Wednesday, September 25, 2019

Six Days to PDPM: AHCA’s Online Courses Take the Mystery Out of PDPM and ICD-10 Coding

Dave Kyllo

The new payment system known as the Patient Driven Payment Model (PDPM) takes effect next Tuesday.  PDPM transforms the way skilled nursing facilities are reimbursed for Medicare Part A stays.  Some of the changes coming October 1 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 who did not attend an in-person PDPM Academy training hosted by an AHCA state affiliate earlier this year are encouraged to take 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:  ahcancal.org/icd10pdpmcoder
  • 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: ahcancal.org/icd10pdpmnoncoder
Access your facility's personal Top-Line PDPM report here. This report is a snapshot of previous coding practices for ICD-Coding on MDS assessments. Use this step-by-step guide to access your reports.

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 educate@ahca.org with your name and facility contact information.

Department of Labor Raises Overtime Threshold for Exempt Employees

Lilly Hummel

The Department of Labor (DOL) finalized its proposed rule to increase the salary threshold under which “white collar” exempt staff would be guaranteed time-and-a-half pay when they work more than 40 hours in a given week. Effective January 1, 2020, the threshold will rise to $684 per week or $35,568 per year for a full-year worker. The current threshold, which has been in place since 2004, is $455 per week or $23,660 per year. Providers should review their exempt salaried staff to identify those who could become newly eligible for overtime.

By way of background, in 2016, the Obama administration finalized a rule that would have doubled this threshold. That rule faced subsequent litigation, during which a judge issued a preliminary injunction and the Trump administration ultimately declined to argue in support of the new threshold. The Trump administration issued a Request For Information to hear from stakeholders before publishing its own threshold.

Stop Utility Company Overcharges with a No-Risk Cleary Energy Utility Audit

Dave Kyllo

Three out of four long term care facilities are being overcharged for one or more of their utilities. Providers don’t receive better service or any other benefit for over paying utility companies. The good news is that putting an end to the overpayments is easy.

Cleary Energy is an AHCA/NCAL preferred provider and has recouped on average 4% to 8% savings on utilities for long term care facility customers. Here are some real life examples of how long term care providers saved:
  • A nursing facility recovered $25,000 in retroactive charges from an electric and gas utility account and the facility will save an additional $7,500 per year going forward.     
  • A nursing facility was overpaying the tariff on their gas account and is now saving $10,000 annually going forward.
  • A Midwest assisted living facility received $5,800 from utility overpayments that Cleary Energy recently found.     
Cleary Energy performs utility bill audits by examining utility, supplier and government charges on utility bills to obtain refunds and/or credits and rate reductions.  Specifically, Cleary Energy audits a facility’s electric, natural gas, propane, heating oil, diesel fuel, water, sewer and telecommunications bills. 

The program is designed to save AHCA/NCAL members significant money on their utility bills without adding new expenses to their budgets.  Cleary Energy guarantees savings or its auditing services are free.  Cleary Energy’s fees are based on facility savings on their utility bills. 

AHCA/NCAL member facilities enter into an audit agreement with Cleary Energy, which is a shared savings agreement that lasts for a period of three years.  If no refund, savings or credits are received, the AHCA/NCAL member facility owes nothing to Cleary Energy for conducting the audit and AHCA/NCAL members will have the peace of mind of knowing that their facilities are not being overcharged for their utilities.   

The process for engaging Cleary Energy to conduct a utility audit is easy.  Most of the information Cleary Energy needs for an audit comes directly from the utilities or suppliers. 

Cleary Energy’s long term care experience sets the company apart with over 40 years of long term care operational experience.  That in-depth knowledge enables Cleary Energy to find the greatest costs savings on utility expenses for AHCA/NCAL members because Cleary Energy knows where to look for savings. 

Take advantage of this unique no-risk opportunity to save on utility costs.  Contact Cleary Energy today in one of the three ways listed below. 
Members attending the 70th Annual AHCA/NCAL Convention and Expo in Orlando October 13-16 can also stop by Booth #2319 in the Expo Hall to learn how easy it is to save money by stopping utility company overcharges. 

Discover Exclusive AHCA/NCAL Member Savings Opportunities at the AHCA/NCAL Convention Expo in Orlando!

Dave Kyllo

AHCA/NCAL members receive special “member only” savings from select premier partners in AHCA/NCAL’s Preferred Provider Program.  Learn more about these exclusive savings programs by visiting these booths in the AHCA/NCAL Convention Expo Hall in Orlando at the 70th Annual AHCA/NCAL Convention and Expo held October 13-16.

HealthCap®  Booth #1903
 
HealthCap® is the premier AHCA/NCAL endorsed insurance program providing liability insurance to the senior care sector!  
 
HealthCap® clients have both lower claims frequency and lower claims severity than other major liability insurance carriers– two powerful reasons why AHCA/NCAL members rave about HealthCap®.  Another plus – AHCA/NCAL members receive a 10% discount on their HealthCap premiums.  The HealthCap® Resource and Education Center is now free and available to all AHCA/NCAL members!   Visit the HealthCap team to learn more.  


AHCA/NCAL Gero Nurse Prep  Booth #2321

Gero Nurse Prep and ANCC Board Certification Create RN Heroes Who Can Improve Key Clinical Outcomes, Reduce Survey Deficiencies and Increase SNF VBP Scores! 

Gero Nurse Prep prepares RNs for the ANCC Board Certification exam in gerontological nursing and increases geriatric nurse competency by 24% based on pre- and post-GNP course test scores.  Visit with Dr. Heidi Keeler to learn how Gero Nurse Prep can help strengthen your clinical performance, increase reimbursements and reduce survey citations.


