More than a Century of Legal Experience
|
|
- Gabriel Daniel
- 5 years ago
- Views:
Transcription
1 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 document is the property of Crowley Fleck, PLLP and is not to be reproduced or distributed without permission. Agenda Benefit Extended Care Services Swing Bed Concept Benefit Level Of Care Prior Hospitalization & Transfer Requirements Level of Care Criteria Questionable Services Physician Certification & Recertification Documentation Requirements Admission &Discharge Orders Medical Necessity & Conditions of Participation Benefit Period Benefit Period Notice of Non-Coverage SNF ABN & HINNs Services Benefit Resources Resources Services Assessment Services Benefit Period Analysis 1
2 Extended Care (SNF )Benefit For treatment of a condition for which a patient was receiving inpatient hospital Services or a condition which arose in the SNF for treatment of a condition for Which a patient was previously hospitalized. Extended Care Services Post hospital services that are an extension of care for which inpatient hospital services were received Swing Bed Concept Allows a CAH to use their beds interchangeably CAH Swing Bed Requirements Received approval from CMS to operate Swing Beds Comply with CoPs, Special Requirements for Swing Bed Services Excluded from SNF PPS Benefit Inpatient: Hospital Specific Documentation Requirements Needed to Swing Inpatient: Skilled Nursing Facility 2
3 Benefit Benefit 100 Days of Skilled Care per Benefit period 1 st 20 Days are covered in full Days co-insurance is required No Lifetime Benefit No limit to the number of benefit periods Benefit period ends when the patient has been neither an inpatient of a hospital or a SNF for 60 consecutive days CAHs: No LOS Limit 100 Covered Days Per Benefit Period Benefits Break in SNF care for: Less Than 30 Days New 3-Day Stay is not needed Lasted for less than 60 days in a row, current benefit period will continue Maximum coverage available is the number of unused days at Least 30 but less than 60 Days New 3-Day Stay is Required Break lasted for less than 60 days in a row Maximum coverage available is the number of unused days At Least 60 New 3-Day Stay is Required Days N D S i R i d Break lasted for at least 60 days in a row Maximum coverage available is 100 Days 3
4 Extended Care (SNF) Benefit Extended (SNF) Level Of Care Extended (SNF) Level Of Care Prior Hospitalization & Transfer Requirements Think 3 midnights 3-Day Inpatient Qualifying Stay Observation Time prior to Medically Necessary Inpatient Stay Inpatient Admissions does not count Day of Admission is counted not day of Discharge Does not need to be in a hospital with which there is a transfer agreement Considered Post Hospital if: Initiated within 30 days of discharge Readmissions to the same or another SNF within days 1-30 do not require another qualifying stay 30 Day count begins on the day following discharge Exceptions to 30 Day Requirement Medical Appropriateness Exception Needs Are Predictable Certain conditions that require SNF care but cannot be initiated within 30 days after discharge 4
5 Level of Care Medical Predictability Exceptions to the 30 Day requirement Scenarios Scenario 1 ORIF of femoral neck; HX of DM Discharged from Inpatient Stay and required Skilled Care at time of discharge After two days of SNF care patient decides to leave and receive care at home with a Private Duty Nurse 5 weeks later is able to bear weight and is readmitted for SNF care of the fracture Exception Applies Scenario 2 Received three weeks of SNF care Discharged because SNF care was no longer needed Six week later there was an unexpected change in the patient s condition which required SNF care Exception Does Not Apply Scenario 3 Patient had a right leg amputation at another facility Discharged from the hospital and transferred to a SNF closer to their home, received two weeks of skilled care and was discharged. Required SNF care after the stump was healed, 8 weeks later Exception Applies Level of Care Think: When is the skilled service needed, not why. Understand: Patient s Condition is not the Sole Factor in determining if a service is Skilled Skilled Service Service that is complex that is ordered by a physician & can only be performed safely under the supervision of skilled nursing or rehabilitation staff Service that is ordinarily considered nonskilled could be considered a skilled service in cases in which required skilled nursing or skilled rehabilitation personally to perform Additional documentation required to support Level of Care Criteria Skilled Nursing or Skilled rehabilitation services must be needed & provided d 7 days a week or Skilled Rehabilitation services at least 5 Days a week Patient who is inpatient for skilled rehab services would meet the daily basis when provided at least 5 days a week Daily basis requirement can be met by furnishing a single type of skilled service every day Not applied so strictly, if there was an isolated break of a day or two during which no SNF was provided d but it is not reasonable for the patient to be discharged Restorative Skilled Nursing Services 6 days a week 5
