Wednesday, December 5, 2018

CMS Posts Annual Update to Part B Therapy Modifier and Targeted Review Dollar Thresholds

Dan Ciolek

CMS recently posted a MLN Matters article describing the annual per-beneficiary incurred expense amounts now known as the KX modifier thresholds, and related Medicare Part B therapy policy updates for CY 2019. These amounts were previously associated with the financial limitation amounts that were more commonly referred to as “therapy caps” before the application of the therapy limits/caps was repealed when the Bipartisan Budget Act of 2018 (BBA of 2018) was signed into law. Another provision of the BBA of 2018 lowered the threshold of the targeted medical review process as listed below.

For CY 2019:
  • The KX modifier threshold amount for physical therapy (PT) and speech-language pathology (SLP) services combined is $2,040. For occupational therapy (OT) services, the CY 2019 threshold amount is $2,040. 
  • The Targeted Medical Review (MR) threshold amount is $3,000 for PT and SLP services combined and $3,000 for OT services.

Make sure that your billing staffs are aware of these updates

Congress Proposes Plan to Fund Government for Two More Weeks

Drew Thies

House leaders released a bill Monday morning that will extend government funding through December 21st, giving lawmakers just days before the Christmas holiday to reach a long-term deal.

Senate Majority Leader Mitch McConnell said the Senate will take up the extension if the House passes it. House Democrats initially wanted a one week deal but accepted the two week proposal.

A key sticking point in negotiations on a broader deal is President Trump’s desire for $5 billion in funding for a wall on the southern border. Senate Democratic leadership offered some concession on wall funding, but not the full amount the President wants.

The short-term deal also comes after the death of President George H. W. Bush, which stalled negotiations this week while the President lies in state at the Capitol.

Democratic House Leader Nancy Pelosi and Senate Minority Leader Chuck Schumer were scheduled to meet with the President privately on Tuesday, but the death of President Bush delayed the meeting until December 11. Negotiations are said to be on hold until Trump meets with Democratic leadership.

Advance Your Long Term Care Career with ACHCA Administrator Credentialing

Dave Kyllo

Administrators are key leaders on long term care teams and are entrusted with the responsibility of caring for residents and patients.  They touch the lives of residents and families, and most importantly, ensure that their staff provides the highest level of quality care to a vulnerable population.

AHCA/NCAL partners with the American College of Health Care Administrators (ACHCA) for its administrator certification programs.  The goals of the partnership are to increase awareness of advanced certification and professional growth opportunities and to encourage independent professional certification for nursing facility and assisted living administrators/directors. 

ACHCA has established eligibility criteria prior to taking the exam, including two years of licensure (other options exist for assisted living administrators in states without administrator licensure) and continuing education requirements.  Both must be established before an individual is authorized to sit for the credentialing exam. While ACHCA membership has many benefits for administrators/directors, ACHCA membership is not a requirement for ACHCA certification.

The application fee for either the nursing facility or assisted living certification exam is $150.   AHCA/NCAL members should use AHCA/NCAL members should use code AHCANCAL when they complete their initial ACHCA applications. The single credential fee (the fee paid after an individual passes the exam) is only $300 for AHCA/NCAL members, a $50 discount off the regular non-ACHCA member price when AHCA/NCAL members use promo code AHCANCAL at checkout. 

Credentialing through ACHCA lasts five years.  Recertification involves obtaining 150 hours of continuing education in five areas during the five-year certification period and paying a recertification fee.

ACHCA certification can provide State licensure reciprocity with certain states.  Licensing rules and requirements vary by state. Check with your state licensing board for your state’s reciprocity requirements. A list of state licensure boards and contact information is maintained on the NAB website at

For more information about ACHCA certification, go to or call 800-561-3148. 

It’s Winter Graduation Season and the Long Term Care Career Center is a Great Place for Jobs!

Dave Kyllo

Winter graduation season is here.  The AHCA/NCAL Long Term Care Career Center, is a great resource for nursing students and high school and college graduates who are interested in careers in long term care or health care. Our Center contains a Career Learning Center that includes professional resources for creating powerful resumes and acing job interviews. 

The LTC Career Center is always free for all job seekers and has some of the top long term care jobs in the country.  Serious job seekers and top health care employers rely on this site to connect. 

Creating an account and posting a resume is quick, free and easy!  Give the graduates you know a graduation gift that will be remembered – their first job leads.  Tell them about and the free Career Learning Center job seeker resources today and help them launch their health care careers.      

Learn How to Avoid the SNF VBP Payment Penalties with AHCA’s Online Training

Dave Kyllo

AHCA has a new education program designed to help skilled nursing facilities succeed under the CMS value based purchasing payment program (SNF VBP) that took effect on October 1, 2018.  The course (Understanding SNF VBP in Detail) contains six modules that provide an in-depth description of each feature of the CMS SNF VBP program along with helpful tools, documents, and primary source references to the program. 

This training program is intended for nursing home administrators, directors of nursing and any other staff including corporate staff who are responsible for payment models and rehospitalization reduction efforts.   No specific license is required take the course and no contact hours or CEUs are awarded for completing the curriculum.
The training program is specifically designed to help long term care professionals:
  • Understand how CMS calculates the measures, risk adjustment, the facility score and payment adjustment.
  • Use and access the CMS SNF VBP feedback reports and the SNF Performance Score Report.
  • Apply the incentive payment multiplier.
  • Use the SNF VBP prediction calculator to estimate the financial impact different SNFRM rates have on your Part A revenue.
  • Adopt best practices to help either avoid a payment penalty or receive an increase in your Medicare Part A payments.
Possessing a detailed understanding of SNF VBP is critical to operational success.  Starting October 1, 2018, all SNFs will receive a payment adjustment to their SNF Medicare Part A claims ranging from a 2 percent cut to potentially a 1.5 percent increase based on rehospitalization rates in prior years. CMS will recalculate the payment adjustment annually every fiscal year (FY) thereafter for the next ten years.

