey Protocol, Regulations and Interpretive Guidelines for Critical Access Hospitals (CAHs) and Swing Beds in CAHs. 32
33 Regulatory Comprehensive Assessment: Medicare State Operations Manual, Interpretive Guidelines for Long term Care Facilities Appendix PP 483.2(b)(2) Medicare Benefit Policy Manual: Section 20.1, Chapter 8 Medicare Claims Processing Manual: Physicians/Non physician Practitioners: Chapter 12, Section B Medicare Claims Processing Manual: SNF Inpatient Part A Billing: Chapter 6, Section 10.2, Medicare Benefit Policy Manual: Chapter 9, Sections and CMS Swing Bed Fact Sheet: Updated November 2010 Each state has its own unique state requirements. Refer to your state s website for the most current information 33
34 Contacts Lisa Pando, LTC Consultant Tammi DeSimone, LTC Consultant Kerry Dunning, Sr. VP LTC Division
Subject: Skilled Nursing Facilities (Page 1 of 6)
Subject: Skilled Nursing Facilities (Page 1 of 6) Objective: I. To ensure that Tuality Health Alliance (THA) and delegated Providence Health Plan Medicare members are appropriately placed in skilled nursing
More informationCAH 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 informationSkilled Nursing Facility Admission Orders
Diagnosis Allergies SNF Admission- Required SNF Regulatory Admit to Skilled Nursing Facility Date: All orders good for 45 days unless otherwise indicated Follow Up Appointment Follow up appointment(s):
More informationProbe and Educate Round 2. Connecting With Medicare Clinical Updates CGS Administrators, LLC. Missouri Alliance for Home Care.
2017 Conference Presenter: Sandy Decker RN BSN; Senior Provider Education Consultant Home Health Coverage Resources CGS Home Health Coverage Guidelines Web page http://www.cgsmedicare.com/hhh/coverage/home_health_co
More informationMedical Review Criteria Skilled Nursing Facility & Subacute Care
Medical Review Criteria Skilled Nursing Facility & Care Subject: Skilled Nursing Facility and Care Background: Skilled nursing facilities () provide facility-based skilled nursing care and related services
More informationCLINICAL CRITERIA FOR UM DECISIONS Skilled Nursing Facilities
COMMERCIAL CLINICAL CRITERIA FOR UM DECISIONS Skilled Nursing Facilities Capital Health Plan (CHP) will provide coverage for care in a skilled nursing facility, subject to the benefit limitations of the
More informationNORTH DAKOTA LEVEL OF CARE FORM INSTRUCTIONS TO BE USED WITH LOC FORM ND
For this section, select which type of LOC screen is to be reviewed Requested Screen Type NORTH DAKOTA LEVEL OF CARE FORM INSTRUCTIONS Nursing Facility Swingbed CMFN PACE MFP Provisional MFP Final Tech.
More informationSWING BED (SWB) Rural Hospitals under 100 Beds and Critical Access Hospitals
SWING BED (SWB) Rural Hospitals under 100 Beds and Critical Access Hospitals Federal Regulations Hospitals under 100 Beds Critical Access Hospitals CMS State Operations Manual Appendix T Regulations and
More informationSkilled Nursing Facility Level of Payment Guidelines for Tufts Health Plan Senior Care Options Members
Skilled Nursing Facility Level of Payment Guidelines for Tufts Health Plan Senior Care Options Members For level of payment guidelines for Tufts Medicare Preferred HMO members, click here. LEVEL 1A - SKILLED
More information3/12/2015. Session Objectives. RAI User s Manual. Polling Question
Session Objectives MDS 3.0 Coding Challenges: Questions, Answers, and Explanations Jen Pettis, BS, RN, WCC Associate March 19, 2015 Upon completion of the program, the participate will: Describe the four
More informationDEMONSTRATED NEED FOR SKILLED CARE FOR MEDICARE PATIENTS: SKILLED NURSING SERVICES
DEMONSTRATED NEED FOR SKILLED CARE FOR MEDICARE PATIENTS: SCOPE: All Ascension At Home, LLC colleagues. For purposes of this policy, all references to colleague or colleagues include temporary, part-time
More informationMDS Essentials. MDS Essentials: Content. Faculty Disclosures 5/22/2017. Educational Activity Completion
MDS Essentials MDS Essentials: Introduction to Care Area Assessments and Care Plans 4 Faculty Disclosures I have no financial relationships to disclose I have no conflicts of interests to disclose I will
More informationCritical Thinking Steps
CAA s = Critical Thinking CAROL SIEM, MSN, RN, BC, GNP Clinical Educator/Team Leader for QIPMO Critical Thinking Steps Recognition/Assessment Gather essential information about the individual Problem definition
More informationMDS 3.0 Questions. Significant change criteria - Resident's incontinence pattern changes - Does this include both bowel and bladder? Yes.
