2 min read

Documentation Critical to CMS Claims, Patient Care and Medical Reviews

By Prime Care Tech Marketing on Thu, Jun 17, 2021 @ 04:10 PM

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. 

Top-5-cms-claims-errors-primeclaims-snf-revenue-cycle

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?

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.

Learn More

Topics: revenue cycle management SNF CMS primeCLAIMS denial management
3 min read

CMS to enforce COVID-19 vaccine education and reporting June 14

By Prime Care Tech Marketing on Fri, May 28, 2021 @ 04:40 PM

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

Videos

Centers for Disease Control and Prevention (CDC) Resources

Other Resources

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.

Get in Touch

Topics: primeVIEW CMS CMS compliance CMS reporting COVID-19
1 min read

[Webinar] OIG Workplan: Your Key to SNF Compliance

By Prime Care Tech Marketing on Fri, Apr 07, 2017 @ 12:01 PM

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!

REGISTER NOW

Topics: compliance SNF CMS post-acute care providers
1 min read

[Event] NHHCA 2017 Spring Conference

By Prime Care Tech Marketing on Thu, Mar 30, 2017 @ 09:40 AM

We are excited to announce that Cheryl Field, Prime Care Technologies Chief Product Officer, has been selected to speak on two different topics at the New Hampshire Health Care Association's (NHHCA) Spring Conference on May 10th

In the morning session Cheryl will be discussing “Five Star & the New Quality Measures".  Attendees will leave with an action plan they can easily implement to strategically improve their position in the market.

Her afternoon session highlights "Who's Paying the Bill? Understanding Today's Payment Models and Data You Need for a Stong Bottom Line".   This presentation will explore changes in the Payer landscape as well as changes in payment models.

 Click here to see a short video about Prime Care Technologies

Click here for information on the NHHCA Conference

Topics: business intelligence BI dashboard reimbursement process Five Star ratings CMS payment models

[Media] McKnight's - 6 PBJ Tips to Consider Before Changing Time and Attendance Companies

By Cheryl Field on Fri, Feb 10, 2017 @ 10:49 AM

Recently I heard our product development managers discussing several PBJ clients who had changed time and attendance vendors. The challenges they discovered, and the lessons learned, are worth sharing with all providers who might be thinking about changing time and attendance software.

To learn more, visit mcknights.com 

 
Topics: CMS PBJ pbj reporting