Outpatient physical therapy programs are often overlooked in the hospital. However, there are several opportunities to increase access to care for patients and increase revenue for the hospital in outpatient therapy. Believe it or not, there are still opportunities for charge capture in this area, along with some basic “blocking and tackling” operational issues. New […]
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Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1737-F] for Fiscal Year (FY) 2021 that updates the Medicare payment rates and the value-based purchasing program for skilled nursing facilities (SNFs). Effective October 1, 2020 under the PPS Patient- Driven Payment Model (PDPM). Federal Based Rates Updates to Payment Rates Under PPS Case-mix […]
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A new issue is affecting some inpatient hospital and Skilled Nursing Facility (SNF) claims when an interrupted stay is billed at the end of the month. The system incorrectly assigns edits U5601-U5608 (overlapping a hospital claim). If you billed the interrupted stay correctly, and your claim is rejected, modify your billing so the claim spans […]
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Effective Immediately: the CMS has made updates to the Nursing Home Compare Website and Five Star Quality Rating System. Under the COVID-19 Emergency Declaration Blanket waiver, CMS waived the requirements for submitting staffing data to the Payroll-Based Journal database (PBJ). CMS is ending this waiver and facilities are required to resume submission of staffing data […]
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On April 10, CMS issued a proposed rule [CMS-1737-P] for FY 2021 that updates the Medicare payment rates and the quality programs for Skilled Nursing Facilities (SNFs). This proposed rule is part of CMS’s continuing efforts to strengthen the Medicare program by better aligning payment rates for these facilities with the costs of providing care […]
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On May 22, CMS announced it has begun distributing billions in relief funds to skilled nursing facilities to combat COVID-19. This funding is to help nursing homes to address critical needs such as labor, scaling up their testing capacity, PPE and other expenses directly related to the pandemic. Distribution Methodology: Each nursing home will receive […]
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The Centers for Medicare and Medicaid Services, on May 18, 2020, issued guidance for state and local officials to ensure the safe reopening of nursing homes nationwide. The purpose of these guidelines per CMS is to give guidance for states to take appropriate and necessary steps to ensure resident’s safety. One main objective of CMS […]
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In response to State Medicaid Agency and stakeholder requests, CMS has updated the MDS 3.0 item sets (version 1.17.2) and related technical data specifications. These changes will support the calculation of PDPM payment codes on OBRA assessments when not combined with the 5-day SNF PPS assessment, specifically the OBRA comprehensive (NC) and OBRA quarterly (NQ) […]
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On March 22, 2020, the Centers for Medicare and Medicaid Services (CMS) announced it is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs. This applies to Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) […]
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The Federal Department of Health and Human Services issued an updated memo on COVID-19 protocols from Centers for Medicare & Medicaid Services (CMS) official, David Wright. The memo states: Facilities should restrict visitation of all visitors and non-essential health care personnel, except for certain compassionate care situations, such as an end-of-life situation. In those cases, […]
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By: Angela Crawford, CPA, Senior Manager The recently enacted Senate Enrolled Act (SEA) 382 (2022) makes significant changes in the way not-for-profit organizations purchase and sell items exempt from sales tax. Sales tax information Bulletin 10 has been revised to reflect these changes. While sales tax-specific changes are detailed within the bulletin, here are the […]
Blue & Co. has performed many Emergency Department Leveling Reviews for hospitals. The two most utilized leveling criteria are “points-based” or “intervention-based.” In either case, each hospital must determine which facility resources (or attributes) to include within its criteria, and how these resources crosswalk into ED visit levels (99281-99285). This can create significant reimbursement differences […]
By: Tom Skoog, Cybersecurity & Data Management Practice Leader Cybersecurity for the construction industry is a growing challenge. The industry is moving towards digital connectivity, not only across the supply chain, but also ‘on site’ as more metrics related to performance, progress, and health & safety are monitored in ‘real time’. This increase in connectivity […]