Section A MDS 3.0 Questions Following are questions raised during OHCA s MDS 3.0 training programs. The reference information provided is based on the CMS Long-Term Care Resident Assessment Instrument
More informationMedical Review Criteria Medical Transportation
Medical Review Criteria Medical Transportation Subject: Medical Transportation Authorization: Prior authorization is required for ALL non-emergent fixed-wing air and ground transportation provided to members
More informationUsing Clinical Criteria for Evaluating Short Stays and Beyond
Using Clinical Criteria for Evaluating Short Stays and Beyond Georgeann Edford I. History A. Social Security Act Medical Necessity and Utilization Review 1. Items or services necessary for the diagnosis
More informationPresented 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 informationWebinar Etiquette. Webinar Resources
Georgia State Office of Rural Health & HomeTown Health, LLC Welcome you to the: Best Practices for Compliance & Efficiency 2016-2017 Rural Swing Bed Management (RSBM) Training Program Use of Swing Beds
More informationCMS Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents Phase 2--Payment Model
CMS Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents Phase 2--Payment Model The Revolving Door One fourth of all nursing home resident go the hospital each year - Some many
More information8/6/2013. More than a Century of Legal Experience. Agenda
Swing Bed Services: 3 Day Qualifying Stays, Medically Necessary Admissions, and Observation Services Oh My!!! August 13, 2013 Presented by: Jennifer McManis More than a Century of Legal Experience This
More informationHome Health Eligibility Requirements
Presented By: Melinda A. Gaboury, COS-C Chief Executive Officer Healthcare Provider Solutions, Inc. healthcareprovidersolutions.com Home Health Eligibility Requirements Meets eligibility for home health
More informationTABLE OF CONTENTS. Medicare Charting Guidelines... Section 3 Documentation Guideline Procedures...1 Medicare Documentation Guidelines...
TABLE OF CONTENTS Medicare Skilled Nursing Training Handout...Section 1 Post Test...1 Training Content...3 Nursing Documentation Subjective/Objective Statements...22 Supportive Nursing Documentation...23
More informationRecognizing and Reporting Acute Change of Condition
Recognizing and Reporting Acute Change of Condition Welcome to the Elizabeth McGowan Training Institute Cell Phones and Pagers Please turn your cell phones off or turn the ringer down during the session.