AHCA/NCAL Insurance Solutions/Compass Total Benefit Solutions    Booth #2418

Discover the Affordable Health Plan Designed to Help AHCA/NCAL Members Recruit and Retain Staff and Reduce Expenses!

With premiums at $1 an hour for full-time employees, the Compass Minimum Essential Coverage plan delivers the health benefits employees want with no deductibles and low co-pays.  Employer contributions can range from 0 to 100% and there is no underwriting!  Stop by and ask the Insurance Solutions team how this plan can cut employee benefit costs and make your facility a more attractive and lucrative place to work and save on your overall health benefits expenses.     



Cleary Energy  Booth #2319

Take Advantage of Cleary Energy’s No-Risk Opportunity to Audit Your Utility Bills and Stop Wasteful Overcharges!

Most (75%) of LTC facilities are being overcharged on their utilities.  Cleary Energy has recouped on average 4% to 8% savings on utilities for long term care facility customers through its exclusive utility audit program. If no refund, savings or credits are received, AHCA/NCAL member facilities owe nothing to Cleary Energy for conducting the utility audit and you’ll know you’re not overpaying.  Stop by to meet Dennis Cleary and learn how easy it is to start saving on your facility utility bills and drop off a business card for a chance to win a “Bose Soundlink Bluetooth Speaker II.”


CARES® Online Dementia Training   Booth #1511

CARES® is the Only Online Dementia Care Training Endorsed by AHCA/NCAL and Recognized by CMS! 

CARES® delivers affordable, high quality, video-based online training for staff at all levels to meet state and federal training requirements.   CARES® is 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. CARES® is recommended by AHCA/NCAL to help reduce the off-label use of antipsychotics.


AHCA/NCAL Member Savings Program  Booth #2420

All AHCA/NCAL Members Receive Exclusive “Members Only” Savings Opportunities Through the AHCA/NCAL Member Savings Program. 

Members can save on outstanding educational programs, liability and health insurance, utility expenses, job postings and more.  Stop by Booth #2420 to learn more about the programs designed to deliver real-world solutions that improve clinical and financial performance.   

Tuesday, September 24, 2019

Opioid Use: What Do We Do & How?

The use of opioid medications to manage chronic pain is complex and challenging, especially in long-term care and post-acute settings. As the care of individuals with chronic pain in these settings increases, it will be imperative to understand concerns, challenges and opportunities surrounding this issue. This program focuses on the foundation of pain management and how optimal pain management can help prevent opioid abuse.

This multi-part resource offers “Steps to Opioid Reduction” which covers steps by which any center can safely and effectively attempt to reduce opioids in individuals who are on opioids as well as “Appropriate and Safe Use of Opioids As Part of Effective Pain Management” which covers key processes and practices of pain management including (but not limited to) the use of opioids in that context.

Members can access these resources here.

AHCA/NCAL Convention: Advance Registration Ends Friday

Jon-Patrick Ewing

The AHCA/NCAL Convention takes place next month in Orlando, FL. If you have not yet registered, now is the time. The Advance Registration period ends on Friday, September 27! After this date on-site rates apply.

Bring your squad of long term and post-acute superheroes and join us for four days of learning and networking that will prepare you for the challenges of the coming year. Choose from over 70 education sessions that focus on PDPM, Requirements of Participation, workforce solutions, clinical care practices, quality improvement, and more. Get answers to your key questions and walk away with new strategies that will help you improve quality and put better practices into place.

You’ll also can meet with more than 300 vendors in the Expo Hall, see new products and solutions, and share ideas and experiences with others in the industry.

It’s an event not to be missed.

Visit ahcaconvention.org for more details and a complete schedule of events.

Announcing the 2020 Quality Initiative Recognition Program

We are pleased to announce that the Quality Initiative Recognition Program is back to honor member skilled nursing centers and assisted living communities for their work in achieving the goals of the AHCA/NCAL Quality Initiative.

Let’s celebrate the hard work you have done to measurably improve the lives of your residents and patients. All achievers will be recognized at the AHCA/NCAL Quality Summit in Grapevine, Texas, March 9-11, 2020.

Eligibility
 
Skilled nursing centers must achieve at least one of the AHCA Quality Initiative goals to be eligible for recognition:
  • Hospitalization: Safely reduce long-stay and short-stay hospitalizations by improving 10%, or maintain a rate of 10% or less
  • Customer Satisfaction: Improve long-stay and short-stay satisfaction by 10%, or achieve a rate of 90% or more
  • Antipsychotics: Safely reduce the off-label use of antipsychotics by 10%, or maintain a rate of 8% or less among long-stay residents, and maintain a rate of 1% or less in short-stay residents
  • Functional Outcomes: Improve short-stay functional improvement or long-stay worsening mobility by 15% - or maintain greater than 75% on short-stay functional improvement or maintain less than 12% on long-stay worsening mobility.
    *Note: Due to data availability, AHCA will not be measuring the original Quality Initiative Functional Outcomes goal for the 2020 Recognition Program and will instead be utilizing Nursing Home Compare’s short-stay functional improvement and long-stay worsening mobility measures.
Assisted living communities must achieve at least one NCAL Quality Initiative goals. The goals are:
  • Staff Stability: nursing and direct care staff turnover is 50% or less
  • Customer Satisfaction: 90% or more of residents and/or family members are satisfied with their experience
  • Hospital Readmissions: readmissions within 30 days of hospital discharges are 20% or less
  • Antipsychotics: off-label use of antipsychotics is 15% of residents or less
The more goals a skilled nursing center or assisted living community achieves, the higher the recognition level!

