As outlined by the Centers for Medicare and Medicaid Services (CMS), Complying with Medical Record Documentation Requirements remains critical to senior care success.

Proper documentation:

• Helps patients get reasonable and necessary items/services
• Facilitates proper claim payment
• Supports favorable medical review decisions

Specific to claims reimbursement, CMS identified the top five reasons for errors. Note, two are related to documentation. 

So, what does insufficient documentation mean?

• It does NOT mean documentation doesn’t exist.
• It means something was incomplete or missing at claim submission.

And, what are the consequences of improper documentation?

Improper documentation disrupts the revenue cycle, which results in loss of financial revenue. CMS claim denials also cost your staff time, requiring them to:

• Complete forms
• Submit additional documentation
• Send a letter explaining why the claim should be paid
• Resubmit claim

Secondarily, if your order for item/service is illegible, your patient care suffers.

What are some tips for improved documentation?

• Send ALL associated documentation supporting the item/service billed
  • Some information may come from a prior claim or test
  • If you're not sure if certain documentation is required, send it anyway
• Send the documentation by the deadline indicated in the request
• Review documentation to make sure it:
  • Answers who, what, when, why, and how
  • Verifies item/service was performed
  • Verifies medical necessity

Where can I get more information regarding CMS claims errors, including documentation?

• Complying with Medical Record Documentation Requirements
• Complying with Medicare Signature Requirements

Lastly, senior care and skilled nursing facilities (SNFs) can greatly simplify claims revenue management by employing a system customized for this industry, and supported by seasoned claims professionals. Get in touch if we can help.

With the majority of nursing home residents now vaccinated, families are naturally asking 'When can we visit?' Though CMS has not updated requirements since September, vaccinations now put nursing homes in a better position to meet them. 

CMS Requirements for Visitation

[With the exception of compassionate care visitation]

• No COVID-19 cases in last two weeks
• No outbreak testing currently underway
• COVID-19 county positivity rate less than 10 percent
• Adherence to the core principles of COVID-19 infection prevention (printable PDF)

CMS further stipulated:

• Visitors adhere to core principles with staff monitoring
• Visitors are limited per resident and by facility size with recommendations:
  • Scheduled
  • Maximum must not exceed 20% facility residents
• Visitor movement is limited and kept to designated spaces, with outdoor preferred

States Reopening This Week

These recommendations reconsidered, we've seen states like Delaware, Ohio, Michigan, New York and Tennessee opening nursing homes this week. Delaware's policies seemed carefully thought out and perhaps offer a good starting point for others.

New York also added the requirement of testing within 72-hours of visit for those in counties with a 5-10% positivity rate. CMS also encourages testing in this scenario, as well as among those who visit as often as weekly.

Pressures from AARP

AARP joins families in pressing for visitation decisions from nursing homes, asking facilities to provide clear, advanced guidance to loved ones. Further, they ask virtual visits to be made a priority. 

Resources to Assist Nursing Homes with Visitation

Understanding your plates remain full, we've collected the following resources as quick reference or help.

• CMS County Positivity Rate Reports
• Core Principles of COVID-19 Infection Prevention [Shareable Flyer]
• Core Principle #1-4 Flyers: Screening | Hand Hygiene | Mask Dos/Donts | Social Distancing

In our recent webinar, "OIG Work Plan: Your Key to SNF Compliance," we partnered with Pathway Health Chief Marketing and Strategy Officer, Lisa Thomson to offer advice on how best to comply with the 2017 Officer of Inspector General (OIG) Work Plan. 

Objectives:

• Identify 3 top compliance concerns related to Affordable Care Act (ACA)
• Highlight 5 OIG Work Plan items that impact SNFs
• Define 3 strategies to prevent Fraud, Waste and Abuse

If you missed it, be sure to take advantage of these resources:

• On-Demand Replay
• Presentation Slides
• HCCA-OIG-Resource Guide

 If you feel unprepared for OIG compliance, get in touch with our experts!

• Prime Care Technologies – Elevate security, expedite IT needs and empower yourself to automate and oversee financial performance, claims processing, managed care, purchasing and workforce.
• Pathway Health – Bring in the experts as consultants, educators or interim managers to assist with your post-acute care requirements. 

Prime Care Technologies and Cheryl Field (our Chief Product Officer) are excited to partner with Pathway Health Chief Marketing and Strategy Officer, Lisa Thomson, for our webinar – OIG Work Plan: Your Key to SNF Compliance – offering advice on how best to comply with the 2017 Office of Inspector General (OIG) Work Plan.  

During the webinar, we'll:

• Identify 3 top compliance concerns related to Affordable Care Act (ACA)
• Highlight 5 OIG Work Plan items that impact SNFs
• Define 3 strategies to prevent Fraud, Waste and Abuse

You won't want to miss this great educational session!

It’s no secret the Affordable Care Act has greatly changed the healthcare landscape. It’s become a value-based industry with financial penalties and incentives involving 33 quality metrics, including hospital readmission rates. As a result, many accountable care organizations (ACO) have recognized the need to partner with post-acute care facilities to ensure quality of care is maintained throughout a patient’s entire treatment. They understand the valuable roll skilled nursing facilities (SNF) play in supporting patient transitions.

In order to ensure their patients are treated by the most effective SNF, many hospitals are establishing Preferred Skilled Nursing Facility Network partnerships. While each hospital or ACO will have its own criteria, here are some of the things they examine when creating their Preferred SNF Networks:  high quality of care, effective communication, and current technology.

Here’s an overview of the top criteria ACOs look for in SNFs:

• High quality of care
  Many ACOs require SNFs to have a CMS three-star rating or higher. The reason is simple. Proactive treatment in the rehab process and good risk management help prevent unnecessary hospital readmissions. 

• Effective communication
  It’s all about transparency, collaboration, and open communication with providers throughout a patient’s entire treatment. ACOs want to know how their patients are doing and be apprised of any changes to their conditions.
  

• Current technology
  Electronic medical records (EMR) and adequate data security are an essential part of sharing patient status with providers. ACOs want to work with SNFs who are able to easily share and protect pertinent patient information.

ACOs are a key driver of referrals for many SNFs. The financial risk is extremely high for any acute or post-acute care provider who doesn’t become part of a preferred SNF network.

You may find that our primeVIEW business performance dashboard for long-term care can help ensure your SNF maintains the high-quality of care expected by ACO/other networks. Its real-time snapshots of integrated data allows SNFs to proactively monitor performance around census, staffing, AR, clinical, financial, five star rating and more.

Resources:

• Hospitals create preferred networks for post-acute care
• Accountable Care Organizations and Skilled Nursing Facilities:  What Providers Should Know