CMS Finalizes Fiscal Year 2014

On July 31, 2013, the Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1446-F] outlining fiscal year (FY) 2014 Medicare payment rates for skilled nursing facilities (SNFs). The major provisions of the final rule are summarized below.

PEPPER Reports – Coming August

Skilled Nursing Facility providers will soon receive a report called the Program for Evaluating Payment Patterns Electronic Report (PEPPER). This report provides Medicare claims data in specific targeted areas comparing the SNF to other SNFs throughout the US.  The Report will be mailed to

QAPI Updates

Over the past several months, I have written several articles about QAPI—Well, after much anticipation, CMS has finally announced the rollout of Quality Assurance and Performance Improvement (QAPI) materials to help nursing homes establish a foundation to support and sustain

Payment Liability: Therapy Cap Denials

According to the May 23 edition of CMS eNews:  “Section 603(c) of the American Taxpayer Relief Act of 2012 (ATRA) changed the payment liability for denials resulting from the outpatient therapy caps from beneficiaries to providers effective January 1, 2013.

Hospital Readmissions Continue To Make News

In an effort to increase acute and post-acute care coordination and improve health outcomes, the Affordable Care Act established penalties in October 2012 for hospitals that have high readmission rates for heart attack, heart failure and pneumonia patients.  Moving forward,

2014 SNF PPS Proposed Rule Posted

On May 1, 2013, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule [CMS-1446-P] outlining proposed Fiscal Year (FY) 2014 Medicare payment rates for skilled nursing facilities (SNFs). The FY2014 proposals are summarized below. Changes to payment

To Treat Or Not To Treat

It is not news to anyone that skilled nursing facilities, in particular therapy services, are under an enormous amount of scrutiny these days and are being inundated with CMS initiatives and regulations that often contradict one another.   A few examples

QAPI: Developing A Plan

A written QAPI plan guides the nursing home’s quality efforts and serves as the main document to support implementation of QAPI. The plan describes guiding principles that will be used in QAPI as well as the scope QAPI will have

Mandatory Payment Reductions in FFS

In a CMS Medicare FFS Provider e-News bulletin released 3-8-13, the Medicare Learning Network issued the following information about the effect of sequestration on Medicare Fee-For-Service Programs: Mandatory Payment Reductions in the Medicare Fee-for-Service (FFS) Program – “Sequestration” The Budget

QAPI: Approach To Teamwork

Teamwork is a core component of Quality Assurance and Performance Improvement (QAPI).  Leadership must convey that it is everyone’ job to contribute to the organization’s Performance Improvement initiatives through clear guidelines identified in job descriptions.  Responsibility rests with the leadership

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