How to Participate
 
By November 21, 2019, nursing centers must submit customer satisfaction data in LTC Trend Tracker. All other data is automatically uploaded by LTC Trend Tracker.  
 
Assisted living members must submit data for all NCAL goals in LTC Trend Tracker by November 21, 2019.
 
If you need assistance with LTC Trend Tracker, please visit the Resource Center or email help@ltctrendtracker.com.
 
For more information, please visit the respective websites for skilled nursing centers and assisted living communities.

#WhyICare: Lori Cooper, Chief Operating Officer

Rachel Reeves and Cristina Crawford

AHCA/NCAL’s #WhyICare workforce campaign broadcasts the stories of individuals who work in long term care, sharing what inspires them about their careers and how they got to where they are today.

This week, we’re pleased to introduce Lori Cooper, Chief Operating Officer. Lori’s passion for her profession is triggered by the joy, laughter, and fun that her residents bring to her each day. She always returns the favor with humor and a positive attitude. Click here to watch and share her story.



Follow us on Facebook and Twitter to hear more stories as we continue to release new #WhyICare videos in the coming weeks.  Click here to see more #WhyICare videos on YouTube.

Submit your AHCA/NCAL National Quality Award Intent to Apply Early!

qualityaward@ahca.org

The Intent to Apply (ITA) for the 2020 AHCA/NCAL National Quality Award application cycle is now open in the Quality Award Portal.
 
Why should I submit an Intent to Apply Payment?
While not mandatory, applicants who submit an ITA will save money on their overall application fee and receive extra educational resources. No paperwork or application is needed to submit the Intent to Apply.
 
ITA Payments by Award Level
Bronze - $75
Silver - $150
Gold - $300

Please note:
  • We encourage all applicants to review the application packet in full before submitting an ITA payment. Application packets are available at ahcancal.org/qualityaward.
  • Check back to Quality Award website for the 2020 Survey Eligibility for all award levels. This will be updated periodically as Nursing Home Compare releases updated data
How do I submit an Intent to Apply?
Log in to the Quality Award Portal here to submit your ITA. To access help documents for the Quality Award Portal, click here.

The deadline to submit an ITA is November 7, 2019 at 8 p.m. Eastern Time. More information about the AHCA/NCAL National Quality Award Program and key dates are available at ahcancal.org/qualityaward.

We hope you will take the next step to continue your quality journey this coming year by submitting an ITA. If you have any questions, please feel free to contact the AHCA/NCAL Quality Award team at qualityaward@ahca.org.
 

Tuesday, September 17, 2019

#WhyICare: Elicia Jacobson, VP of Brain Injury Services

Rachel Reeves and Cristina Crawford

AHCA/NCAL’s #WhyICare workforce campaign broadcasts the stories of individuals who work in long term care, sharing what inspires them about their careers and how they got to where they are today.

This week, we’re pleased to introduce Elicia Jacobson, Vice President of Brain Injury Services. Elicia’s day-to-day is not your typical long term care career and shows a different side to the profession. Working in a short-term rehab facility for traumatic brain injuries, the majority of Elicia’s residents are under the age of 50. Her connection to her residents and helping them recover to return home makes her career worthwhile.  Click here to watch and share her story.



Follow us on Facebook and Twitter to hear more stories as we continue to release new #WhyICare videos in the coming weeks.  Click here to see more #WhyICare videos on YouTube.

AHCA/NCAL Convention: Advance Registration Ends Next Friday

Danielle Levitan

The AHCA/NCAL Convention takes place next month in Orlando, FL. If you have not yet registered, now is the time.

Register today and save.

Bring your squad of long term and post-acute superheroes, and join us for four days of learning and networking that will prepare you for the challenges of the coming year. Choose from over 70 education sessions that focus on PDPM, Requirements of Participation, workforce solutions, clinical care practices, quality improvement, and more. Get answers to your key questions, and walk away with new strategies that will help you improve quality and put better practices into place.

You’ll also have the opportunity to meet with more than 300 vendors in the Expo Hall, see new products and solutions, and share ideas and experiences with others in the industry.
It’s an event not to be missed. Register by September 27th to take advantage of the Advance Registration savings.

Visit ahcaconvention.org for more details and a complete schedule of events.

Updated CMS Resources on CMP Reinvestments

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) published updated resources on Civil Money Penalty (CMP) reinvestments. A portion of CMP funds must be reinvested to support projects that benefit nursing center residents and that protect or improve their quality of care or quality of life. CMS issued a memo that summarizes the updates, which include:
  • A revised “Example CMP Reinvestment Application Template” in order to reduce the review process timeline. The template now allows applicants to provide more information from the beginning, to reduce subsequent CMS requests for clarification. It also now includes a feature to indicate submission of an “extension project” for submissions that are identical to previously approved project or duplicated in another state.  CMS also offers new resources to assist applicants with provident adequate information for a complete review by CMS.
  • Updated CMP reinvestment state plan resources for the CY 2020 submission because the previous resources were specific to 2019. CMS also added guidance for sections including the Emergency Reserve Fund, Annual Administrative Use and Available Funds sections.
  • More information on previously funded projects and results. This includes: updates to the “State CMP Reinvestment Projects Funded in CY 2017” document with additional reported results; adding the “State CMP Reinvestment Projects Funded in CY 2018” document to the web page; and adding articles describing eight approved CMP projects in 12 states.
  • A new document providing examples of project submissions that contain non-allowable uses of CMP reinvestment funds.
AHCA continues to monitor and advocate for CMP reinvestment programs. We welcome any comments or questions to regulatory@ahca.org.