6 Level of Care Skilled Services Management & Evaluation of a Patient Care Plan Observation & Assessment of Patient s Condition Teaching & Training Activities Direct Skilled Nursing Services Skilled Physical Therapy Skilled Speech Therapy Skilled Occupational Therapy Not Skilled Services For Example: Administration of Oral Meds General maintenance care of colostomy Routine services to maintain indwelling bladder catheters Dressing changes for uninfected post-operative conditions Use of heat as a palliative comfort measure Assistance in dressing and eating Periodic turning and position in bed General supervision of exercises unless part of a restorative maintenance program Level of Care QUESTIONABLE SERVICES Primary Service Needed is the Administration of Oral Medicine Patient is capable of independent ambulation, dressing, feeding, and hygiene Ordering a single type of skilled service every e day just to meet the requirement ement Documentation does not support the need for skilled personnel for a non-skilled service 6
7 Benefit Level of Care Documentation Requirements Documentation Requirements Conditions of Participation Same Chart may be utilized; must have a separate section Admission orders, discharge orders, progress notes, supporting documents, and discharge summary Meet the specific SNF requirements, i.e. resident rights, comprehensive assessment, free choice, comprehensive care plan Physician Certification & Recertification Initial within 14 days Recertification every 30 days Signed by the Physician or PA, NP Indicate services are required, estimated period of time required, and any plans if needed for home care Medical Necessity Documentation supports the need for skilled care & ordered by a physician Rendered for a condition for which the patient received inpatient care Required on a daily basis Can be provided only on an inpatient basis Reasonable & Necessary for the condition Admission & Discharge Orders Discharge Order from Acute Inpatient Hospital Stay Admission Order for Inpatient SNF Services 7
8 Benefit Level of Care Documentation Requirements Benefit Period Benefit Period Benefit Period Begins Date of Admission 100 Days Per Benefit Period Benefit Period Ends Patient has not been an inpatient of a hospital or SNF for 60 consecutive days or Remained in the SNF but did not receive skilled care for 60 consecutive days Once the Benefit Ends must have another 3 day qualifying stay 8
9 Notice of Non Coverage Benefit Period Different than the Important Message from Medicare Form CMS Given two days prior to the termination/end of services Deliver 2 days prior to discharge even if they agree with the termination of services Applies to Medicare & Medicare Advantage Combined to one notice ABN is given if the patient decides to continue with services once the decision has been made Do not give when benefits are exhausted or reduced Patient has right request an expedited review by the QIO; Form CMS If requested, did you deliver by close of business day the day you are notified Do not routinely ygive notice at the time services begin unless the service is expected to last fewer than two days SNF ABN & HINNs Given to the patient at the time that they want to continue or request extended care (SNF) services that are no longer medically necessary Benefit ABN, Hospital Issued Notices of Noncoverage (HINN), Notice of Medicare Non-Coverage (NOMNC), & Detailed Explanation of Non-Coverage (DEONC) Inpatient of a Hospital: Part A Inpatient Extended d Care: Part A 9
10 Inpatient Services Important Message from Medicare HINN 10: HRR HINN 11: Noncovered Service SNF Part A Services ABN Form CMS or Denial Letters SNF Part B Services ABN Form CMS-R-131 Detailed Notice of Discharge HINN 1: Preadmission HINN 12: Continued Stay Termination Notice NOMNC CMS HINN 1/*Letter 9(a)-(c) Preadmission FORMS ABN, HINNs, NOMNC,& DENC *HINN Letters 2-9 Retired PT Request Review of Termination DENC CMS HINN 12/*Letters 3-4; 6-7 Swing Bed Combination Letter Continued Stay Benefit The differentiation of when to use a HINN is most difficult for swing beds 10
11 1 st Form of communication when SNF care is no longer needed Benefit Notice of Noncoverage Use when covered skilled care is ending not when benefit is exhausted Use when there is a reduction in service ABN Use when care is ending Services HINN 1/*Letter 9(a)-(c): Preadmission Issued: before providing non-covered NF services provided in a swing bed Physician Concurrence not required Effective: At admission if given before 3:00pm SNF ABN Issued: to patients in a swing bed when services will be reduced or terminated and patient wants to continue with services Effective: Date Issued HINN12/ *Letter 3-4; 6-7: Continued Stay Issued: to a patient who chooses to remain in the hospital as an inpatient beyond the hospital determined discharge date Notice Content: Hospital Acute Care not covered Effective: Depends if the patient requests an Expedited Review Detailed Explanation of Non-Coverage (DENC) Issued: to patient who received a NOMNC and has requested a DENC Provide DENC by close of business day Notice of Medicare Non-Coverage & SNF ABN Issued: two days before the termination of services Patient may request an Expedited Determination Patient may decide to continue with services; issue a SNF ABN *HINN Letters Retired 11