More informationA 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 informationMedicare Part C Medical Coverage Policy
Skilled Care Services Medicare Part C Medical Coverage Policy Origination: June 30, 1988 Review Date: February 21, 2018 Next Review: February, 2020 DESCRIPTION OF PROCEDURE OR SERVICE Skilled Care Services
More informationADMISSION CARE PLAN. Orient PRN to person, place, & time
ADMISSION DATE: CODE STATUS: ADMISSION CARE PLAN ADMISSION DIAGNOSIS: 1. DELIRIUM 2. COGNITIVE LOSS Resident will be as alert and oriented as possible Resident will be as alert and oriented as comfortable
More informationMore than a Century of Legal Experience
Swing Bed Services: 3 Day Qualifying Stays, Medically Necessary Admissions, and Observation Services Oh My!!! August 13, 2013 Presented by: Jennifer McManis More than a Century of Legal Experience This
More informationToday s educational presentation is provided by. The software that powers HOME HEALTH. THERAPY. PRIVATE DUTY. HOSPICE
Today s educational presentation is provided by The software that powers HOME HEALTH. THERAPY. PRIVATE DUTY. HOSPICE At Kinnser, we believe post-acute care businesses need the right software solution for
More informationNM DDSD Intensive Medical Living Services Eligibility Parameter Tool A. MEDICATION ADMINISTRATION SEVERE 4 SIGNIFICANT 3 MODERATE 2 LOW 1 NONE - 0
FACT Scheduled Medications: Note: Any injections provided by Home Health, Hospice or other clinical providers may not be included in these totals for the agency nursing time. Do not include delivery of
More informationPrior Authorization form for Post-Acute Care Admission and Recertification for SNF,LTAC and Rehab
Prior Authorization form for Post-Acute Care Admission and Recertification for SNF,LTAC and Rehab (Required for all Rehab, SNF, LTAC admits) Providers must request authorization for initial admissions
More informationObservation Coding and Billing Compliance Montana Hospital Association
Observation Coding and Billing Compliance Montana Hospital Association Sue Roehl, RHIT, CCS sroehl@eidebaill.com 701-476-8770 IP versus Observation considerations Severity of patient s signs and symptoms
More informationLong Term Care Hospital Clinical Coverage Policy No: 2A-2 Services (LTCH) Amended Date: October 1, Table of Contents
Long Term Care Hospital Clinical Coverage Policy No: 2A-2 Services (LTCH) Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 2.0 Eligibility Requirements...
More informationALABAMA MEDICAID AGENCY ADMINISTRATIVE CODE CHAPTER 560-X-46 HOSPICE CARE TABLE OF CONTENTS
Medicaid Chapter 560-X-46 ALABAMA MEDICAID AGENCY ADMINISTRATIVE CODE CHAPTER 560-X-46 HOSPICE CARE TABLE OF CONTENTS 560-X-46-.01 560-X-46-.02 560-X-46-.03 560-X-46-.04 560-X-46-.05 560-X-46-.06 560-X-46-.07
More informationCMS Updates RAI User s Manual
CMS Updates RAI User s Manual By Rena R. Shephard, MHA, RN, RAC MT, C NE AANAC Executive Editor The Centers for Medicare & Medicaid Services (CMS) June 2 posted revisions to the Long Term Care Facility
More informationConnecting Therapy to Outcome and Process Measures: Moving from Concept to Reality
Connecting Therapy to Outcome and Process Measures: Moving from Concept to Reality Presented By: Cindy Krafft MS PT Director of Rehabilitation Consulting Services President Home Health Section APTA August
More informationReview Process. Introduction. InterQual Level of Care Criteria Long-Term Acute Care Criteria
InterQual Level of Care Criteria Long-Term Acute Care Criteria Review Process Introduction InterQual Level of Care Criteria support determining the appropriateness of Long-Term Acute Care (LTAC) admission,
More informationMLN Matters Number: MM6699 Related Change Request (CR) #: 6699
News Flash Medicare will cover immunizations for H1N1 influenza also called the "swine flu." There will be no coinsurance or copayment applied to this benefit, and beneficiaries will not have to meet their
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: skilled_nursing_services 07/2001 2/2018 2/2019 2/2018 Description of Procedure or Service Skilled Nursing
More informationDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES
Use for a resident who has potentially unnecessary medications, is prescribed psychotropic medications or has the potential for an adverse outcome to determine whether facility practices are in place to
More informationTwo Midnight Rule What does it mean for Coders?
Two Midnight Rule What does it mean for Coders? Heather Greene, MBA, RHIA, CPC, CPMA Vice President, Compliance Services AHIMA Approved ICD-10 CM/PCS Trainer 1 Agenda The Two-Midnight Rule Supportive documentation
More informationInitiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents. Payment Model
Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents Payment Model Payment Model Six Enhanced Care and Coordination Providers (ECCPs) entered into cooperative agreements with
More informationTelemedicine: Solving the Root Causes for Preventable 30-day Readmissions in SNF Settings
For Immediate Release: 05/11/18 Written By: Scott Whitaker Telemedicine: Solving the Root Causes for Preventable 30-day Readmissions in SNF Settings Outlining the Problem: Reducing preventable 30-day hospital
More informationFlorida Health Care Association 2013 Annual Conference
Florida Health Care Association 2013 Annual Conference The Westin Diplomat Resort & Spa Session #29 Therapy and the MDS Coordinator: Collaboration = Improved Outcomes Tuesday, August 6 4:45 to 6:15 p.m.