AHCA Committee Nominations Open

Christy Herle

September 17 through October 21, AHCA members in good standing may nominate themselves or another member to serve on an AHCA committee for the 2020/2021 appointment term.  All AHCA members are encouraged to participate in this process.  Please submit your nomination for up to three committees by completing a Survey Monkey.  We appreciate your willingness to serve in any capacity and are committed to do everything we can to honor your committee selections.  

All 2020/2021 committee appointments will be for a two-year term beginning January 1, 2020.  Appointments are finalized by the AHCA Board of Governors Chair.  In order to keep committee sizes at optimal levels, applicants are likely to be assigned to just one committee.  Please visit the AHCA website for a list of committee descriptions

Please contact Christy Herle with questions about the process

We hope you take this opportunity to be an active member!

Expanded CMS Authority to Deny Medicare Providers

The Centers for Medicare and Medicare Services (CMS) recently finalized a new rule to strengthen protections against Medicare or Medicaid fraud, waste and abuse. The rule goes into effect November 4, 2019. The agency is finalizing the following actions:
  • Implement a provision of the Patient Protection and Affordable Care Act that requires Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) providers and suppliers to disclose any current or previous direct or indirect affiliation with a provider or supplier that: (1) has uncollected debt; (2) has been or is subject to a payment suspension under a federal health care program; (3) has been or is excluded by the Office of Inspector General (OIG) from Medicare, Medicaid, or CHIP; or (4) has had its Medicare, Medicaid, or CHIP billing privileges denied or revoked.
  • Based on these disclosures, the rule permits CMS to deny Medicare enrollment for a provider’s affiliation with a provider or supplier that pose an undue risk of fraud, waste, or abuse.
  • Gives CMS more ability to revoke or deny individuals or organizations from becoming enrolled as a Medicare provider in specified circumstances.
  • Increases the maximum reenrollment bar from 3-10 years in specified circumstances
AHCA will monitor the effects of CMS’s new authority to deny Medicare enrollment based on a provider’s affiliations. Providers should check the Office of Inspector General’s List of Excluded Individuals or Entities for affiliated providers or suppliers.

CMS has also requested comments specifically on obtaining affiliation information from providers and suppliers other than those to which § 424.519(b) will apply. They are looking for information on the timing, mechanism and priority. Comments are due November 4. After these comments are received, CMS will go through the formal notice and comment rulemaking process.

Helpful Emergency Preparedness Resources

Dana Halvorson and Erin Prendergast

This month marks, among other observances, National Preparedness Month. National Preparedness Month, recognized each September, provides an opportunity to remind us that we all must prepare ourselves and our families now and throughout the year.  This month the focus will be on planning, with an overarching theme: “Prepared, Not Scared.”  Take this time to review your facility and community-based risk assessment/hazard vulnerability.  AHCA/NCAL has an emergency preparedness website with helpful information and resources you might be interested in.

In general, having an emergency kit that includes food, water, and at least a week of medications is a smart idea.  Include this card, completed with your vital medical information, and if you have a communication-related disability, this card can help first-responders assist you in the way that is best for you.  Include a flashlight and extra batteries, and first aid supplies.  Ready.gov has an emergency kit checklist that is helpful.  Here is a checklist specific for kids.  If you have any questions around emergency preparedness, please contact Erin Prendergast (SNF Providers) or Dana Halvorson (ICF/IID Providers).

Realistic Online Dementia Care Training for $21 Per Staff Member

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.
 
That 15% discount makes CARES very 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 Dementia Basics™ training with another training module and the cost is only $34 per staff member.
 
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 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.
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.
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.  

The October 1 PDPM Countdown is On: Be Ready with the Online Courses Built for SNF PDPM Success

Dave Kyllo
The new payment system known as the Patient Driven Payment Model (PDPM) takes effect in a less than two weeks.  PDPM transforms 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 who did not attend an in-person PDPM Academy training hosted by an AHCA state affiliate earlier this year are encouraged to take 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: ahcancal.org/icd10pdpmcoder
  • 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: ahcancal.org/icd10pdpmnoncoder
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 educate@ahca.org with your name and facility contact information. 

Participate in an NCAL Committee!

Katherine Preede

Becoming more involved in NCAL by participating on a committee! Now through October 21, you have the opportunity to nominate yourself to serve on one or more of the following committees: NCAL Quality Committee, NCAL Finance and Policy Committee, AHCA/NCAL Workforce Committee, and the AHCA/NCAL Customer Experience Committee.

All NCAL members are highly encouraged to participate in this process. In an effort to create diverse and widespread representation, appointments to specific committees may be limited to one participant per state and company. To assist in the process, individuals should choose two committees and rank their selections in order of preference. To submit your nominations, please complete the Survey Monkey. We hope you will take this opportunity to be an active member!

Wednesday, September 11, 2019

#WhyICare: Bobby and Taylor Rotolo

Rachel Reeves and Cristina Crawford

AHCA/NCAL’s #WhyICare workforce campaign broadcasts the stories of individuals who work in long term care, sharing what inspires them about their careers and how they got to where they are today.

This week, we’re pleased to introduce Bobby and Taylor Rotolo, After witnessing the work his father does every day as a nursing home owner, Taylor aspires to one day follow in his footsteps and integrate his computer science technology skills into the long term care field to further improve care. Click here to watch and share their story.



Follow us on Facebook and Twitter to hear more stories as we continue to release new #WhyICare videos in the coming weeks.  Click here to see more #WhyICare videos on YouTube.

