Recently, CEO Jim Hoey and Sales VP Jae Sparks attended Reimbursement-Con by Zimmet Healthcare. CMS' Patient-Driven Payment Model (PDPM) was a hot topic, with speakers offering strategies for skilled nursing facilities (SNF) to maximize reimbursement.

To fully appreciate these strategies, let's back up to what we know, what we expect, and some wildcards with PDPM. 

What We Know

• PDPM was the biggest overhaul in SNF payments in a generation.
• PDPM was supposed to be budget neutral.
• Before the March 2020 public health emergency, experts said PDPM was more generous than CMS intended. 

What We Expect

• CMS wants $1.7 billion back, which could mean a 5% recalibration.
• Using average daily rates in a post-pandemic world could cause a larger recalibration next year, more like 10-12%.

The Wildcards

• CMS did not compensate SNFs for COVID care until April 1, 2020.
• CMS assumed all SNFs were affected by COVID in the same way.
• ACOs and value-based purchasing are forcing shorter lengths of stay with sicker patients.
• Due to transitional care units, hospitals are seeing most of the PDPM benefits.

While legislators seek reform, SNFs must still try to survive in the PDPM world. To this point, speakers discussed the best practices. An overriding theme here was using Interim Payment Assessments (IPAs). Only 3% of SNFs are, and it's to your disadvantage.

IPAs

• CMS wants IPAs to help SNFs track the status of a patient’s conditions and needs for a higher level of care.
• The purpose of IPAs is to establish a payment rate or billing code for billing Medicare Part A.
• Implement IPAs when a resident condition changes and may last 14 days or more.
• Conduct IPAs as a routine when resident stays hits day 21; a lot can change in three weeks.

Other Suggestions

• Offer specialty care and therapy, like speech and language.
• Stress the importance of documenting all work, using multiple documenters, where possible.
• Correct coding, correct coding, correct coding; billers may need refresher courses.
• Applaud payers when they do the right things, but never take that as enough.

Technology can help.

• Our primeVIEW and Managed Care MASTER solutions allow you to customize alerts on certain clinical conditions or changes that should trigger staff to conduct an IPA. 
• Our primeCLAIMS solution makes coding and editing simple and its backed by a support team experienced in post-acute billing.
  
  

Tired of reading documentation in long-paragraph format? We are too. That's why we put together easy-to-scan bullets and a printable infographic for the CDC's Interim Public Health Recommendations for Fully Vaccinated People. 

Why the change? 

While it's safe to resume most pre-pandemic activities, even without a mask, the CDC believes:

• COVID-10 infections can still occur in a small proportion of fully vaccinated
• Fully vaccinated people infected with the Delta variant can spread it 

Self-Quarantining

• DO if you have tested positive in prior 10-days
• DO if you are experiencing COVID-19 symptoms
• DON'T after travel

Testing

• DO if experiencing COVID-19 symptoms
• DO at 3-5 days after exposure to suspected/confirmed COVID-19
• DON'T before/after domestic travel 
• DON'T before international travel unless required by the destination
• DON'T as part of routine screening, if feasible

Masks

• DO wear it indoors in public in areas of substantial/high transmission
• CONSIDER it in public indoors, regardless of transmission rate and especially if household members are:  
  • Immunocompromised
  • At increased risk of severe disease
  • Unvaccinated

Other Laws

• DO follow any applicable federal, state, local, tribal, or territorial laws, rules, and regulations.

Special Notes for Immunocompromised

• Seek medical counseling on the potential for reduced immune responses to COVID-19 vaccines
• Follow previous COVID-19 prevention measures (mask, 6-foot distancing, avoid crowds and poorly ventilated indoor spaces)

For more information, visit these CDC resources:

• Interim Public Health Recommendations for Fully Vaccinated People
• Substantial or High Transmission Areas
• Increased Risk for Severe Disease
• COVID-19 Symptoms
• COVID-19 Prevention Methods

We see many ads on TV about protecting our personal information. But what about protecting your business? Protecting your business is just as important. So treat your business like a modern-day castle. Review this Q&A for a quick education on how you can do it.

• How can my business be attacked?
• How do these attacks impact my organization?
• How can I protect our network from hackers?
• How can I build a wall for our 'castle'?
• How can I lock the gate of our 'castle'?
• How can I train staff to guard our 'castle'?
  
  

---

How can my business be attacked?