12 Social Admits/Custodial Care Physician did not certify or recertify care refuses to certify 3-Day yq Qualifying Stay Not Met counting day of discharge More than 30 Days have passed since discharge from 3 Day Qualifying Stay Benefits Exhausted Benefit Period has ended NONC not given to patients Claim submitted for a 100 Days of SNF care but documentation does not support SNF care received Documentation from physician states patient no longer needs SNF care & is ready to go home Benefit Summary Level of Care Documentation Requirements Benefit Period Resources Resources: Services Resources Services Risk Assessment Services Benefit Period Analysis 12
13 This document is the property of Crowley Fleck, PLLP and is not to be reproduced or distributed without permission. Contact Information Jennifer McManis
8/6/2013. 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 informationMore than a Century of Legal Experience
Advanced Beneficiary Notice (ABN) and Hospital Issued Notice of Non Coverage(HINN): To Issue, or Not to Issue an ABN or HINN July 30, 2013 Presented by: Jennifer McManis More than a Century of Legal Experience
More informationThe Medicare Admissions Process and Strategies for Success. Your Speakers
The Medicare Admissions Process and Strategies for Success Leading Age Michigan 2014 Annual Leadership Institute Thursday, August 14, 2014 10:45 am 11:45 am 1 Your Speakers Betsy Anderson, President FR&R
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 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 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 informationPassport Advantage Provider Manual Section 5.0 Utilization Management
Passport Advantage Provider Manual Section 5.0 Utilization Management Table of Contents 5.1 Utilization Management 5.2 Review Criteria 5.3 Prior Authorization Requirements 5.4 Organization Determinations
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 informationSNF Determinations of Non-Coverage Denial Letters, ABNs & Expedited Determinations
SNF Determinations of Non-Coverage Denial Letters, ABNs & Expedited Determinations for clients of: www.teamtsi.com 800.765.8998 Content developed and presented by: 3030 N. Rocky Point Drive, Suite 240
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 informationSkilled Nursing Facility (SNF) Beneficiary Notices. Disclaimer
Skilled Nursing Facility (SNF) Beneficiary Notices What SNFs Need to Know POEA0432 (03/09) Disclaimer National Government Services, Inc. has produced this material as an informational reference for providers
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 informationCompliance Issues under Medicare Prospective Payment for Nursing Facilities. Presented by: Patricia J. Boyer NHA, RN BDO / Heritage Healthcare Group
Compliance Issues under Medicare Prospective Payment for Nursing Facilities Presented by: Patricia J. Boyer NHA, RN BDO / Heritage Healthcare Group Anyplace where there is no PPS Risk Areas Physician Certification
More informationCMS -1599F. The 2 Midnight Rule Effective October 1, 2013
Joseph Nitti, M.D. Medical Director/Physician Advisor Continuum of Care Dept. Morristown Medical Center 973-971-4004 CMS -1599F The 2 Midnight Rule Effective October 1, 2013 Determination of Inpatient
More informationMDS Language Impacts CAHs
MDS Language Impacts CAHs April 2014 Kerry Dunning, MHA, MSH, CPAR, RAC-CT Sr VP, Long Term Care Division GPS Healthcare Consultants Objectives To Sufficiently Understand: Medicare intent for documentation
More informationBeneficiary Notices: The Process, Forms and New SNFABN use. February 23, 2018 Carol Reehle RN, BSN, CPC, RAC-CT
Beneficiary Notices: The Process, Forms and New SNFABN use February 23, 2018 Carol Reehle RN, BSN, CPC, RAC-CT INTRO Carol Reehle RN, BSN, CPC, RAC-CT -Compliance Specialist with Peace Church Compliance
More informationHospital Appeals. December 6, Adrienne Mims, MD MPH Medical Director, Medicare Quality Improvement
Hospital Appeals December 6, 2012 Adrienne Mims, MD MPH Medical Director, Medicare Quality Improvement Objectives Review process for appeals for termination of Medicare services in the hospital setting
More informationDischarge Planning/ Transition of Care: What s Hot in the 20-teens CMSANJ - July 24, 2014
Discharge Planning/ Transition of Care: What s Hot in the 20-teens CMSANJ - July 24, 2014 Jackie Birmingham, RN, BSN, MS VP, Emerita, Clinical Leadership Curaspan Health Group jbirmingham@curaspan.com
More informationMedicare Noncoverage Notices