Comprehensive Infection Prevention and Control Training from AHCA/NCAL

Dave Kyllo

AHCA/NCAL has a comprehensive program to help nursing facilities meet the infection prevention and antibiotic stewardship requirements being enforced by CMS. While originally designed for nursing facilities, the program is an equally effective training tool for wellness directors and directors of nursing working in assisted living settings.

The Infection Preventionist Specialized Training (IPCO) course provides education for any healthcare professionals who want to lead infection prevention efforts and prepares individuals to play an active role in the antibiotic stewardship efforts. Antibiotic stewardship is an overarching goal and priority among all health care professionals and is receiving a lot of attention from physicians and state and national health care regulators.

The methods for preventing and controlling infections and managing antibiotic use are universal, so what works in the nursing facility setting will work in the assisted living setting. AHCA/ NCAL’s course is an online, self-study program with 23 hours of training. It includes online lectures, case studies and interactive components taught by subject matter experts who have real life experience working in long term/post-acute care.

The course addresses both clinical and organizational systems, processes and cultural aspects of infection prevention and control that are fundamental to effectively leading and administering successful infection prevention and control programs and antibiotic stewardship programs. Strong and effective infection prevention programs and antibiotic stewardship efforts can set an assisted living center apart from the competition, especially when working with social workers and discharge planners who help seniors with their post-acute decisions

Upon successful completion of this program, participants will receive certificates including 23 ANCC contact hours. The training course registration fee is $450 for AHCA/NCAL members and $650 for non-members. There are no refunds and no transfers.

Payment and registration must be made online in ahcancalED . The IPCO course can be accessed here or at: https://educate.ahcancal.org/p/ipco.

Discounted group purchase rates are available for groups of 25 or more. Those interested in making a group purchase should email AHCA/NCAL at educate@ahca.org.

To access ahcancalED and the IPCO course, members will need to login with their AHCA/NCAL usernames and passwords. For assistance obtaining AHCA/NCAL usernames and passwords, please e-mail update@ahca.org with your name and facility contact information.

What Keeps You Up at Night?

Jon-Patrick Ewing

With so many changes and challenges in our profession, what keeps you up at night? The 70th AHCA/NCAL Convention & Expo is the place where you’ll get the answers to your questions and more. The AHCA/NCAL Convention & Expo tackles key topics in over 70 education sessions.
        • PDPM
        • Requirements of Participation
        • Workforce Solutions
        • Dementia Care
        • Post-acute Care
        • Risk Management
        • Advocacy
        • Quality Improvement
Don't let another week go by without registering. The Advance Registration deadline is September 27th.
 
Get details on all the tracks of learning and specific education sessions and make your plans. Special sessions and events like NCAL Day, the Rehabilitation Therapy Program, ID/DD-specific sessions, and Not for Profit help you get even more out of this unique four-day event.
 
Register today, and we’ll see you in Orlando, October 13-16.

Webinar: Conflict Resolution



Conflict Resolution 
September 17, 2019
3:00 PM- 4:00 PM EST

Please join us for the next American Assisted Living Nursing Association (AALNA)/National Center for Assisted Living (NCAL) Caring Together Webinar on conflict resolution. Workforce challenges is one of the top issues identified by long term care providers. Conflict can be hard to deal with and address but is necessary to reduce staff turnover and improve retention. The presenter will clarify why conflicts arise in the workplace, types and sources of conflict in all long term care settings. Attendees will learn about the stages and impact of conflict. The presenter will share practical tools on how to manage and resolve conflict. This webinar is not only for nurses but appropriate for all employees interested in obtaining practical tools for dealing with conflict. This webinar is a member benefit for AALNA and AHCA/NCAL members. Attendees should sign-up prior to the webinar using this link.

HCS AL Salary Study Underway

Rosanne Zabka

Hospital & Healthcare Compensation Service (HCS) is conducting its annual Assisted Living/Personal Care Salary & Benefits Study, and requests you let members know this important study is underway. Assisted living providers are asked to complete the study’s questionnaire by November 11th. The study is published by HCS and supported by NCAL and LeadingAge.

There is no cost to participate in the study. Participants may purchase the results at the reduced price of $175, versus the $350 nonparticipant rate. Questionnaires can be downloaded at: https://www.hhcsinc.com/survey-questionnaires.html

The report covers management salaries, non-management wages, and fringe benefits. Salaries and bonus payments will be reported according to unit size, profit type, revenue size, CBSA, state, region, and nationally. Also, both for-profit and not-for-profit data will be separately covered. Information on 18 fringe benefits will be reported according to region. Last year’s Report contained data from over 1,200 ALF/Personal Care facilities nationwide.
Percent increases planned for 2020 will be reported for management, non-management, RNs, LPNs, and CNAs.

Nationally known, their reports are recognized as the standard for reliable, comprehensive, and affordable compensation data for healthcare.

The HCS Corporate Compensation Study is also underway, deadline December 2nd. The study covers executive compensation of top executives in long-term care facilities with $20 million+ revenue or oversight of multiple ALFs, CCRCs, and/or Nursing Homes.

The results report salaries and total compensation nationally by revenue size and include salary increases, pay policies, and executive benefits. Last year’s report contained data from over 100 organizations.

There is a tremendous savings for participants. The participant price is only $195, compared to the non-participant price of $675.

Both Reports will be published in late January 2020. HCS publishes ten annual compensation studies. Nationally known, their reports are recognized as the standard for reliable, comprehensive, and affordable compensation data for healthcare.

