New Transition for CMS

CMS, Centers for Medicare & Medicaid Services, is a federal agency within the United States Department of Health and Human Services. It administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards. It was founded on July 30th, 1965 by President Lyndon B. Johnson to protect the health and well-being of millions of Americans all while saving lives and improving the economic security of the nation. 

CMS recently announced the transition of CMS to iQIES (Internet Quality Improvement and Evaluation System) on April 17th for MDS record submissions and reports. According to cms.gov providers are expected to take into account all requirements provided by CMS. To properly prepare for this transition, submissions will be turned off on April 13. Providers need to submit completed MDS records before this Thursday. CMS will be providing more information on what to expect in the coming days through email. Failure to obtain access to iQIES before April 17th will impact your ability to submit MDS records moving forward. For information and instructions to register for an iQIES account, please visit: https://qtso.cms.gov/news-and-updates/action-required-register-iqies-account  

For those in question about iQIES, cms.gov provided key highlights for providers on what to expect in the upcoming days with the new shift. 

Key Highlights of iQIES

• Users will be able to securely access iQIES at any time, from any location (provided there is an internet connection).
• Users will log in once to iQIES. No longer will users be required to log into CMSNet and then into separate applications to upload MDS records or access reports.
• Users will have access to tips and information to guide them throughout the MDS submission process and accessing reports. 
• Users will be allowed to upload MDS assessments similarly as was done in the QIES.
• MDS reports will be similar to those in the Certification and Survey Provider Enhanced Reporting (CASPER) application, with some new functionality built in.
• Users can initially view the report information on the screen and if desired, can then download the report to a Portable Document Format (PDF) or Comma-Separated Values (CSV) file.
• Users can schedule reports to run at their desired intervals and frequency.

AI Enhancing Roles for Senior Living Facilities

AI, also known as artificial intelligence, became popular around the 1980s. John Hopfield and David Rumelhart popularized “deep learning” techniques, allowing computers to learn user experience. Recently we have seen the rise of AI yet again as it made national news, explaining how the system can write term papers for students, update resumes for job seekers, and much more that even made people question their position in the work field. 

AI is taking on a more impactful part in various roles for Senior Living. With the help of AI, senior living facilities are getting assistance with staffing, financial management, fall prevention, and clinical care. According to argentum.com AI is not replacing human intelligence but enhancing it. Well, why AI? What makes this system so reliable for senior living facilities? "It is this analysis of unstructured data, from multiple sources, in real-time, that is perhaps the most unique benefit of AI", says Arena CEO Michael Rosenbaum. 

Now that we know the why let's dive into the how. Rosenbaum says, "AI can find patterns and 'signal' very quickly from massive amounts of data which is the incontrovertible advantage of AI over human capability." It's not that humans are incapable but we are limited when it comes to time and energy whereas a machine is not. As Heather Annolino, senior director of Healthcare Practice at Ventiv, put it, “Artificial intelligence empowers healthcare organizations to obtain and examine data and generate actionable insight quickly and concisely. By quickly uncovering insights and connections, facilities can efficiently enact new or updated protocols without biases—based on fact.” Keefe says better access to data leads to better AI-aided results—and senior living operators and others have better access to data than ever before.“It’s so much easier now for us to collect information from external devices—for example, vital sign monitoring like temperature, pulse, respiration, blood pressure—and also wearable devices such as Fitbits and Apple watches,” Keefe says. This helps not just to alleviate the burden on the caregiver but helps that caregiver provide much better care. 

One of the most compelling uses of AI in senior living today is the pursuit of preventing resident falls, a persistent and critical challenge for all providers. But, how does it work? AI “generally functions by recognizing patterns and then either suggesting optimal solutions for a human to implement or by actually implementing those solutions itself,” he says.

“For example, most modern cars have a multitude of sensors and other technologies that identify potential risks and then alert the driver to react,” Paprocki says. “That is very different from a fully self-driving car, where the AI not only identifies potential risks but reacts to those risks by autonomously operating the vehicle.”

Paprocki says AI solutions are still closer to the former part of the analogy than the latter—but change is coming.

As with other technological tools, the human component of AI is still vitally important. “We live in a time when staffing has never been harder in our industry,” Paprocki says. “Even if we had triple or quadruple the number of caregivers, we still couldn’t predict, observe, immediately react to, or know how to prevent all falls. And that’s where technology like AI can be lifesaving because it can function like an Iron Man suit for our frontline caregivers.” 

The future of senior care is here.

64% of Medicaid enrollees are unaware of the decision for redeterminations this spring!