March 2014 This job aid is intended to assist home health and hospice clinicians in: Understanding and complying with regulations for issuing required Medicare notices at the time of termination and change
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 informationAetna. NOMNC Letter -- SNF needs to fax to NOMNC Fax
FINAL APPROVED 3/17/2015 Aetna Optum has contracted with Aetna Better Health to provide NP model of care during a nursing facility event and has assumed responsibility for obtaining service authorizations
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 informationSection A Identification Information
r Minimum Data Set (MDS) 3.0 Instructor Guide Section A Identification Information Objectives State the intent of Section A Identification Information. Describe the information required to complete Section
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 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 informationChapter 7 Inpatient and Outpatient Hospital Care
7 Inpatient & Outpatient Hospital Care ACUTE INPATIENT ADMISSIONS All elective and emergent admissions require prior authorization and/or notification for all Health Choice Generations Member admissions.
More informationNURSING FACILITIES: FRIENDS OR FOES? Marie C. Berliner Joy & Young, LLP Austin, Texas (512)
NURSING FACILITIES: FRIENDS OR FOES? Marie C. Berliner Joy & Young, LLP Austin, Texas (512) 330-0228 Program Overview Status of Hospice Nursing Facility Relationships Multiple contact points and transactions
More informationAppeals and Grievances
Appeals and Grievances Community HealthFirst MA Special Needs Plan (HMO SNP) Community HealthFirst MA Plan (HMO) Community HealthFirst Medicare MA Pharmacy Plan (HMO) Community HealthFirst MA Extra Plan
More informationOptum is providing NOMNC letter to facilities for skilled care for long-term residents
25-Jun-15 United HealthCare Optum has been contracted with UHC to deliver case management and nursing home model of care with a NP and RN. NP/RN is responsible for authorizing Part A and Part B skilled
More information10/22/2012. Discharge, Revocation and Transfer: Process, ABN and Appeals. Discharge the regulations. Objectives for Today s Session
Discharge, Revocation and Transfer: Process, ABN and Appeals Jennifer Kennedy, MA, BSN, CHC, LNC National and Palliative Care Organization Patricia Smith Putzbach, RN, BSN, MBA, CHPN Life Choice Discharge
More informationRegulatory 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 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 informationMedicare Regulations: Skilled Wound Care. Colleen Bayard PT, MPA, COS-C Director of Regulatory and Clinical Affairs Home Care Alliance of MA
Medicare Regulations: Skilled Wound Care Colleen Bayard PT, MPA, COS-C Director of Regulatory and Clinical Affairs Home Care Alliance of MA Medicare: Conditions of Coverage PART 484 -- HOME HEALTH SERVICES
More informationSection 4 - Referrals and Authorizations: UM Department
Section 4 - Referrals and Authorizations: UM Department Primary Care Referral Process 1 Referrals to In-Network Specialists 1 Referrals to Out-Of-Network Specialists 2 Consultation Referral Forms 2 Consultation
More informationCRS Report for Congress Received through the CRS Web
CRS Report for Congress Received through the CRS Web Order Code RS20386 Updated April 16, 2001 Medicare's Skilled Nursing Facility Benefit Summary Heidi G. Yacker Information Research Specialist Information
More informationUB-04 PART B UB-04 THERAPY CERTIFICATION NO-PAY CLAIMS RECONSIDERATION MEDICARE HOMES BILLING THERAPY NURSING MEDICARE ADVANTAGE PLANS CLAIMS UB-O4
MEDICARE ADVANTAGE PLANS THERAPY DENIALS, APPEALS, AND RECONSIDERATIONS REQUIREMENTS CARE PLANS REJECTED AND RETURNED CLAIMS VETERANS UB-04 NURSING LABORATORY BILLING UB-04 FORM DEFINITIONS DEFINITIONS
More informationMay 2007 Provider Bulletin Number 753. Hospice Providers. Changes to ICF/MR Room and Board Charges for Hospice Beneficiaries
May 2007 Provider Bulletin Number 753 Hospice Providers Changes to ICF/MR Room and Board Charges for Hospice Beneficiaries This is an update to bulletin 743. A correction has been made regarding how to
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 informationSubject: 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 informationInstructions for the Revised Home Health Advance Beneficiary Notice (HHABN) (Notice Approved January 2006)
Instructions for the Revised Home Health Advance Beneficiary Notice (HHABN) (Notice Approved January 2006) I. Overview Previously, home health agencies (HHAs) have issued HHABNs related to the absence
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 informationHOME HEALTH CARE TABLE OF CONTENTS. OVERVIEW TRANSITIONAL... CARE... SERVICES . MEMBERS... MANAGED... BY... EVICORE
TABLE OF CONTENTS. OVERVIEW............................................................................................. 452..... TRANSITIONAL................. CARE...... SERVICES......................................................................
