Wednesday, August 14, 2019

Webinar: 11th Hour PDPM Transition Guide

11th Hour PDPM Transition Guide Webinar
 August 27
 3:00-4:30 PM Eastern Time
Presenters:  Mike Cheek, Senior Vice President, Reimbursement Policy, AHCA and Robin Hillier, Welcome Nursing Home
Register here

During this 90- minute live webinar, the presenters will discuss how providers can use a concise and downloadable 11th hour PDPM Transition Guide tool we developed to help providers answer these questions over the remaining days leading up to October 1.  In addition, the presenters will share important recent PDPM implementation updates from the Centers for Medicare and Medicaid Services (CMS) including: 1) Policy changes and clarifications discussed in the recently published SNF PPS FY 2020 Final Rule, 2) FAQs from the CMS August 8 SNF Open Door Forum call, and 3) Key PDPM-related MDS updates/clarifications discussed in the CMS August 13-14 SNF QRP/MDS/PDPM two-day provider training, and  any other billing guidance issued by CMS prior to the webinar.  There will be a Q&A period of approximately 30 minutes following the presentation.  In addition to the downloadable 11th hour PDPM Transition Guide tool and webinar slides, AHCA will also post an on-demand recording of the live webinar as well as written Q&A responses to all questions submitted shortly after the live webinar.

Class-Action Lawsuit and Observation Stays Issue

Dana Halvorson

Earlier this week, Kaiser Health News published an article entitled, Class-Action Lawsuit Seeks To Let Medicare Patients Appeal Gap in Nursing Home Coverage, by Susan Jaffe.  In the article, Susan noted, “Monday [August 12], a trial begins in federal court in Hartford, Conn., where patients who were denied Medicare’s nursing home benefit are hoping to force the government to eliminate that exception.  A victory would clear the way for appeals from hundreds of thousands of people.  The class-action lawsuit was filed in 2011 by seven Medicare observation patients and their families against the Department of Health and Human Services.  Seven more plaintiffs later joined the case.”  Susan goes on to include that, “If they win, people with traditional Medicare who received observation care services for three days or longer since Jan. 1, 2009, could file appeals seeking reimbursement for bills Medicare would have paid had they been admitted to the hospital.  More than 1.3 million observation claims meet these criteria for the 10-year period through 2017, according to the most recently available government data.”  More on AHCA/NCAL’s work around the observation stays issue in general can be found here.

Tuesday, August 13, 2019

Take a Free Test Drive of the CARES® Online Dementia Training Program & Members Save 15% on all Purchases

Dave Kyllo

AHCA/NCAL members receive 15% off the purchase of any Healthcare Interactive® CARES online training program by using promo code AHCA15 at checkout.  CARES is the only online dementia training to be recognized by CMS.  In addition, CARES online training is recommended by AHCA/NCAL to help reduce the off-label use of antipsychotics. 

To experience the CARES online training difference, test drive the first CARES Dementia Basics module at no cost.  The training programs are easy to use, can be accessed from any computer, tablet, or mobile device and can be started and stopped as often as users wish.

HealthCare Interactive’s CARES® Dementia Basics™ module is recognized by the Alzheimer’s Association® for successfully incorporating the evidence-based Dementia Care Practice Recommendations in the following topic areas: Alzheimer’s and dementia, person-centered care, assessment and care planning, activities of daily living, and behaviors and communication. Providers who train their staff with HealthCare Interactive’s CARES® Dementia Basics™ online training program are eligible to purchase Alzheimer’s Association essentiALZ® certification exams.

CARES training is unique because it includes direct video “before and after” training with an easy-to-use, easy-to-apply approach to dementia care called the CARES® Approach®. The CARES Approach can be used in any situation, with any person with dementia, at any stage of the disease.  CARES has six training modules including:
CARES is affordable.  When AHCA/NCAL members purchase CARES® Dementia Basics™ 25-user package using the AHCA15 promo code, the final cost is less than $21 per staff person for four hours of highly quality dementia care training.  Bundle the BASICS training with another training module and the cost is only $34 per staff member. 

CARES is also the only dementia care training to make extensive use of actual footage of real residents and real staff members (no actors) for truly authentic virtual training environment. Staff members will learn person-centered techniques to address issues, which often leads to behavior such as biting, kicking, punching, screaming, public urination and sexual behaviors.

Don’t forget to use promo code AHCA15 to receive 15% off your order.  Feel free to call HealthCare Interactive at (952) 928-7722 with any questions about the training programs.

