RSBM Training‐ Focus on Financials: April 26, 2017 Georgia State Office of Rural Health & HomeTown Health, LLC Welcome you to the: Be st Pr ac tic e s for Complianc e & E ffic ie nc y 2016- 2017 Rural Swing Be d Manage me nt (RSBM) T raining Program Focus on Financials This project is supported by the Georgia Department of Community Health (DCH) State Office of Rural Health (SORH) grant number 16062G. Continuing E duc a tion Unit Conditions As an IACET Authorized Provider, HomeTown Health, LLC offers CEUs for its programs that qualify under the ANSI/IACET Standard. HomeTown Health,LLC is authorized by IACET to offer 0.3 CEUs/3 Credit Hours for this Session. This educational offering has been approved by the National Continuing Education Review Service (NCERS) of the National Association of Long Term Care Administrator Boards (NAB) to provide 3.0 clock hours/3.0 participant hours. Learning Outcome Conditions In order to obtain credits for this conference, attendees must: 1. Attend all presentations; sign in on the sign in sheet. 2. Submit the CEU Request Form at the end of the meeting. Be sure to provide a valid email address. 3. Complete an online exam with an 80% or better. 4. Complete the online program evaluation. After confirming you have met all minimum attendance requirements, Evelyn Leadbetter will email you a link to the program assessment and evaluation required to receive your CEU Credit Certificate and Transcript. Questions about CEUs? Please contact Evelyn Leadbetter at everlyn.leadbetter@hometownhealthonline.com. AGE NDA Time Topic 10:00 am – 10:05 am Introduction of Kerry Dunning & “Focus on Financials” 10:05 am – 10:35 am Rule Number 1 – Stay our of Trouble 10:35 am – Noon Evaluating Your Program 12:00 pm – 12:15 pm Break – Bring Lunch back for final hour 12:15 pm – 1:15 pm Focus on Tracking, Training & Growth Swing bed programs can improve occupancy and productivity in addition to increasing facility revenue. However, swing bed programs will do more harm than good if hospital leadership do not understand very specific skilled nursing regulations. The ability to utilize swing beds increases revenues and margins that can help support population health, wellness, and other services. Kerry Dunning will provide training and resources in order to help financial hospital staff & leaders to increase utilization and revenue for post-acute care services, as well as ensure compliance in financial matters related to program management. 1
RSBM Training‐ Focus on Financials: April 26, 2017 RSBM Program Trainer Kerry Dunning LLC • Ms. Dunning has 20 years in health care consulting and over 30 years in the industry. • She specializes in the post-acute market working with hospital based skilled nursing and swing bed programs, critical access hospitals, freestanding skilled facilities, inpatient/outpatient rehab programs, inner city teaching hospitals and rural health care systems. • Ms. Dunning worked for HCA and HealthTrust hospitals in administrative roles; Horizon Rehabilitation and ServiceMaster Rehabilitation as a Sr. Vice President and Chief Operating Officer; with GPS Healthcare as the Chief Senior Services Officer; and has spent more than 20 years as an independent consultant. • In addition to serving as an Adjunct Instructor in the College of Health at the University of North Florida, Ms. Dunning regularly leads workshops and webinars regarding Medicare, skilled nursing (including MDS), swing bed programming, and reimbursement cycle improvement. She also works on international health care projects and research. • Her favorite job is on-site helping facilities take better care of patients. Kerry Dunning has no proprietary interest in any product, instrument, device, service, or material discussed during this learning event. The education offered by Kerry Dunning, LLC in this program is compensated by the Georgia Department of Community Health (DCH) State Office of Rural Health (SORH) under grant number 16062G. Based upon Center for Medicare and Medicaid (CMS) Swing Bed Providers guidelines, Georgia State Office of Rural Health identified needs, and hospital based skilled nursing and swing bed program best practices, participants will be able to: 1. Recognize the basic audit targets, coding risks and how to set up double checks 2. Identify opportunities for census growth, revenue enhancement, and staff productivity 3. Focus on tracking key monitors and using information for revenue growth and protection 2
RSBM Training‐ Focus on Financials: April 26, 2017 Swing beds must follow skilled nursing guidelines but the rules are not always well defined. PPS swing beds must provide understand Medicare intent, reimbursement and medical necessity and documentation CAH swing beds must be vigilant in understanding Medicare intent, medical necessity documentation, and achieving measurable outcomes 7 Lower Acute/Other use for Beds Additional revenue source ◦ Consider more Medically Complex admissions Staffing Productivity Community need/Physician billing BUT Must be managed closely Not used as “acute” Staff educated Admissions criteria clear Control cost 8 Section One 9 3
RSBM Training‐ Focus on Financials: April 26, 2017 How are your coders aware of primary services used 1. in skilled nursing? If you are a PPS SWB, do your billers get a copy of 2. the validation report? When is the 3-midnight rule still in play? 3. Do you allow LOAs? How do you bill for LOAs? 4. What services should not occur in a swing bed? 5. When are swing bed claims submitted? 6. How are you tracking outcomes? Trends? Cost? 7. 10 Medicare A and days available 3 Midnight rule (if applicable) Meet skilled criteria and Admissions criteria ◦ Not meant to be a Medicaid program Admissions process and change in level of care MSP Physician Certification Therapy POC signed/dated by physician timely NOMNC Billing AFTER information is verified ◦ PPS: validation report 11 1. Patient requires skilled services on a daily basis (§30.6) 2. As a practical matter, considering economy and efficiency, the daily skilled services can only be provided on an inpatient basis in a SNF (§30.7) 3. The services must be reasonable and necessary for the treatment of a patient’s illness or injury 4. The services must also be reasonable in terms of duration and quantity 5. 12 4
RSBM Training‐ Focus on Financials: April 26, 2017 The Nursing Home Reform Act mandates that nursing facilities use a clinical assessment tool known as the Resident Assessment Instrument (RAI) to identify residents’ strengths, weaknesses, preferences, and needs in key areas of functioning ◦ The assessment is an integral part of the residents’ medical record ◦ It is designed to thoroughly provide each resident with a standardized, comprehensive, and reproducible resident assessment ◦ Determines individualized care plans for each resident ◦ The minimum data set (MDS) is a component of the resident assessment which contains a standardized set of essential clinical and functional status measures 13 The RUGs flow from the MDS and drive Medicare reimbursement to nursing homes Residents are initially assigned to clinical, therapy or clinical + therapy categories ◦ ADLs are a key driver of reimbursement ◦ Therapy minutes are the primary patient types in SWBs Therapy Log Understanding of minutes Matching minutes to claim (PPS) or understanding what is medically necessary (CAH) 14 The SNF-level services provided by Section 4432 of the Balanced a CAH, are paid at 101% of Budget Act of 1997 (BBA, Pub. reasonable cost. L. 105-33, enacted on August 5, ◦ Hospitals must follow the rules for 1997) amended section 1888 of payment in Medicare Claims the Act to provide for the Processing Manual §60 for swing-bed implementation of a per diem PPS services. for SNFs Other elements: Section 1883 of the Act permits ◦ Coinsurance and deductible are certain rural hospitals to enter into applicable for inpatient CAH payment. a Medicare swing-bed agreement, ◦ All items on the ASC X12 837 in accordance with section institutional claim format are completed in accord with the 1888(e)(7) of the Act, these implementation guide applicable to the services furnished by non-CAH dates of the stay. All items on Form rural hospitals are paid under the CMS-1450 are completed in accordance with Chapter 25. SNF PPS CAH PPS 15 5
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