More informationBlue Medicare Private-Fee-For-Service SM (PFFS) 2008 Medicare Advantage Terms and Conditions
Blue Medicare Private-Fee-For-Service SM (PFFS) 2008 Medicare Advantage Terms and Conditions Medicare Advantage Table of Contents Page Plan Highlights...2 Provider Participation The Deeming Process...2
More informationHospice Discharges. Legacy Hospice
Hospice Discharges Legacy Hospice Live Discharges Once a Medicare beneficiary elects the hospice benefit, hospice may not automatically or routinely d/c the beneficiary at it s discretion, even if the
More information4/17/2017 OBJECTIVES FEDERAL REQUIREMENTS. Having the Difficult Conversation: We need to Discharge You from Hospice
Having the Difficult Conversation: We need to Discharge You from Hospice Lisa Meadows/MSW Clinical Compliance Educator Accreditation Commission for Health Care OBJECTIVES Identify the regulatory requirements
More informationThe How and When of Medicare s ABN, HHCCN, & NOMNC (Home Care s Alphabet Soup) Coleen M. Schmidt November 2015
The How and When of Medicare s ABN, HHCCN, & NOMNC (Home Care s Alphabet Soup) Coleen M. Schmidt November 2015 Objectives To understand the purpose of each notification form. To identify requirements for
More informationA1600 A1800: Most Recent Admission/Entry or Reentry into this Facility
A1550: Conditions Related to Intellectual Disability/Developmental Disability (ID/DD) Status (cont.) Code E: if an ID/DD condition is present but the resident does not have any of the specific conditions
More informationMedicare Program Integrity Manual Chapter 6 - Intermediary MR Guidelines for Specific Services
Medicare Program Integrity Manual Chapter 6 - Intermediary MR Guidelines for Specific Services Transmittals for Chapter 6 Table of Contents (Rev. 475, 07-19-13) 6.1 - Medical Review of Skilled Nursing
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 informationSkilled Nursing Facility Level of Payment Guidelines for Tufts Medicare Preferred HMO Members
Skilled Nursing Facility Level of Payment Guidelines for Tufts Medicare Preferred HMO Members For level of payment guidelines for Tufts Health Plan Senior Care Options members, click here. LEVEL 1A SKILLED
More informationArchived SECTION 14 - SPECIAL DOCUMENTATION REQUIREMENTS. Section 14 - Special Documentation Requirements
SECTION 14 - SPECIAL DOCUMENTATION REQUIREMENTS 14.1 PLAN OF CARE... 2 14.2 HCFA-485 HOME HEALTH CERTIFICATION AND PLAN OF TREATMENT (FOR DOCUMENTATION PURPOSES... 2 14.3 HCFA-486 MEDICAL UPDATE AND PATIENT
More informationDEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. Discharge Planning
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services ICN 908184 October 2013 This page intentionally left blank. This booklet was current at the time it was published or uploaded
More informationSECTION A: IDENTIFICATION INFORMATION. A0100: Facility Provider Numbers. Item Rationale. Coding Instructions
SECTION A: IDENTIFICATION INFORMATION Intent: The intent of this section is to obtain key information to uniquely identify each resident, the home in which he or she resides, and the reasons for assessment.
