HCPro.com - Long-Term Care - DO NOT USE Top Stories

CMS issues transmittal to update the Medicare Provider Reimbursement Manual

Fri, 17 May 2013 16:59:00 GMT

On May 10, CMS issued a transmittal updating Chapter 41, Skilled Nursing Facility and Skilled Nursing Facility Complex Cost Reports, Form CMS-2540-10.

These changes included in the transmittal are to clarify and correct existing instructions, incorporate statutory changes, and comply with an Executive order.

View transmittal R5P241 to learn more.

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

Fri, 17 May 2013 15:53:00 GMT

The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule that is proposing to rebase and revise the SNF market basket for 2014 and subsequent years to reflect more recent data. The current SNF market basket reflects data from 2004 and CMS is proposing to revise and update the SNF market basket using data from 2010. In addition, CMS is proposing to make changes to the components of the SNF market basket index by adding five cost categories for a total of 29 cost categories and revising several price proxies.

To continue reading, visit our blog MDSCentral.

Ask the expert: BIMS assessment

Fri, 17 May 2013 15:19:00 GMT

Q: Is it appropriate for a resident to have access to a visual cue (ie: a calendar) during the Brief Interview for Mental Status (BIMS) assessment? It seems to me that the purpose of the assessment is to identify any deficits, even mild deficits the resident may be masking. The MDS 2.0 User’s Manual indicates avoiding this (ie: keeping the resident away from a window when asking the season), but we could not find a clear cut answer in the MDS 3.0 User’s Manual.

To read our Regulatory Specialist’s response, visit MDSCentral.

Reminder: MDS correction policy to be updated effective May 19

Fri, 17 May 2013 14:28:00 GMT

CMS is revising the MDS correction policy outlined in Chapter 5 of the MDS 3.0 RAI manual. This revision is effective May 19, 2013.

Prior to May 19, 2013, an inactivation request was required to address errors in the following items:

A0200: Type of Provider
A0310: Type of Assessment
A1600: Entry Date (on Entry tracking record; A0310F = 1)
A2000: Discharge Date (on Discharge/Death in Facility record;A0310F = 10-12)
A2300: Assessment Reference Date (ARD)

A modification was required for errors for clinical Items (B0100–V0200C), including data entry errors.

To continue reading, visit our blog MDSCentral.

MDS Professor: MAC claim review

Fri, 10 May 2013 14:19:00 GMT

A claim is reviewed with an RUC HIPPS code. The A/B Medicare Administrative Contractor (MAC) determined that the therapy services were reasonable and necessary but not at the level billed. Which of the following will occur?

a. The claim will be denied in full

b. The claim will be adjusted to the level of rehab the reviewer feels is appropriate based on those services deemed reasonable and necessary

c. The claim will be adjusted to a RMC RUG level

d. The A/B MAC will ask the provider for more documentation to support the RUC level billed

Scroll down for the correct answer!

This quiz question originally appeared in the April 2013 issue of PPS Alert for Long-Term Care, which features monthly quizzes to test MDS and long-term care knowledge.

Click here to learn more about PPS Alert for Long-Term Care.

Correct response: B. The A/B MAC medical reviewer will adjust the claim based on the new RUG established using the QC tool.

2014 SNF Proposed Rule Analysis: MDS item addition

Fri, 10 May 2013 14:15:00 GMT

CMS will add MDS item O0420 Distinct Calendar Days of Therapy to the MDS assessment form sets. This item will also be added to the RUG-IV grouper.

Medicare Part A skilled coverage guidelines (IOM 100-02 MBPM, Ch 8) require therapy to be delivered on at least 5 days, if therapy is the only skilled service, in order to meet the daily skilled coverage requirement. However, a beneficiary can currently obtain a RUG score in the Medium categories through the MDS without meeting the 5-day requirement, as the MDS does not record distinct calendar days of therapy.

To continue reading, visit our blog MDSCentral.

2014 SNF Proposed Rule Analysis: Payment changes breakdown

Fri, 10 May 2013 14:10:00 GMT

CMS estimates that aggregate payments to SNFs will increase by $500 million, or 1.4 percent, from payments in 2013.

This is based on:

2.37% Update factor
-0.50% Market basket forecast error or adjustment
-0.40% Multifactor productivity (MFP) adjustment per ACA 2010

To continue reading, visit our blog MDSCentral.

Payment rate changes: How will 2014 compare to this year?

