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Top Stories

• QAPI is coming: Is your facility preparing for its arrival?

  Quality Assurance and Performance Improvement (QAPI) is a hot topic in long-term care as CMS is currently working on formalizing their plans for the program. Read this article to learn more about the buzz.

• Questions surround when time starts for proposed inpatient presumption

  The proposed CMS presumption for inpatient admission includes an interesting nuance that could spell the end of dedicated observation units. According to CMS, the starting point for counting utilization days “would be when the beneficiary is moved from any outpatient area to a bed in the hospital in which the additional hospital services will be provided.”

• Q/A: Should we use modifier -Q0 to override edits for ICDs?

  Q: We are hitting an edit for claims containing the codes for placement of implantable cardioverter-defibrillator (ICD) and Bi-V ICD systems. The edit states we must report certain diagnoses; otherwise, we need a modifier Q0 (investigational clinical service provided in a clinical research study that is in an approved clinical research study). These patients are not always part of a clinical study, so I don’t think the Q0 modifier is appropriate. Many of these patients have failed conservative measures and have cardiomyopathy and congestive heart failure. Can we bypass the edit and submit these claims anyway?

• CNO Tech Decisions May Fail to Meet Staff Nurse Needs

  According to researchers, the clinical communications decisions that CNOs make may not necessarily reflect the working realities of staff nurses. In fact, only 19% of staff nurses feel they have a chance to evaluate new devices before using them.

• Overnight physicians in ICU show little effect on outcomes

  Researchers have found that nighttime intensivist staffing did not significantly improve outcomes, and may increase costs unnecessarily,

• 2014 SNF Proposed Rule Analysis: Revising and rebasing the SNF market basket

  CMS issued its annual proposed rule featuring payment updates for SNFs in 2014, which proposes revising and rebasing the SNF market basket. Do you understand what this proposal means? Let’s breakdown what this revising and rebasing really means to SNFs.