More informationHaving the Difficult Conversation: We need to Discharge You from Hospice
Having the Difficult Conversation: We need to Discharge You from Hospice Lisa Meadows/MSW Clinical Compliance Educator Accreditation Commission for Health Care OBJECTIVES Identify the regulatory requirements
More informationContinuing Education Unit Conditions
Georgia State Office of Rural Health & HomeTown Health Best Practices for Compliance & Efficiency 2016-2017 Rural Swing Bed Management (RSBM) Training Program Use of Swing Beds in CAH Hospitals: SKILLED
More informationCare Plan Oversight Services and Physician Services for Certification
Education Makes the Difference Care Plan Oversight Services and Physician Services for Certification and Recertification of Medicare-Covered Home Health Services A CMS CONTRACTED INTERMEDIARY CARRIER The
More informationPalmetto GBA Hospice Coalition Questions August 7, 2001
Palmetto GBA Hospice Coalition Questions August 7, 2001 1. How should billing be handled when the initial certification is provided outside of the 2 weeks before and 2 days after time frame? For example,
More information2014 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 informationOctober Hospice Fundamentals All Rights Reserved 1. ABNs: The Why, The What & The When. The Plan
ABNs: The Why, The What & The When Subscriber Webinar The Plan CMS Benefit Notices Initiative The Advance Beneficiary Notice of Noncoverage (ABN) The Uses: Statutory & Voluntary The Form The Difficulties
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 informationDEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. Discharge Planning
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services ICN 908184 October 2014 This booklet was current at the time it was published or uploaded onto the web. Medicare policy
More informationClinical Medical Policy Department Clinical Affairs Division DESCRIPTION
Inpatient Rehabilitation Facilities (IRFs) [For the list of services and procedures that need preauthorization, please refer to www.mcs.pr Go to Comunicados a Proveedores, and click Cartas Circulares.]
More informationOIG Work Plan Darci Friedman, Director of Regulatory Products Lynne Rinehimer, Sr. Healthcare Solutions Consultant
OIG Work Plan 2014 Darci Friedman, Director of Regulatory Products Lynne Rinehimer, Sr. Healthcare Solutions Consultant Agenda Introduction to, and how to interpret, the OIG Work Plan Review of Hospital
More informationObjectives 9/18/2018. Patient Driven Payment Model(PDPM) Janine Finck Boyle, MBA/HCA, LNHA Vice President of Regulatory Affairs Fall 2018
Patient Driven Payment Model(PDPM) Janine Finck Boyle, MBA/HCA, LNHA Vice President of Regulatory Affairs Fall 2018 Mission: The trusted voice for aging. Objectives List the five(5) case mix components
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 informationA B C D F F* G K L M N Basic, including 100% Part B coinsurance. Basic, including 100% Part B coinsurance
This chart shows the benefits included in each of the standard Medicare supplement plans. Every company must make Plan A available. Some plans may not be available in your state. AmeriHealth Insurance
More informationCMS Observation vs. Inpatient Admission Big Impacts of January Changes
CMS Observation vs. Inpatient Admission Big Impacts of January Changes Linda Corley, BS, MBA, CPC Vice President Compliance and Quality Assurance 706 577-2256 Cellular 800 882-1325 Ext. 2028 Office Agenda
More informationCAHABA GOVERNMENT BENEFIT ADMINISTRATORS (GBA) PROVIDER-BASED ATTESTATION STATEMENT. Main Provider Medicare Provider Number:
Main Provider Information: Main Provider Medicare Provider Number: Main Provider Legal Business Name: Main Provider Doing Business As Name: Main Provider s Address: Attestation Contact Name (please print):
More informationroutine services furnished by nursing facilities (other than NFs for individuals with intellectual Rev
4025.1 FORM CMS-2552-10 11-16 When an inpatient is occupying any other ancillary area (e.g., surgery or radiology) at the census taking hour prior to occupying an inpatient bed, do not record the patient
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 informationEVALUATION OF THE POST-ACUTE CARE PATIENT
EVALUATION OF THE POST-ACUTE CARE PATIENT Taylor Bailey, NP-C Jessica Reed, NP-C AGENDA What is Post-Acute Care? Why Post-Acute Care? Post-Acute Care: Who Belongs Where? Overview of Post-Acute Care inpatient
More informationHealth in Handbook. a guide to Medicare rights & health in Pennsylvania #6009-8/07
Health in Handbook a guide to Medicare rights & health in Pennsylvania #6009-8/07 Tips for Staying Healthy works hard to make sure that the health care you receive is the best care possible. There are
More informationMACRA for Critical Access Hospitals. Tuesday, July 26, 2016 Webinar
MACRA for Critical Access Hospitals Tuesday, July 26, 2016 Webinar MACRA presenters Harold D. Miller, President & CEO CHQPR Claudia Sanders, Sr. Vice President, Policy Development Andrew Busz, Policy Director,
More informationMedicare 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 informationPayment Policy: 30 Day Readmission Reference Number: CC.PP.501 Product Types: ALL
Payment Policy: 30 Day Readmission Reference Number: CC.PP.501 Product Types: ALL Effective Date: 01/01/2015 Last Review Date: 04/28/2018 Coding Implications Revision Log See Important Reminder at the
More informationAdministrative Guide. KanCare Program Chapter 11: Hospice. Physician, Health Care Professional, Facility and Ancillary. UHCCommunityPlan.
