Mary Madison, RN, RAC-CT, CDPClinical Consultant – Briggs Healthcare NAHC filed a lawsuit against the Secretary of the United States Department of Health and Human Services last week (July 5, 2023) to block CMS from cutting Medicare rates that are expected to total over $18 billion over the next 10 years. The 30-page complaint can…… Continue reading National Association for Home Care and Hospice (NAHC) Files Lawsuit to Block Medicare Rate Cuts
Rhode Island – Medicaid Case Mix Reimbursement
Mary Madison, RN, RAC-CT, CDPClinical Consultant – Briggs Healthcare Rhode Island will require the use of the Optional State Assessment (OSA) for Nursing Facilities Reimbursement effective October 1, 2023 Background: The Centers for Medicare & Medicaid Services (CMS) is ending support for Resource Utilization Groups (RUG)-III and RUG-IV on federally required assessments for patients residing…… Continue reading Rhode Island – Medicaid Case Mix Reimbursement
Ohio Budget and Medicaid Reimbursement
Mary Madison, RN, RAC-CT, CDPClinical Consultant – Briggs Healthcare “This communication serves as an update for all nursing facility providers regarding changes in reimbursement as a result of Am. Sub. H.B. 33, the states FY24-25 biennial budget. Please share this with corporate staff, nursing facility administrators, billing staff, MDS nurses, etc. as needed. July rates…… Continue reading Ohio Budget and Medicaid Reimbursement
UPDATED: Final MDS 3.0 Item Sets Version 1.18.11 v4
Mary Madison, RN, RAC-CT, CDPClinical Consultant – Briggs Healthcare The final Minimum Data Set (MDS) 3.0 Item Sets version (v)1.18.11 have been updated and are now available in the Downloads section on the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual page. The IPA, NP, and SP Item Sets have been replaced with…… Continue reading UPDATED: Final MDS 3.0 Item Sets Version 1.18.11 v4
Most Recent CMS-CDC-NHSN COVID-19 Nursing Home Data
Mary Madison, RN, RAC-CT, CDPClinical Consultant – Briggs Healthcare CMS has posted the nursing home COVID-19 data for the week ending June 25, 2023. If you’ve been following my weekly posts with this data, you’ll see the above reporting is quite abbreviated! The only reference to staff data is the national percentage of staff who…… Continue reading Most Recent CMS-CDC-NHSN COVID-19 Nursing Home Data
SNFs: COVID-19 Enforcement Discretion for Pharmacy Billing Ended June 30th
Mary Madison, RN, RAC-CT, CDPClinical Consultant – Briggs Healthcare For flu, pneumococcal, and COVID-19 vaccines furnished on or after July 1, 2023, to patients in a Medicare Part A-covered skilled nursing facility (SNF) stay, immunizers can no longer bill Medicare directly. Typical SNF consolidated billing regulations are in place, which require SNFs to bill for…… Continue reading SNFs: COVID-19 Enforcement Discretion for Pharmacy Billing Ended June 30th
FY 2024 ICD-10-CM Coding Guidelines and FY 2024 Conversion Table Now Available
Mary Madison, RN, RAC-CT, CDPClinical Consultant – Briggs Healthcare The 2024 ICD-10-CM files below contain information on the ICD-10-CM updates for FY 2024. These 2024 ICD-10-CM codes are to be used for discharges occurring from October 1, 2023 through September 30, 2024 and for patient encounters occurring from October 1, 2023 through September 30, 2024.…… Continue reading FY 2024 ICD-10-CM Coding Guidelines and FY 2024 Conversion Table Now Available
Adverse Events Toolkits: Medical Record Review Methodology and Clinical Guidance for Identifying Patient Harm
Mary Madison, RN, RAC-CT, CDPClinical Consultant – Briggs Healthcare On Thursday, July 6, 2023, the OIG posted two (2) Adverse Events Toolkits for Identifying Patient Harm. Toolkit: Medical Record Review Methodology Provides an explanation of the OIG methodology, including details about our definition of patient harm and how we categorized events by severity…… Continue reading Adverse Events Toolkits: Medical Record Review Methodology and Clinical Guidance for Identifying Patient Harm
Corrections to Home Health Claims Edits
Mary Madison, RN, RAC-CT, CDPClinical Consultant – Briggs Healthcare The purpose of CR 13225 (posted June 29, 2023) is to no longer bypass the edit requiring a matching patient assessment when a HH claim reports condition code DR and occurrence code 50. It also corrects processing of HH claims to ensure the medical review information…… Continue reading Corrections to Home Health Claims Edits
OASIS (Home Health) Error Message User Guide Updated
Mary Madison, RN, RAC-CT, CDPClinical Consultant – Briggs Healthcare CMS has posted the updated OASIS Error Message User Guide … Version 2.1 with the date of June 15, 2023. This is a 164-page document. The Interpreting Initial Feedback and Final Validation Reports is the companion guide. It was last updated in December 2007 but is…… Continue reading OASIS (Home Health) Error Message User Guide Updated
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