Fri, 03 May 2013 14:08:00 GMT

On Wednesday, CMS released a proposed rule that would update the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for 2014.

According to CMS, aggregate payments to SNFs will increase by $500 million, or 1.4 percent, from payments in 2013. This estimated increase is attributable to the 2.3 percent market basket increase, reduced by the 0.5 percentage point forecast error correction and further reduced by the 0.4 percentage point multifactor productivity adjustment required by law.

To continue reading, visit our blog MDSCentral.

CMS releases proposed rule featuring payment updates for 2014

Fri, 03 May 2013 14:01:00 GMT

The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule that would update the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for 2014 and would revise and rebase the SNF market basket. This proposed rule also includes a proposed policy for reporting the SNF market basket forecast error correction in certain limited circumstances and a proposed new item for the MDS Version 3.0.

Some of the major proposals include:

Payment changes

CMS estimates that aggregate payments to SNFs will increase by $500 million, or 1.4 percent, from payments in 2013. This estimated increase is attributable to the 2.3 percent market basket increase, reduced by the 0.5 percentage point forecast error correction and further reduced by the 0.4 percentage point multifactor productivity adjustment required by law.

To continue reading, visit our blog MDSCentral.

FDA warns of potential infection risks tied to mattresses

Fri, 26 Apr 2013 19:26:00 GMT

In an April notice, the Food and Drug Administration (FDA) is alerting health care providers, health care facility staff, and caregivers that damaged or worn covers for medical bed mattresses can allow blood and body fluids to penetrate medical bed mattresses, posing a risk of infection to patients. The FDA is providing recommendations for reducing this risk, clarifying terms used to describe medical bed mattress covers, and encouraging health care providers, health care facility staff and caregivers to report problems related to medical bed mattress covers (fluid ingress).

Fluid ingress may occur if mattress covers become worn or damaged from small holes or rips in the fabric or from incorrect cleaning, disinfecting and laundering procedures. The zipper on the cover may also allow fluid to penetrate the mattress. Some reports indicate that if blood and body fluids from one patient penetrate a mattress, they can later leak out from the mattress when another patient is placed on the bed. Patients are at risk for infection if they come into contact with blood and body fluids from other patients.

According to the FDA, 458 reports were received from January 2011 to January 2013 that were associated with medical bed mattress covers failing to prevent blood and body fluids from leaking into the mattress.

To continue reading, visit our blog MDSCentral.

Reminder: Access our free CMS quality of care initiatives white paper

Fri, 05 Apr 2013 17:02:00 GMT

What do reduction in rehospitalization, caring for dementia patients and preventing abuse, and reduction in the use of antipsychotic drugs have in common? They are all quality of care initiatives advanced by the Centers for Medicare & Medicaid Services (CMS).

At the global level, awareness and education across a broad spectrum of healthcare workers is necessary, while at the local level, each facility must attack the problem individually.

At the core of each of these initiatives, the key to improvement requires a facility to examine existing practices and update as necessary, perform root cause analysis, offer consistent and up-to-date staff education, and have reference tools available to support staff.

Click here to access the FREE whitepaper to learn what your facility can do to adhere to CMS' quality initiatives.

Latest MedPAC report contains four reform recommendations for post-acute care

Fri, 22 Mar 2013 18:23:00 GMT

On March 15, the Medicare Payment Advisory Commission (MedPAC) issued its March 2013 Report to the Congress on Medicare payment policy. The report provides recommendations to increase the efficiency of Medicare by finding ways to provide high-quality care for Medicare beneficiaries at lower costs to the program.

In this report, MedPAC recommends no update in 2014 for five fee-for-service payment systems and a 1% update for the hospital inpatient and outpatient payment systems. In three sectors (physician, skilled nursing, and home health), the report evaluates current payment adequacy indicators but does not take new votes on recommended payment updates.

The report also contains a summary chapter on post-acute care settings, which says that Medicare’s definition of and payments for post-acute care services fail to establish incentives for providers to deliver efficient, high-value care. As a result of these “shortcomings,” the MedPAC has developed four broad reforms to encourage a more seamless, patient-centered approach to match services and settings to the needs of each patient:

Bundled payments and ACOs
A common patient assessment instrument
New quality measures
Expanded readmission policies

Under these reforms, payments would reflect the characteristics of the patient, not the services furnished or the setting, and would encourage the use of the lowest cost mix of services necessary to achieve the best outcomes, according to the report.