KanCare Program Physician, Health Care Professional, Facility and Ancillary Administrative Guide Doc#: PCA-1-003044_06202016 UHCCommunityPlan.com Welcome to UnitedHealthcare This administrative guide is
More informationDeveloping A Discharge Process: Merging Regulation and Patient/Family Satisfaction
Developing A Discharge Process: Merging Regulation and Patient/Family Satisfaction Lisa Meadows/MSW Clinical Compliance Educator Accreditation Commission for Health Care Objectives Gain an understanding
More informationMolina Healthcare MyCare Ohio Prior Authorizations
Molina Healthcare MyCare Ohio Prior Authorizations Agenda Eligibility Medicare Passive Enrollment Transition of Care Definition Submission Time Frame Standard vs. Urgent How to Submit a Prior Authorization
More informationOASIS-C Home Health Outcome Measures
OASIS-C Home Measures 1 End Result Grooming groom self. (M1800) Grooming 2 End Result Grooming same in ability to groom self. (M1800) Grooming 3 End Result Upper Body Dressing dress upper body. (M1810)
More informationPATIENT STATUS DEFINITIONS, 2 MIDNIGHT RULE AND 96 HOUR RULE
PURPOSE It is the policy of Mason General Hospital and Family of Clinics (MGH&FC) that based on the Patient Status Definitions, all placements concerning the use of observation beds, or placements made
More informationCMS IPPS 2014 Final Rule: Physician Education on Observation Status and 2-Midnight Rule
CMS IPPS 2014 Final Rule: Physician Education on Observation Status and 2-Midnight Rule John Zelem, MD, FACS Executive Medical Director Audit, Compliance and Education (ACE) AHA Solutions, Inc., a subsidiary
More informationSkilled Nursing Facility Medicare Basics
Judy Wilhide Brandt, RN, BA, RAC-MT, QCP, CPC, DNS-CT judy@judywilhide.com 909-800-9124 www. Skilled Nursing Facility Medicare Basics January 2018 NC & VA Helpful Resources:. Resources judywilhide.com
More informationSNF proposed rule revisions to case-mix methodology
SNF proposed rule revisions to case-mix methodology Comments due: August 25, 2017 CMS intent to propose case-mix refinements in the FY 2019 SNF PPS proposed rule Summary of changes Goals of the change:
More informationIMPORTANT PROVIDER UPDATES
December 28, 2015 IMPORTANT PROVIDER UPDATES Dear Provider, Please find attached important updates, reminders and policy changes for Coordinated Care providers regarding: Page Title Number 2 Notice 1:
More informationHospice Continuous Home Care LEGACY HOSPICE
Hospice Continuous Home Care LEGACY HOSPICE The Basics CONTINUOUS HOME CARE OF THE HOSPICE PATIENT What is Continuous Home Care? A day on which an individual who has elected to receive hospice care is
More informationAAPC Webinar 3/28/2016
Short Stays for the Coder Where Are We Now? Heather Greene, MBA, RHIA, CPC, CPMA AHIMA Approved ICD-10 CM/PCS Trainer Copyright 2016 AAPC Agenda The Two-Midnight Rule Supportive documentation Observation
More informationOUTLINE OF MEDICARE SUPPLEMENT COVERAGE
A Medicare Supplement Program Basic, including 100% Part B coinsurance A B C D F F * G Basic, including Basic, including Basic, including Basic, including Basic, including 100% Part B 100% Part B 100%
More informationInpatient Psychiatric Facility (IPF) Coverage & Documentation. Presented by Palmetto GBA JM A/B MAC Provider Outreach and Education September 7, 2016
Inpatient Psychiatric Facility (IPF) Coverage & Documentation Presented by Palmetto GBA JM A/B MAC Provider Outreach and Education September 7, 2016 1 Disclaimer This information is current as of August