Six Weeks to PDPM! Take the Online Courses Built for SNF PDPM Success

Dave Kyllo
A new payment system known as the Patient Driven Payment Model (PDPM) takes effect in two months that will transform the way skilled nursing facilities are reimbursed for Medicare Part A stays.  Some of the changes coming October 1, 2019 include: 
  • The PDPM system will rely on more than 180 MDS item fields and completely transforms the existing system Medicare Part A payment system for skilled nursing facilities. Staff roles and facility processes must be substantially modified to operate effectively under PDPM, including ICD-10 coding which will directly tie to reimbursement. 
  • Simply accepting the hospital’s ICD-10 code or using the ICD-10 code that seem most appropriate won’t work under PDPM.  Assuming the admitting physician has the correct diagnosis and code won’t work either. MDS Coordinators and billing staff must be masters at ICD-10 coding and how it maps to PDPM and play an active role in admission process.
  • As a condition of coverage, physicians must certify on admission and then recertify by day 14 and every 30 days thereafter that skilled care is needed.  Physicians and MDS Coordinators must be able to understand and effectively communicate about arriving at the reason for SNF care and defining the clinical basis for admission using appropriate ICD-10 codes that map to PDPM.
  • Primary diagnosis tied to accurate ICD-10 coding will matter more than ever under PDPM.  CMS will have a much clearer way to monitor whether SNF care is really needed.  Accurate ICD-10 coding will minimize the risk of payment delays and denials. 
  • SNFs that are not well versed in PDPM and ICD-10 coding are at a much higher risk of seeing their revenue negatively impacted and are at a substantial increased risk for potential audit and recovery. 
AHCA SNF members that did not attend an in-person PDPM Academy training hosted by an AHCA state affiliate earlier this year, should register now for AHCA’s Virtual PDPM Training.  Included with the virtual training is access to all materials on AHCA’s PDPM Academy. The PDPM Academy is where updates, tools, webinars and other supporting materials are housed. AHCA SNF members who attend the Virtual PDPM Training will also be able to join in free monthly PDPM Academy webinars hosted by AHCA.
This training is available to AHCA SNF provider members only. The cost for the training – whether first time or repeated - is $350. The training has been approved for 8 NAB CE credits. 
Virtual ICD-10 Coding training is also available through AHCA and is equally important to PDPM success and bulk purchases are available.  There are two online trainings offered, including: 
  • AHCA/AHIMA ICD-10 Training for PDPM – Coder is an in-depth course designed for SNF billing staff, MDS staff, Nursing and Therapy staff, and Admissions and Discharge staff.  The course contains seven modules and comes with 16 CNEs for nurses and 16 AHIMA CEs upon successful completion.  The cost is $499 for AHCA members and $599 for non-members. AHCA/AHIMA ICD-10 Training for PDPM – Coder:
  • AHCA/AHIMA ICD-10 Training for PDPM – Non-Coder is a four-hour course developed for individuals who need to lead a successful PDPM transition and is intended for Administrators, DONs, and other management staff.  The course for non-coders comes with 4 CNEs for nurses, 4 AHHIMA CEs or 4.5 NAB approved CEs upon successful completion.  The cost is $199 for AHCA members and $249 for non-members. AHCA/AHIMA ICD-10 Training for PDPM – Non-Coder:
Members will need to login with their AHCA/NCAL usernames and passwords to register for any of these courses.  For assistance obtaining AHCA/NCAL usernames and passwords, please e-mail with your name and facility contact information. 

Time is running out.  Prepare for PDPM today by registering for AHCA’s on-line courses built for PDPM success. 

Don’t Miss This August 20 Webinar: Competent Geriatric RNs – The New Driver of Financial Performance

Dave Kyllo

AHCA/NCAL will host a free webinar on Tuesday, August 20 at 3 p.m. EDT titled "Competent Geriatric RNs – The New Driver of Financial Performance." This webinar discusses how the Gero Nurse Prep program increases geriatric care knowledge and prepares RNs to take the American Nurses Credentialing Center (ANCC) Board certification exam in gerontological nursing.

The webinar will include findings from research conducted by AHCA/NCAL this year showing that SNFs that employ at least one ANCC Board certified RN performed higher on average on SNF VBP performance scores. The average 2017 SNF VBP performance score across the nation was 34.4.  For SNFs with at least one RN who has been ANCC Board certified in gerontological nursing, the average SNF VBP performance score was 44.2.  The net result is that these SNFs get higher Medicare Part A reimbursements.
The AHCA/NCAL 2019 research also found that SNFs with at least one ANCC Board certified RN also experienced:
  • Fewer survey deficiencies
  • Fewer IJ citations
  • Lower rehospitalization rates
  • Lower rates of off-label use of antipsychotics
  • Higher CMS 5-Star ratings
To help RNs prepare for the ANCC Board certification exam, AHCA/NCAL offers an online course called Gero Nurse Prep.  RNs who complete the course earn 30 nursing contact hours and experience a 96% pass rate on the ANCC certification exam on the first try.  Gero Nurse Prep students also see a whopping 24 percent average increase between their pre- and post- Gero Nurse Prep test scores. ANCC Board certification in gerontological nursing is the gold standard in demonstrating clinical excellence in geriatric patient care for RNs.
Follow this link to register for the free August 20 webinar.  To learn more about Gero Nurse Prep and ANCC Board certification, watch this video and check out AHCA/NCAL Gero Nurse Prep today.

