Mediware Rehabilitation Blog

LOS Revisited

Rehabilitation hospitals have routinely valued length of stay (LOS) as a key metric for assessing hospital performance both clinically and financially. Tracking, reporting and comparing LOS has occupied the past times for many administrators seeking the strategic advantage to improve performance.

NCCI Modifier Madness - No Need for that!

Modifier alerts occur when CMS attempts to further differentiate the services provided and whether those services are payable as distinct and separately. Way back in 1996, NCCI edits began and have evolved to mutually exclusive and component codes that are generally considered non-payable on the same date of service. This is true unless you append that line on your bill with the 59 MODIFIER that specifically permits the 'unbundled' payment. How often have you used or needed to use the modifier in your practice? Some facilities, by the nature of what they do, will systematically trigger the need more often. Let's discuss because the new 'X' modifiers are causing some 'ruckus'. There is more than a month to plan and educate... now let's discuss if you are one of those practices!

 

Preparing for IMPACT

It has been a month since the President signed into law the Improving Medicare Post-Acute Care Transformation Act. This Act focuses on improving the contribution of post-acute care to our nation’s objectives of improving the health of the population, enhancing the experience and outcomes of the patient, and reducing per capita cost of care for the benefit of communities.

Population Healthcare Management (PHM) - The Foundation of Future Leadership

Population Healthcare Management (PHM) is a concept in healthcare that will not soon disappear. And, although as a concept the definitions of PHM is still being defined, I think more than ever the need for communities at large to engage in appropriate and well dispersed population health concerns are reaching a peak of imperative understanding. It takes no less than the present 'ebola crisis' to help reiterate how truly connected we are as individuals sharing common spaces, air and yes - health!

Inpatient Physician Accountability Reaches into the Part B Payment Pocket

There have been long awaited discussions of how to keep the part B reimbursed physician in alignment with the acute care responsibilities of oversight and management of the patient; we have heard that at some point denied inpatient stays could result in denied part B payment as well. Has the time come? Keeping the physician's 'skin in the game' just got a little more serious as it relates to following conditions of participation, medical necessity documentation and general adherence to level of care physician oversight.

Facility Location and IRF PAI Patient Vaccinations Must Be Understood

It is imperative that the person answering and collecting data on your IRF PAI in regards to Patient Flu Vaccination FULLY understand that the IRF is a distinct and separate 'facility' from your acute care units when you have an IRF within an ACUTE CARE hospital system. The IRF PAI instructions may not fully spell this out but CMS has guided us in several other ways to be certain this particular question is answered appropriately. Follow these instructions....

The IRF’s Future Depends Upon the Ability to Deliver Unique Rehab Value

The Rehab Model of Care (problem oriented, goal directed, coordinated, team delivered) is being replicated across all healthcare. These models target improved coordination of care, fewer errors, lower costs and improved patient outcomes. The demand for cost-effective and preventive care that also reduces overuse and misuse has providers turning to the structure and processes of the team delivered collaboration models. While functional impairment and the restoration of activity-participation remains the purview of IRFs, other healthcare organizations adopt this model and venture to provide a therapeutic approach to functional restoration.

IRF 2015 Final Rule - Let the New Rule Begin

It's Oct. 1, 2014, and that signals a fiscal year for Inpatient Rehabilitation Facilities. The 2015 Final Rule is now in place and the changes that come with this date begin with all discharges beginning today (10/1/14). 

Let's revisit some helpful LINKS and information so that you can check off your list of things to do beginning now!

IRF Quality Indicator Reporting - Mystery Solved

As quality reporting becomes more and more entrenched into the IRF/U requirements, there exists some confusion for how indicators are reported and ultimately how CMS knows the required reporting has been completed so as not to take a 2 percent penalty in a future reimbursement year. Just recently, on the 2015 Final Rule Webinar we hosted, there were several left behind questions looking for directives. Clarification has been provided by a Public Health Analyst/Contractor for the National Health Safety Network (NHSN); let us share that information with you!

Rapid Migration to Specific Modifiers over 59 for NCCI Edits

As if a year of acclimating to G-Code modifiers hasn’t been enough for the outpatient world, CMS has decided to ‘tighten up’ the National Correct Coding Initiative edits (NCCI edits) because officials fear duplication of charges has crept into outpatient billing. The problem? CMS thinks that coding with a blanket ‘59’ modifier is being used solely to override the intentions of the original NCCI purpose. Now, CMS wants more specificity.

Meaningful Use of Data

Electronic Health Records (EHR) are electronic file cabinets for collecting and storing primary information about patients seen in care. The effort to adhere to the requirements of entering that into an electronic documentation system demands some change in clinical behavior. Often, “it takes too long” is expressed when the discipline of electronic entry is compared to handwritten charting. However, these personal time costs have the potential to reap significant benefits when those data are called upon to answer questions beyond simple evidence of what was performed.

Site Neutral Payment Proposal Has Flawed Understanding of Rehabilitation

CMS has built levels of care with specific expectations and resource allocation unique to the various care provided by them. Although it has created disparate silos of care, inability to sometimes compare continuum services and general legal expectations for documentation, oversight and reimbursement formulas, suddenly there is an expectation that 'site neutral' payment is and can be substituted for certain conditions when treated by SNF's and IRF/U's.  Do you agree?

Proposed Rehabilitation Standards Need Your Professional Feedback

Inpatient Rehabilitation as a specialty is being challenged more each day for the care and skills uniquely provided in the IRF/U environment. Continuing to defend the highly individualized and specific skill sets of patients that enter IRF somehow are not apparent because 'Rehabilitation' as a word has been highly generic in terms of explaining recovery for just about any impairment. CARF certification standards certainly demonstrate that the basic expectations for a rehabilitation level of care are highly unique, individualized and specialized for the patient population treated; each year CARF provides opportunities for comment on new standards. An invitation just arrived. Please be a part of this review! 

Auditing IRF Records is Essential - Are You at 90% Risk?

90 percent seems like a good number unless it's 90 percent incorrect. Recently, CMS hired Strategic Health Solutions as their Supplemental Medical Review Contractor (SMRC) to look at IRF/U documentation and see if it was meeting the required medical necessity documentation and regulatory requirements. Unfortunately, the findings were not in favor of payment. Let's look at what they discovered. If you haven't heard it loud and clear you MUST audit your own records for the appropriate elements of charting or you too could be in the risk pool for non-payment.

If you were a part of this initial review, AMRPA would like to speak to you!