More informationDean Health Plan Physical Medicine Overview
Dean Health Plan Physical Medicine Overview Provider Training / Presented by: Leta Genasci Above and throughout this document, NIA Magellan refers to National Imaging Associates, Inc. Dean Health Plan
More informationPO Box 350 Willimantic, Connecticut (860) Connecticut Ave, NW Suite 709 Washington, DC (202)
PO Box 350 Willimantic, Connecticut 06226 (860)456-7790 1025 Connecticut Ave, NW Suite 709 Washington, DC 20036 (202)293-5760 Se habla español Produced under a grant from the Connecticut State Department
More informationPlan F & Plan F* Skilled Nursing Facility Coinsurance Part A Deductible Part B. Deductible. Part B Excess (100%) Foreign Travel Emergency
Outline of Medicare Supplement Coverage By Reason of Age Cover Page: Benefit Plans A, F, High F, G, and N See Outlines of Coverage sections for detail about all plans. This chart shows the benefits included
More informationHOSPICE POLICY UPDATE
#02-56-13 Bulletin June 24, 2002 Minnesota Department of Human Services # 444 Lafayette Rd. # St. Paul, MN 55155 OF INTEREST TO County Directors Administrative contacts AC, EW, CAC, CADI, TBI DD Waiver
More informationCASE MANAGEMENT. Process into Practice
CASE MANAGEMENT Process into Practice HINTS Prep Handbook- candidate and written Think globally Study Buddy Scenarios First TESTING Handbook Review Find textbooks on the case management process Multiple
More informationPROVIDER POLICIES & PROCEDURES
PROVIDER POLICIES & PROCEDURES EXTENDED NURSING SERVICES The purpose of this document is to provide guidance to providers enrolled in the Connecticut Medical Assistance Program (CMAP) on the requirements
More informationAnthem Blue Cross and Blue Shield Commercial Professional Reimbursement Policy
Subject: Documentation and Reporting Guidelines for Consultations IN, KY, MO, OH, WI Policy: 0030 Effective: 12/01/2016 Coverage is subject to the terms, conditions, and limitations of an individual member
More information* NEW PROCESS FOR ADVISING MEDICARE ADVANTAGE MEMBERS OF THEIR RIGHTS AS INPATIENTS AND AT DISCHARGE *
* NEW PROCESS FOR ADVISING MEDICARE ADVANTAGE MEMBERS OF THEIR RIGHTS AS INPATIENTS AND AT DISCHARGE * JUNE 22, 2007 MSFB-HOSP-2007-004 TO: FROM: (1) CHIEF EXECUTIVE OFFICER (2) CHIEF FINANCIAL OFFICER
More information2014 Hospital Admission Criteria
2014 Hospital Admission Criteria Created on 11/20/2013 Audio and/or Video Recording of this Educational Session is Prohibited Agenda Inpatient vs. observation 2-midnight benchmark and presumption Admission
More informationClinical. Financial. Integrated.
Clinical. Financial. Integrated. April 2015 Table of Contents When are the rule changes effective? What is changing? What requirements must be met to avoid payment at the site neutral rate? How is the
More informationUpdates to the erehabdata PAS Tool & Referrals Outcomes Reports
Updates to the erehabdata PAS Tool & Referrals Outcomes Reports Teresa Hayes Management Consultant Melissa Berkoff erehabdata Project Manager Pre-Admission Screening Why do we conduct a pre-admission screening?
More informationHOSPITAL PATIENT SAFETY INITIATIVE (PSI)
HOSPITAL PATIENT SAFETY INITIATIVE (PSI) DRAFT RISK EVALUATION TOOL Discharge Planning Name of State Agency: Instructions: The following is a list of items that must be assessed during the on-site survey,
More information