AHCA/NCAL Convention Keynote Speakers

Jon-Patrick Ewing

This year’s keynotes are a squadron of super speakers. They’re all set to inform, inspire, and invigorate you! From beginning to end, you’ll gain fresh insights and perspectives on leadership, innovation, problem-solving, and managing difficult challenges. Make plans to attend the AHCA/NCAL Convention & Expo now and don’t miss this unique opportunity hear from the best. Learn more about our keynotes here.

Advance Registration ends September 27, after this date on-site rates apply. We hope to see you in Orlando!

Have Your Heard About AHCA’s Nurse Assistant Training Solution?

CNAonline Is a Flexible and Affordable Solution to Your Workforce Challenges
If you’re looking for a solution to help manage your frontline staff shortages, consider  This unique hybrid nurse assistant training program blends online coursework and in-person clinical and skills training, making it easier for students to learn what they need to know for certification. The program produces highly trained CNAs who elevate the quality of care available in the centers where they work. uses AHCA’s renowned How To Be a Nurse Assistant curriculum which has been successfully training students for certification for 30 years. Other features of the program include:
  • Practice tests, study guides, and quizzes to ensure student success
  • Competency-based skills checklists, videos, and visual aids
  • Professional instructors for online and in-person clinical training
  • Offers real time data analytics, including class activity reports and individual student competencies
  • Allows for customization of content for both state affiliates and providers
  • Students and instructors have access to the online content 24 hours a day, and you can start classes anytime.
For more information on how to get started, please visit or call 502-221-7765.

Updated List of Excluded Individuals and Entities (LEIE) Database File

Lilly Hummel

The US Department of Health and Human Services, Office of Inspector General (OIG) has released its updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in July 2019. This new file replaces the updated LEIE database file available for download last month. Individuals and entities that have been reinstated to the federal health care programs are not included in this file.

The updated files are posted on OIG’s website at, and healthcare providers have an “affirmative duty” to check to ensure that excluded individuals are not working in their facilities or face significant fines.

Instructional videos explaining how to use the online database and the downloadable files are available at

As a best practice, long term care providers should check the LEIE on a regular basis.

Trauma-Informed Care – Action Brief

Pamela Truscott

Trauma-informed care will be implemented as part of the Requirements of Participation Phase 3, which goes into effect on November 28, 2019.  AHCA has developed an Action Brief highlighting §483.25(m) trauma-informed care to assist facilities in implementation strategies, preparation, and additional resources.  You can find more information about trauma-informed care and §483.25(m) here.

Wednesday, August 7, 2019

Aplisol and Tubersol Shortage. Now What?

Pamela Truscott

Some states are experiencing a shortage in Tubersol and Aplisol, tuberculin purified protein derivatives for intradermal tuberculin testing, and are wondering what to do.  The Center for Disease Control (CDC) is aware of this widespread issue and has issued recommendations on how to deal with the shortage. 

According to the CDC, there is a 3- to 10- month nationwide shortage on tuberculin skin test (TST) antigens (Aplisol and Tubersol).  The recommendations to maintain compliance until the tuberculin supplies can be replenished include:
  • Substitute IGRA blood tests for TSTs. Clinicians who use the IGRA blood tests should be aware that the criteria for test interpretation are different from the criteria for interpreting TSTs.
  • Prioritize allocation of TSTs, in consultation with state and local public health authorities.  Prioritization might require the deferment of testing some persons.  CDC recommends testing only for persons who are at risk for TB.  Groups at high risk for TB infection include:
    • Persons who are recent contacts exposed to person with TB disease
    • Those born in or who frequently travel to countries where TB disease is common
    • Those who currently or previously lived in large group settings (i.e. homeless shelters or correctional facilities)
    • Persons with compromised immune systems, including those with health conditions or taking medications that might alter immunity
    • Children, especially those aged <5 years, if they are in one of the risk groups noted above.
Facilities are encouraged to work with your local health department to confirm recommendations on testing during the shortage.  In addition, facility policies and procedures may need to be reviewed and updated.  Finally, facilities should educate team members on the TST shortage and the changes to the processes during the shortage. 
You can learn more about the CDC recommendations here.