More information2016 SUMMER STUDENT NURSE EXTERNSHIP PROGRAM SKILLS CHECK LIST
2016 SUMMER STUDENT NURSE EXTERNSHIP PROGRAM SKILLS CHECK LIST STUDENT NURSE EXTERNNAME SCHOOL OF NURSING STUDENT AGREEMENT: I request the Clinical Skills Check list be released to (hospital/agency). I
More informationOASIS-C2 FIELD GUIDE TO DATA COLLECTION
OASIS-C2 FIELD GUIDE TO DATA COLLECTION Outcome and Assessment Information Set OASIS-C2 Guidance Manual Effective January 1, 2018 Manual: Effective January 1, 2018 Q&A from November 2016 Categories 1 through
More informationDetermining the Appropriate Inpatient Rehabilitation Candidate
Determining the Appropriate Inpatient Rehabilitation Candidate Brandi Damron, OTR/L, MBA Program Director Norton Community Hospital Inpatient Rehab Unit Objectives Discuss the preadmission process limitations
More informationPrivate Duty Nursing (PDN) Eligibility Determination Workshop. A refresher course for current PIHP Nurses and initial training for new PIHP Nurses
Private Duty Nursing (PDN) Eligibility Determination Workshop A refresher course for current PIHP Nurses and initial training for new PIHP Nurses Presenters: Linda Fletcher, RN, MS, CPNP Deb Ziegler, HSW
More informationChanges 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 informationUnitedHealthcare Medicare Readmission Review Program for Medicare Advantage Plans General Clinical Guidelines for Payment Review
UnitedHealthcare Medicare Readmission Review Program for Medicare Advantage Plans General Clinical Guidelines for Payment Review Introduction The UnitedHealthcare Medicare Readmission Review Program is
More informationPPS Therapy. Medicare 2/28/ year Home Health clinician/contractor. 30 years Geriatric Rehab. Home Health consultant, author, speaker
PPS Therapy Changes 30 year Home Health clinician/contractor 30 years Geriatric Rehab Home Health consultant, author, speaker Progressive programming/clinical delivery Progressive management systems Home
More informationUsing Clinical Criteria for Evaluating Short Stays and Beyond. Georgeann Edford, RN, MBA, CCS-P. The Clinical Face of Medical Necessity
Using Clinical Criteria for Evaluating Short Stays and Beyond Georgeann Edford, RN, MBA, CCS-P The Clinical Face of Medical Necessity 1 The Documentation Faces of Medical Necessity ç3 Setting the Stage
More informationMedicare General Information, Eligibility, and Entitlement
Medicare General Information, Eligibility, and Entitlement Chapter 4 - Physician Certification and Recertification of Services Transmittals for Chapter 4 Table of Contents (Rev. 50, 12-21-07) 10 - Certification
More informationMichigan Medicaid Nursing Facility Level of Care Determination
Michigan Department of Health and Human Services Michigan Medicaid Nursing Facility Level of Care Determination Applicant's Name: Medicaid ID: Field 1 (Last) (First) (M.I.) Field 2 Date of Birth: Field
More informationHealth Management Policy
Health Management Policy Policy Number: 0101 Effective Date: 4/1/18 Policy Title: Circumvention of PPS/Readmission Review Applies To: Generations Advantage Purpose: The Martin s Point Health Care Medicare
More informationRNSG Pre-Class Activities REQUIRED Ticket to Lab*
Week 1 January 19-24 Online course ientation in Blackboard (Bb) course site (No Lab until next week) Week 2 January 25 January 28 1: Infection Control Medical & Surgical Asepsis 28 Module 2 Basic Skills/Basic
More informationCMS 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 informationMaggie 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 informationNEW JERSEY. Downloaded January 2011
NEW JERSEY Downloaded January 2011 SUBCHAPTER 25. MANDATORY NURSE STAFFING 8:39 25.1 Mandatory policies and procedures for nurse staffing (a) There shall be a full time director of nursing or nursing administrator
More informationBased on the comprehensive assessment of a resident, the facility must ensure that:
7. QUALITY OF CARE Each resident must receive, and the facility must provide, the necessary care and services to attain or maintain the highest practicable physical, mental and psychosocial wellbeing,
More informationWHAT IS DOCUMENTATION?