Read more about these reforms and the other MedPAC recommendations by clicking here.

President Obama completes long-term care commission

Fri, 15 Mar 2013 17:39:00 GMT

A bipartisan commission on long-term care whose purpose is to develop a plan to establish, implement, and finance a set of long-term care services for seniors and people with disabilities was created as a part of January’s American Taxpayer Relief Act. On February 6, Democratic House Minority Leader Nancy Pelosi appointed SCAN Foundation President Bruce Chernof, MD, FACP; the Center for Medicare Advocacy’s Executive Director Judith Stein; and activist and philanthropist George Vradenburg.

A week later, the first two GOP appointees were added to the commission by Republican Speaker of the House John Boehner:

Neil L. Pruitt Jr., chairman of the American Health Care Association Board of Governors and chairman and CEO of UHS-Pruitt Corporation
Judith Y. Brachman, former director of the Ohio Department of Aging and former president of the National Association of State Units on Aging

On March 12, President Obama completed the commission, which has since seen seven more members appointed from the Democrats and Republicans, by appointing three new individuals:

Henry Claypool, former Department of Health and Human Services administrator and executive vice president of the American Association of People
Julian Harris, MD, director of the Office of Medicaid in Massachusetts
Carol Raphael, chair of the American Association of Retired Persons (AARP) Board of Directors

Read more about their biographies in this White House press release.

View the full list of the commission on Forbes.

Trainer’s tip: Nursing assessment for GCS

Thu, 19 Apr 2012 13:51:00 GMT

Before applying compression hosiery initially, consider these safeguards:

Review the physician order.
Clarify hosiery length, if necessary.
GCS are available in light compression, moderate compression, and firm compression. Clarify the compression strength, or follow facility policies. Common strengths are:

--Mild compression (8–15 mmHg)

--Medium compression (23–32 mmHg)

--Firm compression (20–30 mmHg)

--Strong compression (25–35 mmHg)

Systematically assess the resident and each lower extremity for appropriate use of compression.
Review contraindications to hosiery and be sure they do not apply to the resident.
Assess the peripheral circulation, popliteal, posterior tibial, and dorsalis pedis pulses.
Consider the person’s age, dexterity, and ability to apply the hosiery independently, as appropriate. Determine whether a caregiver is needed to assist with application.
Assess the need for an adaptive device or specially modified hosiery (an occupational therapist can assist in obtaining an adaptive application device, or hosiery that fasten with Velcro).
Check the skin condition for potential pressure points, fragile skin, open areas, rashes, signs of infection, healed ulcerations, and areas of possible vulnerability.
Check the patient’s allergies. Although the incidence of allergic reaction is low, some brands contain latex, nylon, Lycra, and other potential allergens.
Review facility policies and procedures for fitting, application, and circulation checks, and follow them.
Initiate a plan of care for the use of GCS.

This is an excerpt from the HCPro book, The Long-Term Care Nursing Desk Reference, Second Edition, by Barbara Acello, MS, RN.

Graduated compression stockings

Thu, 19 Apr 2012 13:46:00 GMT

Graduated compression stockings (GCS) have been used effectively for years to prevent deep venous thrombosis (DVT) in hospitalized patients. They are also common in long-term care facilities, and are worn by many persons living in the community.

The hosiery provides graduated pressure, and is tightest at the ankle, becoming progressively looser as it extends up the proximal leg. The hosiery increases blood flow velocity and improves valve function. The increased speed reduces the risk of venous stasis and pooling. GCS compress superficial veins and capillaries, which redirects blood to the deeper, larger veins, where it flows effortlessly to the heart. This reduces venous hypertension and decreases the risk of stagnation. The controlled compression of the skin provides additional support for the venous system, reducing edema and promoting venous return from the ankles and calves.
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Although GCS are believed to be a low-tech, low-risk treatment, they are not risk-free. Patients with diabetes, neuropathy, connective tissue diseases, signs of clinical infection in the extremity, and peripheral vascular disease have an increased risk of complications. Contraindications for GCS use include:

Severe arteriosclerosis or other ischemic vascular disease
Pulmonary edema, congestive heart failure
Massive leg edema
Local conditions such as dermatitis, postoperative vein ligation, recent skin graft, and gangrene
Deformity of leg
Circumference greater than 25 inches (63.5 cm) at the gluteal fold, if thigh-high hose are ordered

Potentially serious complications resulting from GCS use include:

Reduced blood flow and tissue oxygenation
Pressure ulcers
Arterial occlusion
Thrombosis
Gangrene

Complications are usually associated with hosiery that do not fit properly, failure to remove the stockings for skin and circulation checks, and folding and bunching up of hosiery, causing a tourniquet effect to the skin.

