United States

Senior Living Health Care Connection: Ready for Oct. 1 changes?


Multiple changes are due to take place Oct. 1, 2016 and beyond. The following are some key highlights to address.

Center for Medicare and Medicaid Services (CMS) issued the final rule outlining fiscal year 2017 payment policies and rates for skilled nursing facilities (SNF).

  1. There is a 2.4 percent payment increase for Medicare SNF covered services provided under Part A.
  2. Requirements for the SNF value-based purchasing program, which includes the potentially preventable readmission measure, were posted.
  3. Four new quality and resource use measures for the SNF quality reporting program were implemented.

Continuity assessment record and evaluation item set due to the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT ACT) requires that standardized data must be submitted between various long-term care providers.

  1. Minimum data set (MDS) SNF Medicare Part A prospective payment system discharge assessment in Section A was implemented with the MDS 3.0 for use Oct. 1, 2016 and after.
  2. The new Section GG containing 16 new items to be completed on Medicare MDSs was implemented for MDSs starting Oct. 1, 2016. Be aware that Section GG must be completed for all Medicare PPS beneficiaries for assessment reference dates (ARDs) of Oct. 1, 2016 and after. Some admissions from Sept. 24 and forward may have ARDs of Oct. 1, 2016.
  3. Some changes to Section S were also implemented on the MDSs for Oct. 1, 2016.

Payroll based journal reporting

  1. Starting on July 1, 2016, the CMS began collecting staffing and census data from nursing homes and long term care facilities including SNFs.
  2. Mandatory submission of staffing information based on payroll data and census data must be electronically submitted through the quality improvement and evaluation system including contract and agency staff.
  3. Staffing and census data will be collected for each fiscal quarter. The Q4 ended Sept. 30 and submissions must be received by the end of the 45th calendar day after Sept. 30 to be considered timely, which is Nov. 14, 2016.
  4. Non-compliant facilities may have a 2 percent rate decrease in 2018 if staffing data is not submitted in a timely fashion.

ICD-10 updates

  1. CMS has allowed the Centers for Disease Control and Prevention to add 1,900 ICD-10 CM new diagnosis codes, revise 425 codes and delete 311 codes beginning Oct. 1, 2016.
  2. Currently Medicare is not denying claims based on the specificity of codes as long as the codes are from the appropriate family of codes; however, we have seen numerous denials from some commercial payers for inaccurate or unspecified primary or admission codes.

For more information, contact Joan McCarthy at +1 312 634 3479.

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