LEARNING OBJECTIVES: Describe documentation and its purpose in hospice Distinguish problematic documentation practices Recognize the relationship between documentation and the payment of claims Describe
More informationMedical Policy Definition of Skilled Care
Medical Policy Definition of Skilled Care Document Number: 015 Authorization required for skilled care and shortterm rehab Notification within 24 hours or next business day No notification or authorization
More informationJoint Statement on Ambulance Reform
Joint Statement on Ambulance Reform Policymakers Should Examine Short- and Intermediate-Term Policies to Promote Innovation in the Delivery of Emergency and Non- Emergency Care Provided by Ambulance Services
More informationHOSPITAL ACQUIRED COMPLICATIONS. Shruti Scott, DO, MPH Department of Medicine UCI Hospitalist Program
HOSPITAL ACQUIRED COMPLICATIONS Shruti Scott, DO, MPH Department of Medicine UCI Hospitalist Program HOSPITAL ACQUIRED COMPLICATIONS (HACS) A medical condition or complication that a patient develops during
More informationHEALTH SERVICES POLICY & PROCEDURE MANUAL
PAGE 1 of 8 PURPOSE To provide guidelines on: 1. rating offenders using patient acuity, 2. how to properly handle offenders who are housed in facilities with conflicting acuity levels, 3. how to properly
More informationCRITICAL ACCESS HOSPITAL SWING BED PROGRAM
CRITICAL ACCESS HOSPITAL SWING BED PROGRAM Operational and Management Strategies March 1, 2016 Andrea Elliott, CPA Senior Managing Consultant aelliott@bkd.com Suzy Harvey, RN-BC, RAC-CT Managing Consultant
More informationMedicare: This subset aligns with the requirements defined by CMS and is for the review of Medicare and Medicare Advantage beneficiaries
InterQual Level of Care Criteria Subacute & SNF Criteria Review Process Introduction InterQual Level of Care Criteria support determining the appropriateness of admission, continued stay, and discharge
More informationUnderstanding Levels of Rehab for Effective Discharge Planning
Understanding Levels of Rehab for Effective Discharge Planning Rose M. Turner, RN, BSN, ACM Thursday, January 22 nd, 2015 The information provided in AHC Media Webinars does not, and is not intended to
More information60 Memorial Medical Parkway Palm Coast, Florida 32164
POLICY & PROCEDURES TITLE: Privileges of Student Nurses and Student Nursing Assistants POLICY # EDU 001 POLICY CATEGORY: Administrative / Education Origination Date: 12/2008 Last Review/Revision Date:
More informationA Closer Look at the Revised Nursing Facility Regulations. Quality of Care
A Closer Look at the Revised Nursing Facility Regulations Quality of Care Executive Summary The substantive requirements for quality of care are retained in the revised regulations, and the Centers for
More informationE: Nursing Practice. Alberta Licensed Practical Nurses Competency Profile 51
E: Nursing Practice Alberta Licensed Practical Nurses Competency Profile 51 Competency: E-1 Critical Thinking E-1-1 E-1-2 E-1-3 Demonstrate knowledge and ability to apply critical thinking concepts throughout
More informationdoes staff intervene; used? If not, describe.
Use this pathway for a resident who requires or receives respiratory care services (i.e., oxygen therapy, breathing exercises, sleep apnea, nebulizers/metered-dose inhalers, tracheostomy, or ventilator)
More informationRestorative Nursing: The NHA s Role and Organizational Outcomes
Restorative Nursing: The NHA s Role and Organizational Outcomes SUE LAGRANGE, RN, BSN, NHA, CDONA, CIMT DIRECTOR OF EDUCATION PATHWAY HEALTH 1 Objectives Upon completion of this program, attendees should
More informationAHLA. GG. Physician Orders. Timothy P. Blanchard Blanchard Manning LLP Orcas, WA
AHLA GG. Physician Orders Timothy P. Blanchard Blanchard Manning LLP Orcas, WA Institute on Medicare and Medicaid Payment Issues March 26-28, 2014 Physician Orders Timothy P. Blanchard, MHA, JD Medicare
More informationObjectives. Home Health Benefits. Pretest 1. True or False. Pretest 2. Multiple choice. Pretest 4. Multiple choice. Pretest 3.
