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.

In Feds to deliver ‘positive news’ on Provider Relief Fund in coming days: Parkinson, McKnight's LTC News summarized recent comments from AHCA President and CEO Mark Parkinson at the Synergy Summit in Utah.

Among other things, Parkinson stressed managed care is not going away and encouraged senior care providers to embrace it by:

• Becoming a top provider in a given market
• Improving demographics
• Becoming part of a network
• Taking advantage of institutional special needs plans (I-SNPs)

Naturally, you may want to know more about I-SNPs and if/how you might take advantage of them. The below Q&A may be of help to you in assessing this.

What is an I-SNP?
I-SNP stands for Institutional Special Needs Plan and is designed for those who will live in a long-term setting for 90 days or more with no immediate plans for discharge

How does it fit within Medicare?
An I-SNP is a Medicare Advantage plan focused on the care of specialized populations. It replaces traditional Medicare to cover inpatient and outpatient services, plus prescription drugs (as a Part D service).

Who is eligible for an I-SNP?

• Reside in a long-term care facility with no anticipated discharge
• Currently enrolled in Medicare A/B
• Live in a county where I-SNP is licensed

*Check CMS' Special Needs Plan (SNP) Data to see who is operating in your state.

What are the highlights of an I-SNP?

• Nurse practitioners provide preventative and proactive care
• RN case managers coordinate care according to the Model of Care (MOC) required by CMS
• Residents are assigned a 'Risk for Hospitalization' level, which determines care plan and a schedule for proactive rounds
• Rounds occur as often as weekly or can be more frequent for high-risk residents
• Provider visits are not subject to medical necessity requirements of traditional Medicare, so they can be more proactive and frequent

How do I-SNPs benefit SNFs/residents?

• Increased provider visits; faster identification of conditions/treatment
• Treatment-in-place advantage – visits can happen in the nursing facility
• Proactive and preventative care; prevents unnecessary hospitalizations
• Reduce risks and stress associated with hospital stays

How can technology help facilities with I-SNPs?

• Case-to-contract management is essential to following an ISNP
• Our Managed Care MASTER software brings contracts online, PLUS pairs them with best-practice workflows and alerts
• With this automation, you can easily train anyone to act as a case manager and ensure reimbursement

If our Managed Care MASTER can help you 'manage' your managed care, including I-SNP contracts and care, let's connect.

As seen in McKnight's article, CMS: Educate, vaccinate and be ready to prove it, Centers for Medicare & Medicaid Services (CMS) will start enforcing their Interim Final Rule for COVID-19 Vaccination the week of June 14. Officially effective May 17, CMS is motivated to get staff vaccination rates up to 75 percent. Here's what's expected for both residents and staff.

1. Offer COVID-19 vaccines
2. Educate on COVID-19 and document efforts
3. Report COVID-19 vaccines and therapeutic treatments each week to the National Health and Safety Network (NHSN) 

The data collected will also be posted on the agency’s COVID-19 Nursing Home Data website as soon as possible, likely in mid-June.

Said Evan Shulman, CMS’ director for its Division of Nursing Homes, "For starters, let’s remember that the intent of this is to get as many people vaccinated as quickly as possible." He continued, "So, we will likely start prioritizing those individuals who are not vaccinated and start asking them how they were educated and if they were offered the vaccine.”

In other words, your first priority should be reporting who has received the vaccination, as those who aren't even achieving that goal are likely to be targeted first for audits. Next up, make meaningful attempts to educate residents and staff on vaccine safety – and track these efforts. Following are some educational resources that may be of help.

Webinars & Training

• COVID-19 vaccine safety monitoring - World Health Organization (WHO)
• AHA’s Newest COVID-19 Vaccine Confidence Resources Include Video, Webinar and Infographic - American Hospital Association (AHA)
• COVID-19 Vaccination in Long-Term Care: Safety, Efficacy, and Residents’ Rights - NursingHome411.org
• Vaccination for COVID-19 QuickPATH - Pathway Health

Videos

• Is the COVID-19 Vaccine Safe? - National Institutes of Health (NIH)
• 9 COVID-19 Myths Debunked - Cleveland Clinic
• Your COVID-19 vaccine questions answered - Mayo Clinic
• COVID-19 Vaccines: How Do We Know They Are Safe? - U.S. Department of Health and Human Services (HHS)

Centers for Disease Control and Prevention (CDC) Resources

• Tips for Building Confidence in COVID-19 Vaccines Among Patients
• COVID-19 Vaccination Communication Toolkit
• COVID-19 Vaccination Training Programs and Reference Materials
• Importance of COVID-19 Vaccination for Healthcare Personnel

Other Resources

• Invest in Trust: A Guide for Building COVID-19 Vaccine Trust and Increasing Vaccination Rates Among CNAs- Agency for Healthcare Research and Quality
• Patient education: COVID-19 vaccines - UpToDate.com Doctor Team
• COVID-19 vaccines: Get the facts (Q&A) – Mayo Clinic

In related news, long-term advocates encourage senior living caregivers to begin planning for the possibility of giving COVID-19 boosters. If you don't already have a good grip on vaccination tracking, know that technology can help. Our primeVIEW facility dashboard now has the ability to track which residents have received COVID-19 vaccinations.

In our recent webinar, executive panelists from Health Dimensions Group (HDG), SageLife, and Titan Healthcare Solutions joined our tech expert, Jonathan Duvall to discuss what senior care providers should take forward from this time of forced management innovation. We've simplified these takeaways into an infographic for your quick read.

A key theme heard repeatedly was for operators to have real-time access to data to track and trend what's going on in each of these key areas. As our clients at HDG have learned, technology can help. We would love to show you exactly how our primeVIEW dashboard can be there for you – today, or in times of crisis.

In good news, the CDC says those vaccinated for COVID-19 do not need to wear masks – even indoors. If trading masks for the vaccine doesn't sway staff, you may wonder how others are driving vaccine acceptance.

A recent McKnight's article, Mandate staff vaccines or promote them with a $1K bonus? compares Jewish Senior Services' decision to mandate the COVID-19 vaccine to The Gardens at DePugh Nursing Center's offer of a $1000 bonus, which helped them achieve a 92% vaccination rate.

Adding to that, we've put together a summary of how other organizations are getting it done based on an article from Becker's Hospital Review, 15 employers, hospitals rewarding workers to get COVID-19 vaccines.

Additionally, take look at our previous infographic, 9 Tactics for COVID-19 Vaccine Acceptance in Nursing Homes.

These tactics come at a good time, given CMS' release Tuesday of a new rule, asking requires long-term care facilities to report weekly COVID-19 vaccination data for residents and staff.  

For those of you using our primeVIEW KPI dashboard, you now have the ability to track COVID-19 vaccinations across residents. If you're not using primeVIEW, request a demo. Vaccinations aren't the only critical measurement it tracks!