• Ransomware
• Hackers encrypt your files
• Work comes to a stop
• Potentially a permanent file loss
• Even if you pay, no guarantees

• Cyber email/extortion
• Very common as part of ransomware attacks now
• Steal your files and release them on the dark web if you don’t pay

• Access your computer system
  • Steal intellectual property or company secrets to sell to competitors
  • Gain access to your bank account; transfer funds
  • If you store/process confidential information, they can sell:
    • Financial – average $6/record
    • Medical – as much as $259/record

How do these attacks impact my organization?

• Ransom cost to recover data
• Competitor access to your company secrets
• Federal/State fines due to loss of confidential information
• Negative impact on the reputation of your company
• Criminal negligence charges from State governments

 

How can I protect our network from hackers?

Think of your organization like it’s a castle from the olden days. What would you need to protect your castle? A high wall, a locked gate, and armed guards inside might help?

 

How can I build a wall for our 'castle'?

• Modern and managed firewall
• Wi-Fi password changed regularly
• Separate guest and business Wi-Fi with different passwords
• Antivirus on your servers, laptops and desktops
• Email protection

 

How can I lock the gate of our 'castle'?

• Passwords
  • Require them, change them often
  • Employ multi-factor authorization (MFA)
• Physical security
  • Lock server and network equipment rooms
  • Encrypt computers/laptops in case of theft
• Appropriate access
  • Limit access to need to know
  • Extend minimum access necessary
• Data backups
  • Keep backups of your backups somewhere safe

 

How can I train staff to guard our 'castle'?  

• Provide ongoing training, not just for new employees.
• Conduct phishing awareness training and exercises
• Train staff on response to suspicious emails, websites, and computer behavior
• Prepare an incident response plan (IRP) in case you are a victim of an attack

If you need help protecting your castle, get in touch for an IT assessment today.

Prime Care Technologies announced today the addition of Michelle Burdette as Vice President of Operations. Michelle now oversees operations for the primeCLAIMS post-acute claims revenue management application and the primeVIEW analytics dashboard for skilled nursing/senior living facilities (SNFs/SLFs). She is responsible for driving adoption, utilization, and retention across the two product lines.

With more than 25 years of experience serving the healthcare/skilled nursing industry as a financial leader, Burdette has overseen multiple software implementations across billing, accounting, and operations groups. Most recently, she was the Chief Financial Officer at Prema Financial Solutions, a back-office consultant to SNF and other healthcare organizations.

Said Prime Care Technologies Chief Operating Officer, Carl Mickiewicz, “Michelle's knowledge of both the operational and financial needs of senior living organizations positions her to meet our ongoing goal of providing senior care operators with decision-driven data applications.”

Added President and CEO, Jim Hoey, “We are pleased to add a highly experienced and qualified team member like Michelle to our operations team. We look forward to her ideas for growing the software and delivering operational efficiency to more senior care clients.”

About Prime Care Technologies

For nearly two decades, Prime Care Technologies has provided senior care operators with integrated business intelligence and software solutions, driving proactive decision-making and the highest quality care. Based in Atlanta with 175 employees and 200+ healthcare/IT partnerships, its technology-driven solutions have been leveraged in 10,000+ facilities. With deep multi-vendor interoperability expertise, including the integration of 70+ healthcare applications and 3,500+ EDI payers, Prime Care Technologies offers the leading data warehouse in post-acute care. Learn more at http://www.primecaretech.com.

Are you a small or midsize business (SMB)? Most skilled nursing and senior living organizations find themselves in this category and like all other SMBs, cyber security should be a top concern given that 60% of companies impacted by cyber attacks go out of business. If that gets your attention, you'll be interested to see these related stats.

The onus is on business owners to create a culture of cyber security across the workforce. Make staff feel part of the team when it comes to blocking out attackers -- train them to recognize and avoid threats. Many companies now offer phishing resistance training, which is a great tool to have in your belt.

Lastly, we can't stress enough the importance of password management. It's estimated that 60% of employees use the same password across multiple work and home applications. Educate them on creating better ones, automate your password expiration policy and consider multi-factor authorizations (MFAs).

If you're feeling vulnerable, take our cyber security self-audit to see if you've got cyber security basics in place. If you've got weaknesses, we can help.

• IT Assessment Service
• Bait & Phish Employee Training
• primeCLOUD IT Service Suite