Tuesday, September 10, 2019

Two 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: ahcancal.org/icd10pdpmcoder
  • 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: ahcancal.org/icd10pdpmnoncoder
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 educate@ahca.org with your name and facility contact information. 

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

Soap or Alcohol for Hand Hygiene? HealthCap® Resource Helps Make the Right Decision

Dave Kyllo

Cleaning your hands can prevent the spread of germs, including those that are resistant to antibiotics and are becoming difficult, if not impossible to treat according the Centers for Disease Control and Prevention (CDC).  The CDC also says that health care providers clean their hands on average less than half of the times they should.  
 
Hand hygiene is the primary means of preventing transmission of infections, but confusion exists about the when soap and water is preferred over alcohol hand rubs.  To address this confusion, HealthCap® has created a one-page resource detailing when soap or alcohol can be used and when soap only is the preferred hand hygiene method.  The single-page flyer is a user-friendly tool for staff and families to help reduce the spread of infections.
 
Numerous useful resources can be found on the Resource and Education Center on the HealthCap® website.  Providers will find education opportunities (including ANCC-approved sessions), manuals, best practices and model policies. 
 
HealthCap® is endorsed by AHCA/NCAL and is the premier program solely dedicated to providing liability insurance to senior care communities.  One of the reasons HealthCap® gets such great results is its focus on quality care as the foundation of good risk management practices.  HealthCap® clients have the fewest liability claims in the industry and HealthCap® settles claims for approximately one-half the industry average. 
 
HealthCap® is owned and governed by the senior care providers insured by HealthCap®.  AHCA/NCAL members get a bonus advantage by always receiving a 10% discount on their HealthCap® premiums.
 
HealthCap® clients also receive:
  • Risk management services that make a financial difference
  • An annual on-site risk consult
  • Unlimited telephone support
  • Accredited in-service education
For more information about HealthCap®, contact Peter Feeney at Peter.Feeney@chelsearhone.com
Connections September 11, 2019
 

Nursing Facilities Should Have Two Infection Preventionists Trained by November 28 to be ROP III Ready

Dave Kyllo

Phase III Requirements of Participation (ROP) take effect November 28, 2019 and mandate that every nursing facility have a designated and specially trained Infection Preventionist who is running a comprehensive infection prevention and control program.  AHCA’s Infection Preventionist Specialized Training (IPCO) program is specifically designed to prepare individuals to effectively implement and manage an Infection Prevention & Control program in nursing facilities.

AHCA recommends that each nursing facility train at least two Infection Preventionists through AHCA’s Infection Preventionist Specialized Training (IPCO) program. It is important to have at least two people trained so that if one specially trained individual leaves, the facility won’t be found to be out of compliance with the requirement to have at least one designated Infection Preventionist who is specially trained and that meets the other requirements set forth by the CMS Requirements of Participation for this mandatory role.

AHCA’s course is an online, self-study program with 23 hours of training that meets the educational requirements outlined by CMS. It includes online lectures, case studies and interactive components taught by subject matter experts who have real life experience working in long term/post-acute care.  It addresses both clinical and organizational systems, processes and cultural aspects of infection prevention and control which are fundamental to effectively leading and administering a nursing center’s Infection Prevention & Control program.  

Another reason for nursing facility staff to take the course now is to reduce the risk of receiving the most frequently cited F-Tag in standard nursing facility health inspection surveys under the new survey process is F880 – Infection Prevention & Control.  Since November 2017 when the new infection prevention and control mandates began, more than one-third of surveys conducted across the nation have included a F880 Infection Prevention & Control citation.  The primary change coming this November under Phase III ROP is the designation of a specially trained Infection Preventionist who must work at least part-time at the facility.  Facilities will continue to be surveyed on all the new infection prevention and control requirements and the antibiotic stewardship requirements. 

While CDC/CMS released a free infection prevention training course in March that members can access, AHCA’s training provides more in-depth learning.  AHCA’s course is the only specialized training for the long term and post-acute care setting that provides in-depth learning about the leadership and culture change elements necessary to create a comprehensive and sustainable infection prevention and control program that covers all operational components of a nursing facility.  

The AHCA training program gets rave reviews with nearly 97 percent of health care professionals who have completed the course recommending IPCO to their colleagues. 

The registration fee is $450 for AHCA/NCAL members and $650 for non-members.  There are no refunds and no transfers. 

Payment and registration are made online at ahcancalED. The IPCO course can be accessed here or at: https://educate.ahcancal.org/p/ipco.   Discounted group purchase rates are available for groups of 25 or more.  Those interested in making a group purchase should email AHCA at educate@ahca.org.  

To access ahcancalED and the IPCO course, members will need to login with their AHCA/NCAL usernames and passwords.  For assistance obtaining AHCA/NCAL usernames and passwords, please e-mail update@ahca.org with your name and facility contact information. 
Connections September 11, 2019

Good Samaritan Society Residents Successfully Evacuated and Return Home

Dana Halvorson and Erin Prendergast

In what now is the aftermath of Hurricane Dorian in Florida, Good Samaritan Society residents have safely returned to their homes in Daytona and Kissimmee, Florida.  Prior to the hurricane, within 48 hours Good Samaritan Society-Kissimmee Village and Good Samaritan Society-Daytona successfully evacuated more than 200 residents to the safety of DeLand, Fla., at another Good Samaritan Society location about 20 miles west of Daytona and 60 miles south of Kissimmee.  You can read about the coordinated effort in more detail here.   

If your facility or member facilities have been affected by Hurricane Dorian, please contact Erin Prendergast (SNF Providers) or Dana Halvorson (ICF/IID Providers) with any requests for support, resources, or questions.