The registration fee for AHCA’s SNF VBP online course is $25 for AHCA/NCAL members and $65 for nonmembers.

The individual who wants to take the SNF VBP course must login to ahcancalED and register for the course under their individual login.  To access ahcancalED, members will need to login with their AHCA/NCAL usernames and passwords.  For assistance obtaining AHCA/NCAL usernames and passwords, please e-mail with your name and facility contact information. 

Payment is made in ahcancalED upon registration via credit card or check. If paying by check, an order is not complete until the check is received and approved by AHCA staff. You will not have access to the training until approval.  Registrations for SNF VBP cannot be done by another person or under another person’s ahcancalED login.
Know how to succeed under SNF VBP.  Follow this link to register today for Understanding SNF VBP in Detail or go to

Bronze Early Submission Day January 14

Save the date for the first-ever Bronze Early Submission Day on January 14!  Join the Quality Award staff for a step-by-step, how-to on submitting your Bronze Quality Award application and payment, including live Q & A. Applicants who submit their application on January 14 will be entered into a raffle for a waived application fee.

Click here to register today.

If you have any questions, please feel free to contact the AHCA/NCAL Quality Award team at

Independent Owner Leadership Conference Offers Critical Education Sessions

It’s time to register for the 2019 Independent Owner Leadership Conference. 

Taking place in sunny Tampa, FL March 20-22, the conference has tremendous networking and educational opportunities you can’t get anywhere else.

“Learning different views on how others are handling the challenges we deal with is true value.”
— J. Mark Traylor, President, Traylor-Porter Healthcare

The popular Owner-to-Owner Town Hall discussion will focus on emerging trends as well as litigation, records requests, and risk management.

You can earn up to 12.75 CEs.

Learn fresh ideas and perspectives when you attend education sessions such as:
  • Patient-Driven Payment Model (PDPM)
  • Navigate the Ever-Changing World of Assisted Living
  • The Building Blocks to Creating a Strong and Stable Workforce
  • Risk-Sharing: A Path to IO Success
  • Grassroots Advocacy for Independent Owners

Get more details on all the education sessions, social events, speakers, and more at

Register today.

Sponsors as of December 3, 2018:
Drive DeVilbiss Healthcare, Ecolab, Evan Senior Investments, Guardian Pharmacy Services, Kronos, MatrixCare

Disrupt to Lead. Innovate to Succeed.

2019 Quality Summit Takes Exciting Approach to Inspire Fresh Ideas

What does it take to disrupt the status quo? How can you best move forward with new ideas in patient-centered care and operational excellence?

Find out at this year’s Quality Summit.

March 18-29, 2019
Marriott Tampa Waterside
Tampa, FL
It’s packed with sessions and speakers who will challenge you to think in new ways.  Sessions focus on:
  • Providing stronger patient-centered care
  • Using quality improvement methodology to begin or advance change
  • Disruption and innovation to tackle workforce challenges
  • How PDPM will create innovation in patient care

Keynote Speaker Chris Field
Inspirational speaker and author of Disrupting for Good: Using Passion and Persistence to Create Lasting Change, Chris Field will weave his own story with those of other ordinary people who became extraordinary disruptors. His clear call to action is sure to motivate you — anybody, anywhere, can choose to disrupt for good. Field will also walk attendees through his personal Disruption MAP so that everyone leaves prepared and inspired to disrupt for good.

Join us for three-days of value-packed education, networking, and fun!

Get more information and register at QS.AHCANCAL.ORG.

The Independent Owner Leadership Conference immediately follows the Quality Summit. Save $50 when you register for both.

Host sponsors: MatrixCare, Medline
Contributing Sponsors: Kronos, nrc Health

Updates to the OMHA Case Processing Manual

Lilly Hummel

The Office of Medicare Hearings and Appeals (OMHA) has published two revised chapters of the OMHA Case Processing Manual (OCPM). The revised chapters are Chapter 17: Dismissals and Chapter 18: Requests for Information and Remands. The changes went into effect November 30, 2018. The manual standardizes the day-to-day procedures for carrying out adjudicative functions, in accordance with applicable statutes, regulations, and OMHA directives, and gives OMHA staff direction for processing appeals at the OMHA level of adjudication. As part of an ongoing effort to make the manual more user friendly and reflect recent regulatory changes, OMHA is in the process of drafting new OCPM chapters and revising existing chapters under a new format.

Thursday, November 29, 2018

CMS launches Civil Money Penalty Reinvestment Program

Urvi Patel

The Centers for Medicare & Medicaid Services (CMS) launched the Civil Money Penalty Reinvestment Program (CMPRP) as a three year effort to help providers reduce adverse events, improve staffing quality, and improve dementia care. Under this program, CMS provides a variety of resources to providers on the aforementioned topics, and last week announced the availability of the first of three toolkits – Nursing Home Staff Competency Assessment. This toolkit contains competency assessments for Certified Nursing Assistants (CNA)/Certified Medication Technicians (CMT), Licensed Practical/Vocational Nurses (LVN/LPN) and Registered Nurses (RN), and assistant directors of nursing (ADON), directors of nursing (DON) and administrators. Each competency assessment incorporates in questions on behavioral, technical and resident based competencies.

The second toolkit, Nursing Home Employee Satisfaction Survey, and third toolkit, Guide to Improving Nursing Home Employee Satisfaction will be available on the CMPRP website by next summer.

Questions on CMPRP can be directed to