The Consolidated Appropriations Act of 2023 disengages with the Medicaid continuous enrollment provision.  The termination of the provision is planned to start on April 1, 2023, and the states will then begin Medicaid disenrollment. Over half of the applicants have yet to be included in the loop. This is due to many factors, including lack of updated information, language barriers, and accessing information in needed formats, to name a few. Not enough people are receiving the data and will be disenrolled from having Medicaid. “The risk is that if the message is not delivered loudly and often, millions of people will simply lose coverage.” (Marissa Plescia, www.medcitynews.com)

The U.S.  Department of Health and Human Services has predicted that about 15 million people nationwide could lose coverage when this happens! The 15 million may include your aunt, friend's grandmother, neighbor's sister, or anyone you might know.

According to CMS, states must develop operational plans for implementing the process.  The Georgetown University Health Policy Institute has provided a tracking map. The tracker shows that 41 states have a public plan. 

What is being done?

• Planned State Actions
• Streamlined renewal processes.
• Outreach through community health centers

What can you do?

• Update your contact information. 
• Check your mail.
• Complete your renewal form. 

In the meantime, try to stay in the know and watch what your state might be doing next. Look at the tracking map and see who else you can inform. With Spring quickly approaching, time is of the essence and can’t be wasted! Start talking and informing your loved ones.

It has been three years since the COVID-19 outbreak and the unfortunate labor shortage struggle continues. We have created different alternatives that have allowed us to continue life as we once knew it. But the question is how are companies able to adapt to this labor shortage and how do they come out on the other side stronger than ever? These labor insufficiencies have affected the nursing population tremendously and are now trickling into the world of IT.

Sadly, healthcare industries took a heavy hit with this. Staffing poverties are nothing new for Skilled Nursing Facilities (SNF), yet it is highly unfortunate. When there is a staffing shortage not only does that overwork the staff that is already available, it puts a strain on the company as a whole. These businesses are unsure how to improve the facility crisis or how to properly prevent it!

IT industries are experiencing staffing shortages as well due to non-flexible work hours, a lack of remote working options, feeling under-appreciated, and even the possibility of a toxic work environment. According to Sherweb.com "A whopping 85% said they felt their company focused more on attracting new talent than investing in existing staff. It is estimated that the demand for IT specialists will increase by 22%." This is a much faster increase than any other occupation and can result in nearly 85 million tech talent shortages! However, primeCLOUD can provide the staff augmentation you are yearning for during these critical times.

Companies are always evolving and changing. People come and go, but what if you have staff resign unexpectedly? It happens. This same scenario recently happened to a company we partnered with. A senior networking staff member had resigned and the company did not have a backup plan. Luckily, we were their backup plan as our company was able to provide the work they needed to fill that position. Why replace a hard worker with a supplemented lack of talent quick hire? Rely on us to fill in the gaps when needed with high-quality and skilled technicians!

There are many different risks of labor shortages such as workplace injuries, product liability, and even property! To assist with the lack of time and resources, many healthcare facilities are upgrading to technologically advanced resources. Some are even installing automatic monitoring devices to provide simple and accurate contactless monitoring. These innovative monitoring devices can help provide a variety of vital signs and bio-data features along with indications in a continuous, contactless, and passive manner. With these technology upgrades, proper installation is necessary. Our expert technicians can come to the site and complete those jobs for you as well. 

primeCLOUD can provide over-the-phone assistance as they work effortlessly around the clock 24/7. Aside from primeCLOUDs impeccable 24/7 service, we also can provide network monitoring assistance that oversees problems such as slow traffic or component failure. Allow us to be your boots-on-the-ground service when needed. We provide the tech, so you can provide the care.

PrimeCLAIMS Clearinghouse Propels Proclaim Partners to "Company of the Year"

The Financial Services Review has awarded ProClaim Partners “Company of the Year in its Claims Processing Solutions Providers category for 2022,” for outstanding innovation with its primeCLAIMS clearinghouse.  We are honored to be acknowledged for the technology and performance we bring to Post Acute Care and other industry claims processing.

When healthcare billers transitioned out of COVID, they had to do more with less. In 2022, primeCLAIMS streamlined the claims process, creating a higher standard of superior performance through technology.

Jonathan Duvall, Senior Director of Product Management, says, “Our goal is to provide software that goes beyond processing claims and integrates into an organization’s revenue cycle workflow. By studying workflow, primeCLAIMS delivers an intuitive experience to get companies paid every dollar for every day of patient care.”

- primeCLAIMS Clearinghouse facilitates seamless electronic claim submissions by automating the claims handling process.

- primeCLAIMS Sequential Billings compares month-to-month billing through side-by-side, claim-to-claim comparisons to detect discrepancies.

- primeCLAIMS Enhanced Aging lets you compare what was billed VS what was paid and highlights discrepancies of missing payments.

- primeCLAIMS EzDDE enables billers to edit hundreds of lines quickly and move to the next claim - saving up to 30 minutes per claim.

PrimeCLAIMS continues to work towards innovations and deliver technologies that focus on billers. Don't hesitate to contact Jae Sparks VP of Sales & Marketing, at 770-543-0473, to schedule a demo.