Beneficiaries and providers of healthcare services that have been impacted can seek help by visiting CMS’s emergency webpage.  CMS will be temporarily waiving or modifying certain Medicare, Medicaid, and CHIP requirements.  CMS will also issue a number of blanket waivers, listed on the website below, and the CMS Regional Office will grant other provider-specific requests for specific types of providers in Florida, Georgia and South Carolina.  These waivers work to provide continued access to care for beneficiaries.  For more information on the waivers CMS has granted, visit: www.cms.gov/emergency.

To find additional hurricane preparedness and response resources for the health sector and the latest regarding HHS activities for Hurricane Dorian, please visit: www.phe.gov/dorian.

Apply to Become a National Quality Award Examiner

Meghan K. Karstetter

AHCA/NCAL is seeking Senior and Master Examiners to evaluate 2020 Silver and Gold National Quality Award applications.

What You Gain By Participating:
  • Networking and professional development opportunities 
  • Develop a marketable skillset and invaluable knowledge
  • Education in Baldrige Excellence Framework from content experts
  • Make a national impact on long term care performance
  • Earn Continuing Education Units (CEUs)
  • Attend AHCA/NCAL’s Quality Summit or Convention at a discounted rate 
  • Learn best practices to bring back to your own organization
Learn more about the role, the timeline, and responsibilities here: www.ahcancal.org/examiners

Submit your application to become a 2020 AHCA/NCAL Quality Award Examiner today! All applications are due by November 7th at 8pm ET. Please share this opportunity with anyone who may be interested! Questions? Email us at qualityaward@ahca.org.

Congressional Letter to Heads of CMS and HHS on 3-Day Stay Requirement and Observation Stays Issue

Dana Halvorson

Last week, U.S. House of Representative Members, Joe Courtney (D-CT) and Glenn ‘GT’ Thompson (R-PA), wrote to the Secretary of Health and Human Services (HHS), the Honorable Alex Azar, and to the Administrator of the Centers for Medicare and Medicaid Services (CMS), the Honorable Seema Verma, on the three-day stay requirement and observation stays issue.  In the letter, Reps. Courtney and Thompson specifically noted to the agency heads, “This year, we ask if you intend to use your authority to once and for all remove this inequitable, longstanding, and bureaucratic barrier to care.”

Under current law, a Medicare beneficiary must spend at least three days as a hospital inpatient for Medicare to cover a subsequent stay in a skilled nursing center (known as the “Skilled Nursing Facility 3-day rule”).  Each year numerous beneficiaries are unable to access their skilled nursing benefit because of the administrative classification of their hospital stay, even if the stay is deemed medically necessary, and even if the stay spans three days or more.  AHCA/NCAL has also urged CMS to take action and eliminate this confusing policy barrier by recognizing observation stays as qualifying stays for the purposes of the three-day stay requirement.  For more information about this issue, be sure to visit the AHCA/NCAL website.

Candida Auris – What you need to know!

Pamela Truscott

Candida Auris is a type of yeast that has been causing severe illness in residents and patients in a variety of health care settings, including long-term care.  The yeast can enter the bloodstream and spread throughout the body causing serious invasive infections.  Unfortunately, this strain of yeast does not respond to common antifungal drugs, making infections more difficult to treat.  People at highest risk of infection with this type of yeast are people who have been hospitalized or live in a healthcare facility a long time, have central venous catheters, or other lines or tubes entering their body, or have previously been receiving antibiotics or antifungal medications.  Common symptoms include fever and chills that don’t improve after antibiotic treatment for suspected bacterial infection.  Only laboratory testing can diagnose Candida Auris infection.  The Centers for Disease Control and Prevention (CDC) is alerting U.S. healthcare facilities to be on the lookout for Candida Auris.  For more information on Candida Auris, refer to the CDC website.

Centers are encouraged to review their infection prevention and control programs to identify if updates are needed to address this issue.

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 August 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 http://www.oig.hhs.gov/exclusions/exclusions_list.asp, 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 http://oig.hhs.gov/exclusions/download.asp.

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

Wednesday, September 4, 2019

September is National Preparedness Month and Important Hurricane Dorian Information

Dana Halvorson and Erin Prendergast

September 2019 marks, among other observances, National Preparedness Month.  National Preparedness Month, recognized each September, provides an opportunity to remind us that we all must prepare ourselves and our families now and throughout the year.  This month the focus will be on planning, with an overarching theme: “Prepared, Not Scared.”  Take this time to review your facility and community-based risk assessment/hazard vulnerability.  AHCA/NCAL has an emergency preparedness website with helpful information and resources you might be interested in.  Members should also visit the Assistant Secretary for Preparedness and Response, the Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE) website for additional resources for long term care centers. 

If your facility or member facilities are being affected by Hurricane Dorian, please contact Erin Prendergast (SNF Providers) or Dana Halvorson (ICF/IID Providers) with any requests for support, resources, or questions.

Beneficiaries and providers of healthcare services that have been impacted can seek help by visiting CMS’s emergency webpage. CMS will be temporarily waiving or modifying certain Medicare, Medicaid, and CHIP requirements. CMS will also issue a number of blanket waivers, listed on the website below, and the CMS Regional Office will grant other provider-specific requests for specific types of providers in Florida, Georgia and South Carolina. These waivers work to provide continued access to care for beneficiaries. For more information on the waivers CMS has granted, visit: www.cms.gov/emergency.

To find additional hurricane preparedness and response resources for the health sector and the latest regarding the Department of Health and Human Services activities for Hurricane Dorian, please visit: www.phe.gov/dorian.