This is an excerpt from the HCPro book, The Long-Term Care Nursing Desk Reference, Second Edition, by Barbara Acello, MS, RN.

Trainer’s tip: Signs and symptoms of dehydration

Thu, 05 Apr 2012 17:39:00 GMT

Signs and symptoms of dehydration include:

Sunken cheeks or eyeballs
Dry, brown tongue and mucous membranes
Furrows or lines in tongue
Dry, inelastic skin
Poor skin turgor (check forehead or over the sternum in the elderly)
Weight loss
Concentrated urine
Constipation and impaction
Nausea and anorexia
Increased time for veins to refill
Abnormal laboratory values (elevated hemoglobin/hematocrit, potassium, chloride, sodium, albumin, transferrin, BUN, urine specific gravity)
Greater than three-pound weight loss within seven days
Delusions, dizziness, delirium
Unsteady gait
Headache
Flushed appearance

Sadly, by the time signs and symptoms appear, most residents are already dehydrated, and aggressive interventions are essential.

This is an excerpt from the HCPro book, The Long-Term Care Nursing Desk Reference, Second Edition, by Barbara Acello, MS, RN.

Reasons for inadequate fluid intake in the elderly

Thu, 05 Apr 2012 17:33:00 GMT

Unfortunately, normal aging changes increase the risk for fluid imbalance and dehydration. Elderly residents are less capable of maintaining fluid balance compared with younger people. Also, many elderly persons (especially women) deliberately limit fluids to reduce the risk of accidental urination. Some residents may refuse all fluids after the evening meal to avoid having to get up at night to urinate.

Other common reasons for inadequate fluid intake and abnormal loss of fluids include:

Decreased content of body water
Age-related changes in thirst sensation; decreased thirst response
Physical or mental inability to consume fluids independently
Depression, alteration in mood, or cognitive status
Renal changes
Dysphagia
Poor dietary intake (food is up to 80% fluid)
Lack of available fluid
Warm environmental temperature
Delirium
Gastrointestinal distress
Apathy
Bedrest, causing physiological changes and fluid loss
Immobility

This is an excerpt from the HCPro book, The Long-Term Care Nursing Desk Reference, Second Edition, by Barbara Acello, MS, RN.

Physical assessment of the geriatric resident

Thu, 22 Mar 2012 15:30:00 GMT

Physical assessment of elderly individuals can present many challenges. Over time, you will become proficient in adapting the environment and modifying the examination to account for sensory changes, slower response time, acute or chronic diseases, and the resident’s need for assistance. Avoid stereotyping the resident or making assumptions about his or her mental status or physical ability. Individualize the examination to accommodate the resident’s deficits. Anticipate that the process may take longer than it would with a younger resident. If a caregiver or family member is present, privately ask the resident to state his or her wishes regarding whether this person should be asked to leave the room during the examination.

Consider doing the following when examining a resident:

Elderly persons are often very modest and uncomfortable if clothing is removed; arrange for a warm, private area
Provide draping for comfort and warmth
Position the resident in a comfortable position that he or she can maintain during the exam
Provide pillows, props, or other positioning aids as needed
Provide bright, non-glare lighting
Eliminate background noise
Warm instruments before touching the resident with them
Provide a chair with arms and a high seat

This is an excerpt from the HCPro book, The Long-Term Care Nursing Desk Reference, Second Edition, by Barbara Acello, MS, RN.

Trainer’s tip: Ways to help a resident perform a task

Thu, 08 Mar 2012 15:40:00 GMT

Residents with dementia have difficulty performing day-to-day tasks. The following steps go a long way in helping dementia residents:

1.Explain each step in simple language, one at a time
2.Demonstrate each step, doing the task while the resident watches
3.Move the person through the steps of the task, placing arms and legs in the right positions
4.If distracted, begin at the beginning

Remember to be patient an unhurried!

This is an excerpt from the HCPro book, The Long-Term Care Nursing Desk Reference, Second Edition, by Barbara Acello, MS, RN.