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Coronavirus & Your Residents: How Senior Care Communities Should Respond

By Prime Care Tech Marketing on Mon, Mar 09, 2020 @ 05:08 PM

You can’t turn on a TV or read a news story without hearing about the continuing spread of coronavirus. Travel plans are being postponed, events and conventions are being cancelled, and sales on products like hand sanitizer are spiking. Coronavirus has kept cruise ships from docking and reminded the entire world how important it is to wash your hands. Many workplaces and colleges are encouraging remote work from the safety of home. It’s even been blamed for a recent thousand-point drop in the stock market.

A quick browse over the internet would be enough to convince anybody that the world is ending. But the situation isn’t that dire, we promise. However, that doesn’t mean you shouldn’t take precautions, particularly as a senior care provider. Here’s what we know about coronavirus, how it can affect your senior care community, and what you should do:

The Facts on 2019 Novel Coronavirus

Coronaviruses are a large family of viruses that are common in people as well as a variety of animals. This particular virus, designated as SARS-CoV-2, causes a disease called COVID-19 (short for COronaVIrus Disease 2019). The virus originated in China and has spread throughout the world in just the last few months. As of this writing, the worldwide death toll is just under 4,000 people, and confirmed cases number in the hundreds of thousands. Also important to note is that over 60,000 people have already made a full recovery from the virus, a fact that is not being reported as often as it should be.

Coronavirus infects the lungs. According to experts interviewed by BBC News, the disease seems to begin with a fever, followed by a dry cough and shortness of breath. Other symptoms include headache, muscle pain, and fatigue.

How Dangerous Is Coronavirus to Senior Care Communities?

Novel Coronavirus 2019 is most dangerous to the elderly and those with compromised immune systems. People with pre-existing medical conditions like asthma, diabetes, and heart disease are also more susceptible.

Because the virus is particularly dangerous to the elderly, it’s not hard to see why senior care communities would be on alert. Due to the proximity of residents to each other and to staff, one senior contracting the disease would increase the likelihood of the virus spreading throughout your community. However, just because something is possible doesn’t mean it’s likely.

Should We Be Worried About Coronavirus?

On the surface, the facts about coronavirus are scary. Almost 4,000 people have died from COVID-19 so far. However, when compared to more common diseases, it loses a bit of its fear factor. For example, over 16,000 people (and counting) have died from the flu during the 2019-2020 flu season. And that’s with widespread availability of flu vaccines.

Looking only at the numbers, COVID-19 is only lethal for a very small percentage of the people it infects. Of the cases reported so far, only 3-4% of those infected have died.

That’s not to say that the virus and the disease it causes aren’t serious. But we don’t believe it’s the world-ender the media is making it out to be.

What Can We Do to Safeguard Our Community?

That being said, there are some simple things you can do to help keep your community safe from COVID-19:

  • Wash, wash, wash your hands. It goes without saying, but we’re going to say it anyway. Your staff should be washing their hands frequently. Many media outlets have released instructional videos and guides, but we like the video offered by USA Today. Click here to watch.
  • Flu shots all around. While flu shots will not help stop the spread of coronavirus, fewer cases of the flu mean more resources for fighting COVID-19. Also, the healthier your residents are, the more resilient they will be toward other viruses.
  • Invest in sick days. Encourage your staff to stay home when they are feeling sick. Yes, we know you’re short-staffed. Everyone is. But the ramifications of them coming to work when they’re sick aren’t worth it. Even if they don’t have coronavirus, infecting your residents with any kind of disease will weaken their immune systems and make them more susceptible to other infections.

Despite what the media coverage might make you think, coronavirus is not the end of the world. While it is dangerous, particularly for the elderly and the immunocompromised, there are steps you can take to ensure you and your senior care community remain unaffected.

Topics: coronavirus

[Webinar Series with Pathway Health] Operationalizing PDPM: ICD-10 Code Management

By Prime Care Tech Marketing on Fri, Mar 06, 2020 @ 12:00 PM


Under PDPM, ICD-10-CM codes and diagnoses will impact OT, PT, SLP, NTA, and nursing components – so it's essential to stay on top of these critical operations. 

