Online resource packed with regulatory news and expert guidance, tips & tools pertinent to professionals across the post-acute care continuum.
Question: “Physical therapy has generalized muscle weakness as a secondary diagnosis, and we are worried this will cause our claim to kick out. Why can’t they just use muscle wasting?” Response: You are correct that generalized muscle weakness would be considered an RTP code for primary diagnosis in I0020B; however, there may be instances during […]
With concern about staff refusing the COVID-19 vaccine, the National Association for Home Care and Hospice (NAHC) will present a series of town hall events, beginning February 17. The weekly webinars will include clinical experts from three care groups to “answer a series of tough questions about vaccine hesitancy among caregivers based on their first-hand […]
Q: Acute respiratory failure is consistently one of our top denied diagnoses. We’ve tried to address common documentation errors through education but are still seeing issues. How can our CDI staff and coders create more effective queries for this condition? A: The main reason I see for acute respiratory failure denials is a lack of […]
Q: What are some key revenue cycle topics that should be included in education geared toward clinical staff? A: Education for clinical staff should be specifically tailored to their functions and their direct interaction with and impact on the revenue cycle. Clinical staff should not be inundated with information that is not relevant to them. […]
In the past, Medicare contractors have been allowed to deny a claim for inpatient rehab if the required three-hour minimum of direct care mark was missed by mere minutes, even if the additional minutes were made up on a subsequent day. Now, however, due to new guidance released by CMS, this denial trend could change. […]
In response to a Congressional mandate, in 2016 The Medicare Payment Advisory Commission (MedPAC) recommended design features of a unified payment system, the post-acute-care (PAC) prospective payment system (PPS), to pay for services in the four post-acute care settings (home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals). In a meeting […]
The Centers for Disease Control (CDC) report that roughly 40–50% of antibiotics are prescribed incorrectly, with the possibility that nearly 50% of antibiotics are given for too long in nursing homes. These numbers highlight the shortfalls that may exist in long-term care staff education when it comes to antibiotic usage. In the past two years, […]
What Phase 2 requirement does your facility need help with in 2017? Choose an answer from our polling question located on the sidebar to the right of this post. If you need help with Phase 2 requirements that are not listed there, leave your questions/challenges in the comments box. Let us know how we can […]
CMS’ final evaluation report of phase one of their Initiative to Reduce Avoidable Hospitalizations among Nursing Facility (NF) Residents found that intervention sites with a full-time nurse at each facility providing direct care to residents had the strongest improvements in both cost and quality. These models demonstrated greater changes in facility culture, greater support for […]
Written by Steven Littlehale, MS, GCNS-BC, executive vice president & chief clinical officer for PointRight. The full article originally appeared in the October issue of PPS Alert for Long-Term Care. The clinical and technical eligibility requirements for skilled care coverage in a SNF are unchanged under the proposed RCS-1 system—and frankly, those are just about […]