Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency This past month’s HarmonyHelp hotline fielded an inordinate amount of questions on the SNF Denial Letters.  The following blog post is intended to help clarify the confusion since the changes implemented May 7, 2018.  Notice of Medicare Non-Coverage (NOMNC) (Generic Notice and Detailed Notice) (CMS For...

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency What are the hot topics from last week on the audit front?  Medicare and Medicare Advantage claims are being denied for a misunderstanding of the “Medicare Week”. Denials occur when the service delivery exceeds the Physician Ordered frequency of treatment.  What is the Medicare week?  Is it Sunday to the...

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency As a continuation of Tuesday’s blog post, lets discuss missed assessments. The fundamental difference between a missed and late assessment is where the patient is at the time of the due assessment.  A late assessment occurs when the patient is still in the facility while a missed assessment occurs when th...

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency Harmony Healthcare International (HHI) performs monthly auditing, monitoring and educational services to the healthcare industry. During our on-site monthly audits, we hone in on MDS Assessments.  Compliance of MDS content accuracy and timeliness are critical focus areas as they impact care planning and r...

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency The SNF VBP (Value-Based Purchasing Program), begins Oct 1, 2018 and rewards Skilled Nursing Facilities with motivational payments for performance on reducing hospital re-admissions known as the Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM).  The calculation is based on a facility...

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency Admission and Re-admission Nursing Notes: Harmony Healthcare International (HHI) suggests that the following information be included in all admission notes:  Time and date of admission. Mode of Transportation, assist level and number of assist with transfers and bed mobility.

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency We spent the last few blog posts discussing F-Tags.  Let’s shift gears and look at E-Tags.  The Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers was implemented November 15, 2017. This set of tags are utilized to cite non-compliance during initial, re-cer...

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency The last two blog posts reviewed F-Tags and Deficiencies.  Given the significant amount of changes in the regulatory landscape, CMS applied an 18-month enforcement freeze (no monetary payments but tags can still be cited for non-compliance).  The purpose of this moratorium is to allow facilities time to...

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency Per the January 31, 2018 CASPER Data for last standard health surveys of active Skilled Nursing Facilities (excluding complaint, federal monitoring, and special focus surveys), the most frequently cited Severity Level is the D Level at 55.65% with E Levels coming in in second at 28.92%.

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency Health Inspections are the topic of every nursing facility across the country.  According to Nursing Home Compare, the current national average of deficiencies is 5.8 F-Tags Per Facility.  There are 204 possible deficiencies a nursing home is subject to during a Federal Survey derived from the below 20 c...

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency Usage of the Merry Walker Ambulation Device requires observation of a professionally trained medical person to determine if the device constitutes a restraint.  The Merry Walker may not constitute a “restraint” if the patient is able to open, close and maneuver out of the front gate independently.  ...

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency The Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) released the SNF Proposed Rule for Fiscal Year 2019.  Within the regulation, multiple items addressed including the:  Medicare Rate (increase of 2.4%), Value Based Purchasing (Hospital Re-Admission Metric wi...

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency We continuously hear the story told by Kris Mastrangelo about her experience at the Boston MS clinic years ago when she was convinced she had Multiple Sclerosis.  The Physician asked her to walk down the hall 50 feet, turn around, and walk back as fast as she could.  She was perplexed by the request, but ...

Harmony Healthcare International
Harmony Healthcare International
Blog Post
Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency Payroll-Based Journaling goes live next week (4.23.18) on the Nursing Home Compare Five Star!  Staffing Information Collected for Quality InterpretationThe Centers for Medicaid and Medicare Services (CMS) collects, tracks and analyzes Skilled Nursing Facility (SNF) staffing data.  The purpose of this m...

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency The last few weeks have been a whirlwind with the Harmony Healthcare International (HHI) trainings across the country. The focus is on the phases of the Requirements of Participation as well as the Regulatory and Survey climate. Skilled Nursing Facilities are working diligently to implement the changes.  ...

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency Interview with Esther Nederhood, Owner of Belle Oakes Assisted Living Center Kris Mastrangelo, President of Harmony Healthcare International (HHI) interviews Esther Nederhood, Owner of Belle Oakes Assisted Living Center, in the 2017 AHCA Provider Lounge.  Esther discusses working with a mostly rural popu...

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency The annual PEPPER report for SNFs is released 4/9/18.  To access, log on to the TMF website at:  https://securefile.tmf.org/  Risk Areas are present in every healthcare organization.  Skilled Nursing Facilities must perform Risk Assessments to determine, rank and prioritize focus areas for their annual c...

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency Interview with Don Pelligrino, CEO and Owner of Bridgeway Healthcare Kris Mastrangelo, President of Harmony Healthcare International (HHI) interviews Don Pelligrino, CEO and Owner of Bridgeway Healthcare in the 2017 AHCA Provider Lounge.  Don discusses his staffing challenges in the ever-changing regulat...

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency Interview with Gerald Hamilton, Owner of Bee Hive Homes Kris Mastrangelo, President of Harmony Healthcare International (HHI) interviews Gerald Hamilton, Owner of Bee Hive Homes in the 2017 AHCA Provider Lounge.  Gerald discusses how his assisted living facilities are seeing a sicker, albeit better-infor...

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency As a final Blog on the SNF Assessments series, here is an overview of the Discharge Assessments.  There are 3 Assessments to address:  OBRA Discharge Assessment – Return Anticipated  OBRA Discharge Assessment – Return Not Anticipated  Medicare-Required Part A PPS Discharge Assessment 

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency Unscheduled Assessments  Last week we reviewed the PPS MDS Scheduled Assessments required for Medicare Part A Billing.  Often, situations arise in which the MDS Coordinator must complete an assessment outside of the planned assessments.  These types of assessments are known in the industry as “Unschedul...

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency While the Skilled Nursing Facility prepares for Payment Reform in the form of a bundled payment or RCS-1, the facility clinical teams need to ensure that the basics of the current PPS System are completed correctly and timely.  The Harmony Healthcare International (HHI) Team who travel the country (Harmon...

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency As a follow up to the webinar Friday March 16, 2018, here is a narrative of the discussion of the modes of therapy and the related MDS Guidelines form section of the RAI Manual:  1.  Minutes of Therapy 2.  Non-Skilled Services3.  Co-Treatment4.  Therapy Aides5.  Therapy Students6.  Individual Therapy7.  ...

Harmony Healthcare International
Harmony Healthcare International
Blog Post
  • C.A.R.E. Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency Therapy Services (PT/OT/ST) rendered in SNF are subject to the parameters outlined in the Medicare Benefit Policy, Chapter 8.  Specifically, the daily skills, knowledge and judgement of therapist are necessary for the provision of said services as no other caregiver is qualified to render the interventio...

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