On March 25, we'll kick off a series of educational webinars with Pathway Health to help you "operationalize PDPM," starting with ICD-10 Code Management - presented by Karolee Alexander, ICD-10-CM expert and trainer.

We'll offer Q&A after, so don't miss this lunchtime learning  to keep the positive PDPM momentum going! 




Topics: ICD-10 coding, ICD-10 training, PDPM, PDPM revenue

How Medicare Advantage Will Affect Your Nursing Home

By Prime Care Tech Marketing on Thu, Feb 20, 2020 @ 05:06 PM

Traditionally, Medicare hasn’t covered long-term care. And — spoiler alert — it still doesn’t. However, the rise of Medicare Advantage plans has opened a few doors that weren’t open before. While Medicare still doesn’t provide long-term care coverage — patients will have to subscribe to a different type of plan if they want that — it is beginning to provide coverage for certain aspects of long-term care.

So what “aspects” are we talking about?

What is the Difference Between Medicare and Medicare Advantage?

First, let’s dive into the difference between traditional Medicare (often referred to as Original Medicare) and Medicare Advantage. The first thing to understand is that Medicare Advantage, also known as Medicare Part C, is a private insurance plan. It replaces an individual’s Medicare Part A (hospital visits and inpatient care) AND Part B (physician appointments and outpatient care) with a plan from a private insurance provider. This plan must provide the same benefits as the Medicare plan it replaces. However, it also adds a lot of additional benefits not provided under Original Medicare.

What Types of Benefits Does Medicare Advantage Cover?

In addition to the benefits provided by Medicare Parts A and B, Medicare Advantage plans often offer dental, vision, and prescription drug coverage. Recently, insurance providers have expanded the coverage they offer to include benefits like meal delivery, home care services, rides to medical appointments, and home modifications like bathroom grab bars.

The benefits each plan offers varies based on the area it serves. In qualifying areas, Medicare Advantage plans can even cover grocery deliveries and transportation for non-medical needs for those with chronic illnesses. Some providers also offer options for gym memberships and fitness plans.

Are There Additional Costs with Medicare Advantage?

The cost of each Medicare Advantage plan depends on the plan itself. Most people who qualify for Medicare receive Part A benefits for free and pay a small monthly premium for Part B benefits. This is true for Medicare Advantage, as well. Some plans charge a monthly premium, while others do not. It all depends on which provider an individual chooses for their Medicare Advantage plan.

Custodial Care Vs. Skilled Care

Even with all the changes Medicare Advantage is bringing, it’s still limited in the kind of care it will cover in a long-term care environment. To understand what is covered and what isn’t, we must discuss the different types of care.

Medicare, along with most private insurance plans, pay for services that fall under “skilled care.” This includes medical services, rehabilitation, nursing, or medication administration. Medicare Advantage also covers specialized care, including stays in skilled nursing facilities, hospice care, and some home care services.

So what isn’t covered?

“Custodial care,” not typically covered by Medicare Advantage, includes services that are considered help with activities of daily living, or ADLs. These include eating, bathing, dressing, toileting, and other non-medical care. This is the type of care provided by most long-term care and assisted living facilities.

What Does This Mean for My Nursing Home?

Unless you have a contract with a Medicare Advantage insurance provider, Medicare Advantage will not cover most of the services your nursing home provides for long-term care. Stays in skilled nursing facilities and nursing homes are covered up to the first 100 days (though plans require coinsurance beyond 20 days). After that, residents are on their own. The plans should cover prescription medications and any therapies provided by your facility, however.

For nursing homes, the real benefit of Medicare Advantage is the coverage of prescription medications. Under Original Medicare, medications were not covered unless the resident was under a Part A stay. For many residents, that's a game changer.

While Medicare still doesn’t cover long-term care, the recent expansion of benefits under Medicare Advantage indicate that relief is on the way — and options could be opening up in the future.

Topics: Medicare, medicare advantage

Debi Damas Joins Prime Care Technologies as Senior Director of Product Management

By Prime Care Tech Marketing on Mon, Feb 17, 2020 @ 11:50 AM

DebiDamas2February 14, 2020, Duluth, Ga – Prime Care Technologies, Inc. announced today via press release the appointment of Debi Damas to its product management team as Senior Director. In her role, she will contribute her post-acute care and regulatory expertise to the development of the company's SaaS services.