Home Health Benefits Objectives Coleen M. Schmidt, VP Clinical Services, COO June 2015 Wisconsin Association for Home Care (WiAHC) 1. List the type of home health providers/services within the home care
More information*Your Name *Nursing Facility. radiation therapy. SECTION 2: Acute Change in Condition and Factors that Contributed to the Transfer
Gaining information about resident transfers is an important goal of the OPTIMISTC project. CMS also requires us to report these data. This form is where data relating to long stay transfers are to be
More informationReview Process. Introduction. InterQual Level of Care Criteria Subacute & SNF Criteria. Reference materials. Informational notes
InterQual Level of Care Criteria Subacute & SNF Criteria Review Process Introduction InterQual Level of Care Criteria support determining the appropriateness of admission, continued stay, and discharge
More informationNURSING. Class Lab Clinical Credit NUR 111 Intro to Health Concepts Prerequisites: None Corequisites: None
NURSING Class Lab Clinical Credit NUR 111 Intro to Health Concepts 4 6 6 8 Prerequisites: None Corequisites: None Course Description This course introduces the concepts within the three domains of the
More informationACTIVITIES OF DAILY LIVING (ADL) DECLINE Facility Assessment Checklists
ACTIVITIES OF DAILY LIVING (ADL) DECLINE Facility Assessment Checklists This is a series of self-assessment checklists for nursing home staff to use to assess processes related to activities of daily living
More informationPolling Question #1. Denials and CDI: A Recovery Auditor s Perspective
1 Denials and CDI: A Recovery Auditor s Perspective Tim Garrett, MD Medical Director Barb Brant, RN, CCDS, CDIP, CCS Sr. Clinical Trainer/DRG Auditors Cotiviti, Atlanta, GA 2 Polling Question #1 Does inpatient
More informationChronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease This booklet has been written to answer questions that many patients and family members ask about their care during their hospital stay. It will explain the experiences
More informationMDS 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 informationOlder Person's Assessment Form. Name: Contact details: Provide detail: Detail: Detail: Detail: Detail:
BASELINE: COGNITION REVIEW: COGNITION Residents details Resident name: Gender: NHS No: Age: Religion, Spirituality: Older Person's Assessment Form Care Home details Phone number: Address: Date of admission:
More informationLOUISIANA MEDICAID PROGRAM ISSUED: 02/01/12 REPLACED: 02/01/94 CHAPTER 5: PROFESSIONAL SERVICES SECTION 5.1: COVERED SERVICES PAGE(S) 11
Anesthesia Services Surgical anesthesia services may be provided by anesthesiologists or certified registered nurse anesthetists (CRNAs). Maternity-related anesthesia services may be provided by anesthesiologists,
More informationTable of Contents. Nursing Skills. Page 2 of 8. Nursing School Made Simple Guaranteed 2014 SimpleNursing.com All Rights Reserved.
Table of Contents 1 Universal Competencies... 3 1.1 Universal Elements... 3 2 Critical Thinking Question... 4 3 Documentation... 4 4 Handwashing... 4 5 Moving a patient up in bed... 4 6 Applying restraints...