New CMS Beneficiary Notice Initiative Mailbox

Lilly Hummel

The Centers for Medicare and Medicaid Services (CMS) announced the launch of the new Beneficiary Notices Initiative (BNI) mailbox portal for Medicare beneficiary notices and related policy questions.  Please access the new BNI mailbox via the following link:  https://appeals.lmi.org. CMS reports that the purpose of this new BNI mailbox portal is to provide a more efficient method for responding to provider, industry, and stakeholder questions.

The new BNI mailbox portal provides links to a variety of resources and links to other CMS mailboxes and e-mail addresses.  CMS encourages Medicare beneficiaries to review the available resources before submitting a question. 

2019 HUD Updates on Residential Care Facilities Asset Management

2019 HUD Updates on Residential Care Facilities Asset Management
October 1, 2019
3-4 pm ET
 
In this webinar, representatives from HUD's Office of Residential Care Facilities (ORCF) will discuss the Section 232 program, which provides mortgage insurance for residential care facilities, including nursing homes, assisted living facilities, and board and care homes. In this webinar, get an overview about programs offered through ORCF and detailed information related to the recent changes in the HUD-published documents that are required for use by borrowers and operators in performing asset management functions in their facilities.
 
Learning Objectives:
  • Understand the updated form and procedures for Reserve for Replacement and Residual Receipt withdrawals.
  • Understand the updated form to request access to the 232 Healthcare Portal.
  • Understand the requirements and forms for changes in participants of residential care facilities that currently have FHA-insured financing.
  • Understand the updated form for adding or submitting changes to the  Accounts Receivable Financing for your facility.
  • Understand the requirements and updated form for requesting a Loan Modification.
  • Understand the updated form for certification of completion of Non-Critical Repairs.
  • Understand the requirement and updated form for notification to HUD of threats to permits and approvals for your facility.
 
Speakers:
  • John Hartung, Director, Policy, Risk Analysis and Lender Relations Division, Office of Residential Care Facilities, HUD
  • Philip Head, Director, Asset Management Division, Office of Residential Care Facilities, HUD
  • Rita Dockery, Supervisory Account Executive, Office of Residential Care Facilities, HUD

Week One of PDPM – “One-Time” Transitional Policies Webinar

Week One of PDPM – “One-Time” Transitional Policies Webinar
September 17, 2019
3:00-4:30 PM Eastern Time
Presenters:  Mike Cheek, AHCA Senior Vice President, Reimbursement Policy; and Dan Ciolek, AHCA Associate Vice President, Therapy Advocacy
Register
here.

During this 90- minute live webinar, the presenters will discuss details related to unique challenges providers will face during the SNF PPS transition period from the RUG-IV to PDPM.  Many of these are related to “one-time” transitional policies for residents receiving Part A services under RUGs in September and transitioning to PDPM on October 1.  Specific topics to be discussed include: 1) Handling RUG-IV assessments and billing for late September admissions expected to extend into October; 2) Use of the 5-Day PDPM assessment versus the Transitional IPA Assessment during week one in October; 3) Interrupted stay policy during week one in October; 4) Assessment considerations for payers that may have continued with RUG-III or RUG-IV payment models (i.e. Medicaid, Medicare Advantage, VA); and 5) Strategies to troubleshoot and resolve payment challenges should they occur.  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.

Three 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: ahcancal.org/icd10pdpmcoder
  • 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: ahcancal.org/icd10pdpmnoncoder
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 educate@ahca.org with your name and facility contact information. 

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

Give Your Staff A Second Employee Health Benefit Option with No Deductibles, Low Copays and Unlimited Free 24/7 access to TELADOC®

Dave Kyllo

AHCA/NCAL Insurance Solutions offers a minimum essential coverage (MEC) health plan to members.  The plan was developed by Compass Total Benefit Solutions and offers two affordable options for providing many of the health insurance benefits that are important to long term care employees.  This short video explains the MEC plan for AHCA/NCAL members in less than two minutes and highlights the features that make the MEC plan so popular with LTC employers and employees. 
 
Both Compass plans feature affordable premiums and co-pays for valued and commonly used services, including prescriptions, physician visits and free unlimited 24/7 access to TELADOC®.  Benefits are instantaneous with no deductibles.  The difference in the two plans is based on the level of hospital indemnity benefits.  Here’s the exclusive AHCA/NCAL “Member Only” rate schedule:

  Monthly Premiums
Compass 1
Compass 2
EE
$161.29
$181.75
EE & Spouse
$264.70
$306.39
EE & Children
$244.19
$279.94
Family
$356.70
$417.20

The plan is designed to help AHCA/NCAL members recruit and retain frontline staff who cannot afford major medical health plan premiums or high deductibles.  Employers determine their level of contribution for plan expenses for coverage for employees, their spouses, their children or family coverage. 

There is no additional underwriting for the Compass plan and no mandatory wait periods for new employees to join the Compass MEC plans.  Any wait periods are determined by the employer.  There is a minimum of five employees that must be enrolled to offer the plan to employees.
Read this Q&A document for more information about Compass plans for AHCA/NCAL members. Versions of the Compass Plan are available in all 50 states. Hospital indemnity benefits vary based on state approvals, which is why some states have different hospital indemnity benefit levels.

For more information, please contact Nick Cianci at 202-898-2841 or Dave Kyllo at 202-898-6312, visit www.ahcabenefits.org or www.ncalbenefits.org or email ahcainsurancesolutions@ahca.org.  Or, stop by Booth # 2418 in the AHCA/NCAL Expo Hall in Orlando to learn more.