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[On-Demand Webinar] OIG Workplan: Your Key to SNF Compliance

By Prime Care Tech Marketing on Fri, Apr 21, 2017 @ 03:37 PM

In our recent webinar, "OIG Work Plan: Your Key to SNF Compliance," we partnered with Pathway Health Chief Marketing and Strategy Officer, Lisa Thomson to offer advice on how best to comply with the 2017 Officer of Inspector General (OIG) Work Plan. 

Objectives:

  • 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

If you missed it, be sure to take advantage of these resources:

 If you feel unprepared for OIG compliance, get in touch with our experts!

  • Prime Care Technologies – Elevate security, expedite IT needs and empower yourself to automate and oversee financial performance, claims processing, managed care, purchasing and workforce.
  • Pathway Health – Bring in the experts as consultants, educators or interim managers to assist with your post-acute care requirements. 

Topics: real-time reporting, compliance, SNF, reporting and analytics, OIG, Office of Inspector General

[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

[Blog] Preferred Skilled Nursing Facility Networks: How do you measure up?

By Bryana Allen on Wed, May 25, 2016 @ 11:30 AM

It’s no secret the Affordable Care Act has greatly changed the healthcare landscape. It’s become a value-based industry with financial penalties and incentives involving 33 quality metrics, including hospital readmission rates. As a result, many accountable care organizations (ACO) have recognized the need to partner with post-acute care facilities to ensure quality of care is maintained throughout a patient’s entire treatment. They understand the valuable roll skilled nursing facilities (SNF) play in supporting patient transitions.

In order to ensure their patients are treated by the most effective SNF, many hospitals are establishing Preferred Skilled Nursing Facility Network partnerships. While each hospital or ACO will have its own criteria, here are some of the things they examine when creating their Preferred SNF Networks:  high quality of care, effective communication, and current technology.

Here’s an overview of the top criteria ACOs look for in SNFs:

  • High quality of care
    Many ACOs require SNFs to have a CMS three-star rating or higher. The reason is simple. Proactive treatment in the rehab process and good risk management help prevent unnecessary hospital readmissions. 
  • Effective communication
    It’s all about transparency, collaboration, and open communication with providers throughout a patient’s entire treatment. ACOs want to know how their patients are doing and be apprised of any changes to their conditions.
  • Current technology
    Electronic medical records (EMR) and adequate data security are an essential part of sharing patient status with providers. ACOs want to work with SNFs who are able to easily share and protect pertinent patient information.

ACOs are a key driver of referrals for many SNFs. The financial risk is extremely high for any acute or post-acute care provider who doesn’t become part of a preferred SNF network.

You may find that our primeVIEW business performance dashboard for long-term care can help ensure your SNF maintains the high-quality of care expected by ACO/other networks. Its real-time snapshots of integrated data allows SNFs to proactively monitor performance around census, staffing, AR, clinical, financial, five star rating and more.

Resources:

Topics: ACOs, Affordable Care Act, SNF, CMS

To get paid or not, the answer could be a simple “Yes” or “No” – POA

By Prime Care Tech Marketing on Thu, Feb 18, 2016 @ 07:00 PM

iStock_000020034644_Small.jpgSome SNF providers strongly assert that HAC-POA (Hospital Acquired Condition-Present on Admission) indicators do not apply to claims submitted to SNFs. Yet, recently an entire batch of claims submitted to a large insurance carrier was rejected, because the SNF provider’s billers had not included the POA indicator. The provider resubmitted the claims and mysteriously the insurer processed the claims without further difficulties related to POA. So what happened? In essence, these providers are right about POA and Medicare claims, but in fact, since the beginning of the year, we are observing that some insurers are indeed beginning to impose the POA indicator requirement on SNFs for non-Medicare claims and, possibly, Medicare co-insurance claims.

What is a Present on Admission Indicator? A little background

POA is defined as “being present at the time the order for inpatient admission occurs.”[1] It is not new (to IPPS [Inpatient Prospective Payment System] hospitals, that is) and has been in effect since 2007. “As required by the Deficit Reduction Act of 2005 (DRA), … hospitals must submit POA information on the principal and all secondary diagnoses for inpatient discharges….”[2] This all appears to relate to HACs and the DRA’s intent to not pay for conditions that could have reasonably been prevented which were acquired during a hospital stay.  

So, why is that important? IPPS hospitals do not receive the higher payment for cases when one of the selected conditions is acquired during hospitalization (that is, the condition was not present on admission). The case is paid as though the secondary diagnosis was not present. Here are the POA indicator codes:

Indicator

Description

Payment

Y

Diagnosis was present at time of inpatient admission.

Payment is made for condition when a HAC is present.

N

Diagnosis was not present at time of inpatient admission.

No payment is made for condition when a HAC is present.

U

Documentation insufficient to determine if condition was present at the time of inpatient admission

No payment is made for condition when a HAC is present.

W

Clinically undetermined. Provider unable to clinically determine whether the condition was present at the time of inpatient admission.

Payment is made for condition when a HAC is present.

1 or blank

Unreported/Not used. Exempt[3] from POA reporting. This code is equivalent to a blank on the UB-04, however; it was determined that blanks are undesirable when submitting this data via the 4010A.

Exempt from POA reporting

But this applies to IPPS hospitals. What about SNFs?

Why POA could be important to SNFs

While the above rule appears not to apply to SNFs billing Medicare, we are indeed seeing that some large insurers, like Cigna, require “the POA indicator to be present for all diagnosis codes submitted on the inpatient claim form. Cigna reserves the right to return any inpatient claim without a POA indicator.”[4] This reinforces what NUBC (National Uniform Billing Committee) requires for all diagnosis codes.[5]

How should billers use the POA?

“POA indicators must be reported on each diagnosis code submitted on facility claims, except for ‘specific’ diagnosis codes. CMS publishes a listing of diagnosis codes that are exempt from the POA indicator requirement….It’s crucial that claims submission staff be familiar with the ICD-10-CM codes currently on the file”[6] SNF billers may have to complete the POA indicator box next to each diagnosis code, using the Y, N, U, or W indicators listed in the table above, especially when submitting claims to CIGNA which is requiring it for all diagnosis codes. Failure to do so may result in claims rejections.

Hint: The indicator is case sensitive. Always use the upper case.

Caution: Other insurance companies, like CIGNA, may require completion of the POA for Medicare co-insurance claims submitted to them for payment.

Advice: Be aware and check with the insurance payers. We are going to keep our eyes on this issue. We’ll keep you posted.

It only makes cents.

What has your experience been with POA?

 

[1] https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/wPOAFactSheet.pdf

[2] Ibid.

[3] Ibid.

[4] http://www.centercare.com/pdf/referenceguides_nat_803774_2013_2ndqtr.pdf

[5] http://www.nubc.org/aboutus/PDFS/Feb2014TentSchedule.pdf, p. 14 of the pdf

[6] http://www.cgsmedicare.com/parta/pubs/news/2015/0915/cope30310.html

Topics: SNF, POA, Deficit Reduction Act, IPPS, POA indicator, Present on Admission, Hospital Acquired Condition

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