For the past 28 years, Damas has served in leadership roles in clinical services and product management for LTPAC organizations looking to increase quality of care, retention, and ROI.

"We are delighted to welcome Debi and her breadth of knowledge of the senior care industry as we weather the course of regulatory change," stated Jim Hoey, President and CEO, Prime Care Technologies. "Her passion for the LTPAC industry coincides with our mission to help these organizations – through technology – solve the issues that keep them up at night."

Damas holds an Associate of Applied Science, Registered Nurse degree from Cuyahoga Community College, a Diploma in Paralegal Studies/Legal Nurse Consultant, and a nano-degree in Data Foundations. She contributes to McKnight's Long-Term Care News and is a frequent speaker at industry conferences for senior care. 


About Prime Care Technologies

Since 2003, Prime Care Technologies has equipped long-term care providers with flexible hosting, managed services and cloud software that evolve with industry demand, such as managed care optimization and mobile. Based in Atlanta with 175 employees and 200+ healthcare/IT partnerships, its technology-driven solutions are installed in 6,500+ 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 and claims clearinghouse in post-acute care. Learn more at – We provide the tech. You provide the care.


Not So Fast: The Truth About Those Initial PDPM Payment Boosts

By Prime Care Tech Marketing on Thu, Feb 13, 2020 @ 04:17 PM

Traditionally, additional revenue is a good thing. However, things aren’t always what they seem. Shortly after the Patient Driven Payment Model was implemented, skilled nursing facilities and nursing homes started reporting boosts in reimbursement. But many analysts are urging providers not to get used to the increased payments.

“The illusion of PDPM budget-neutrality is already over,” writes Michael Zimmet, President and CEO of Zimmet Healthcare Services Group. Zimmet contributed his thoughts on the future of skilled nursing for a January 2020 article in Skilled Nursing News. “We should enjoy the largesse while it lasts,” he continues, “but [we should] prepare for the inevitable correction long before 2020’s back-to-school sales are over.”

But why is PDPM leading to payment boosts in the first place? And what does that mean for future reimbursements?

When New Patients Aren’t New Patients

When the Patient Driven Payment Model was rolled out, most skilled nursing facilities and nursing homes saw an immediate boost in reimbursements. This was due to CMS counting all residents of a care community as new admissions, regardless of how long they had been already been there. Understandably, this rate boost won’t be replicated in the future.

Be Prepared for Inevitable Rate Adjustments

It seems that 9 is a magic number. According to Zimmet Healthcare Services Group, nine out of ten skilled nursing facilities saw a reimbursement boost after PDPM went into effect. On average, SNFs saw an increase of 9 percent or more in Medicare reimbursement. Because the model was designed to be revenue-neutral, industry experts expect that reimbursement rates will be recalculated soon.

The failed attempt at revenue-neutrality has many concerned that CMS could claw back reimbursements or adjust future payments to recoup losses. After all, the goal of model was to cut back on what it saw as inappropriate spending on therapy services that may not be needed.

Length of Stay Issues: When More Can Still Be Less

While per-diem rates are on the rise, the average length of stay is on the decline. This effectively erases any potential boost from per-day payment increases. In fact, CMS data shows that fee-for-service days have decreased by over 17 percent since 2010. Covered days per skilled nursing admission have also dropped by just over 7 percent.

As patient care and outcomes improve, lengths of stay are going to naturally decrease. Unfortunately, this also means that reimbursement will, as well.

What You Can Do to Protect Your Community

The best way to optimize your Medicare reimbursements is to check and double-check your data. Make sure that every diagnosis is captured and reported accurately so you don’t leave money on the table. Inaccurate recording can lead to missed Medicare payment opportunities.

PDPM was designed to be revenue-neutral. CMS didn’t plan to spend any more under this model than it did before. But that’s exactly what is happening, and we don’t expect it to keep happening for long.


Topics: Skilled Nursing Facility, Medicare, PDPM, length of stay, reimbursements

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