More informationGENETICS CLINICAL PRIVILEGES
Name: Page 1 Initial Appointment Reappointment All new applicants must meet the following requirements as approved by the governing body effective: 8/5/2015. Applicant: Check off the Requested box for
More informationChances are.. Based on my experience MDS 3.0 Update for Long Term Care PRESENTED BY 2/13/2017. New focus on Data by CMS and Regulatory Agencies
PRESENTED BY 2017 MDS 3.0 Update for Long Term Care LEAH KLUSCH EXECUTIVE DIRECTOR THE ALLIANCE TRAINING CENTER ALLIANCE, OHIO 330-821-7616 leahklusch@tatci.com New focus on Data by CMS and Regulatory
More informationCAH 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 informationSUNY DOWNSTATE MEDICAL CENTER UNIVERSITY HOSPITAL OF BROOKLYN POLICY AND PROCEDURE
SUNY DOWNSTATE MEDICAL CENTER UNIVERSITY HOSPITAL OF BROOKLYN POLICY AND PROCEDURE Subject: GUIDELINES FOR USE OF THE No. NURSE-17 INTERDISCIPLINARY PLAN OF CARE Page 1 of 5 Prepared by:dianne Woods, RN
More informationCyclophosphamide INFUSION Infusion 4 Plus
Cyclophosphamide Infusion Day DEPARTMENT OF RHEUMATOLOGY DAY CASE ADMISSION RECORD PATIENT DAY CASE BOOKING REQUEST To be completed by Consultant, Registrar requesting day case Admission Hospital No. Forename
More informationRURAL SWING BED MANAGEMENT (RSBM) TRAINING PROGRAM
RURAL SWING BED MANAGEMENT (RSBM) The Georgia State Office of Rural Health and HOMETOWN HEALTH Present: The Need for Rural Swing Bed Training One of the challenges that rural hospitals face today is a
More informationUpcoming Seminars for the Illinois Health Care Association and the Illinois Council on Long Term Care
February 8, 2011 Number 47 Upcoming Seminars for the Illinois Health Care Association and the Illinois Council on Long Term Care Seminars included in this issue: MDS 3.0 RAC-CT Certification and Recertification
More informationSubacute Care. 1. Define important words in the chapter. 2. Discuss the types of residents who are in a subacute setting
175 26 Subacute Care 1. Define important words in this chapter 2. Discuss the types of residents who are in a subacute setting 3. List care guidelines for pulse oximetry 4. Describe telemetry and list
More informationStatement of Financial Responsibility
Statement of Financial Responsibility Patient Name: Date: Acct : BIR JV, LLP including; Out-Patient, In-Patient and, Home Health Rehab appreciates the confidence you have shown in choosing us to provide
More information4/24/2012. Cake Walk for a Successful National Government Services Medical Review Process. Today s Presenter. Disclaimer. Sally Rosiello, BSN
Cake Walk for a Successful National Government Services Medical Review Process 2012 Today s Presenter Sally Rosiello, BSN 2 Disclaimer has produced this material as an informational reference for providers
More informationLABORATORY-IDENTIFIED (LABID) EVENT REPORTING MRSA BACTEREMIA AND C. DIFFICILE. National Healthcare Safety Network (NHSN)
LABORATORY-IDENTIFIED (LABID) EVENT REPORTING MRSA BACTEREMIA AND C. DIFFICILE National Healthcare Safety Network (NHSN) CMS PARTICIPATION Acute care hospitals, Long Term Acute Care (LTACs),IP Rehabilitation
More informationRoutine Practices. Infection Prevention and Control
Routine Practices Infection Prevention and Control Routine Practices Elements of Routine Practices: Risk assessment + hand hygiene + personal protective equipment Environmental controls (patient placement,
More informationNursing Home Pearls or
Nursing Home Pearls or How to Enjoy Practicing in Skilled Nursing Facilities Lowell C. Dale, MD November 11, 2016 2016 MFMER slide-1 DISCLOSURE Relevant Financial Relationship Medical Director Golden Living
More informationAcute Care to Rehab & Complex Continuing Care (CCC) Referral
o General Rehabilitation Low Intensity Rehabilitation (GRH, SJHCG) o (CMH, GRH, SJHCG) o Chronic Assisted Ventilator (GRH only) o o Ischemic o Hemorrhagic Stroke Rehab: Program Readiness Date: Complex
More informationChapter 01: Professional Nursing Practice Lewis: Medical-Surgical Nursing, 10th Edition
Chapter 01: Professional Nursing Practice Lewis: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. The nurse completes an admission database and explains that the plan of care and discharge goals
More informationReturned Missionary Study Guide
Returned Missionary Study Guide Skills to Refresh if Returning to Capstone: 1st Semester skills Head to Toe Assessment (Need to be able to document each of these.) o Vital Signs BP Pulse Respirations Temperature
More information