Brenda Sheppard, RN

Off-Cycle SNF Provider Revalidation: Mandatory Form CMS-855A Top 7 Things To Know: 1. Mandatory Revalidation: Starting October 1, 2024, all SNFs must revalidate their Medicare enrollment by the end of the year. This process requires completing an updated CMS provider enrollment form, which now asks for more detailed information than before. 2. Off-Cycle Revalidation: Normally, provider revalidation happens on a regular cycle. However, this "off-cycle" revalidation is a one-time requirement starting this year, impacting 100% of SNFs, regardless of their size or ownership structure. 3. CMS Enrollment Form 855A: The new form, which must be completed by SNFs, is longer (20 pages compared to the previous 14 pages) and includes additional sections about "Additional Disclosable Parties" (ADP). SNFs must provide detailed information about all ADPs that have a significant operational or financial role in the facility. Providers can access the form via the PECOS (Provider Enrollment, Chain, and Ownership System) online platform. ·     Visit the PECOS website: https://lnkd.in/g5kBTqfW ·     Log in using your CMS credentials. ·     Locate the revalidation section. ·     Link to CMS 855A Form: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://lnkd.in/gqAvEnZk 4.    Timeline: ·     CMS will send letters to SNFs starting on October 1, 2024, and through the end of the year. ·     Providers have 90 days to respond after receiving the letter. ·     Failure to complete the revalidation in time could disrupt the facility's ability to bill Medicare.   5.    Additional Disclosable Parties (ADP): This is a key new requirement. An ADP is anyone or any entity that: ·     Has significant operational, financial, or managerial control over the SNF. ·     Owns, leases, or subleases property to the SNF. ·     Provides management, consulting, or financial services to the SNF. This information must be disclosed in the new enrollment form. 6. Importance of Compliance: SNFs must complete this revalidation within the specified timeframe to avoid disruptions in their Medicare billing. Providers are advised to consult legal counsel to ensure they correctly interpret the reporting requirements and avoid errors in their submissions. 7. PECOS System: The information must be submitted through the PECOS system, which is the online system used by CMS for provider enrollment. This process requires more detailed reporting, especially concerning the ownership and operational control of SNFs and the ADPs involved with the facility. Since all SNFs are affected, every provider should be prepared for this and take timely action to prevent any interruption in Medicare billing. Failure to comply could result in significant financial issues for the facility. #SNFCompliance #MedicareRevalidation #CMSUpdates #HealthcareProviders #HealthcareCompliance #CMSFrom855A

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Hear what healthcare providers are saying about PrescriberPoint—the one-stop solution transforming their prescribing workflow! Create your free account today and experience it for yourself: https://hubs.li/Q02T6q5r0

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2024 CDI Week Some suggestions for those CDI professionals celebrating CDI week this year: 1- Begin the process of transforming and updating CDI's role as a collaborator and facilitator of better physician documentation, recognizing that the physician is the only individual who can improve his/her documentation. A reasonable starting point is asking physicians how you can help them master documentation and charting in the EHR. Inquire as to what physicians desire and expect in a helpful CDI program, making the physician the focus of our attention. In short, how can we help physicians work smarter not harder with more time doctoring in front of the patient versus doctoring in front of the computer screen 2- Prepare for CDI week by beginning to become more proficient and knowledgeable in best practice standards of documentation. An ideal starting point is becoming familiar with the 2023 E & M documentation requirements, and being able to apply these standards in your chart review process. The History of Present Illness and Medical Decision Making within the H & P is vital in driving the establishment of medical necessity, an area that is often overlooked by CDI. Yes, CDI plays a role through more effective documentation in guiding physicians to support their clinical judgment that the patient needs to be hospitalized in an inpatient level of care 3- Commit to working onsite, hand in hand with Case Management, Utilization Review, and Physician Advisors. Working remotely five days per week creates too many roadblocks to collaborating with physicians and others using a multidisciplinary approach to documentation excellence. Like a used car salesman, out of sight out of mind. I have found that onsite CDI activities allow for more interaction with physicians and the multidisciplinary team. Remote CDI does not allow for critical situational awareness including providing feedback through conversation with physicians on documentation tips to consider in the future to better capture the patient's clinical story and support of clinical judgment and medical decision-making. Real-time feedback and documentation education are not effective through email. Physicians are bombarded with emails, they want fewer emails and more education on documentation #CDIweek, #happyCDIweek, #CDIhelpingphysicians, Cesar M. Limjoco, M.D. https://acdis.org/cdi-week

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Key Strategic Insights = A Successful OP CDI Program The challenge of value-based care starts with a collaborative approach, when launching an Outpatient Clinical Documentation Integrity (OP CDI) program. Here are some key strategic insights to success: 1. Engage with Population Health Understand Pain Points: Begin by understanding the specific challenges faced. This fosters collaboration. Tailored Questions: Use customized questions to facilitate productive discussions and ensure alignment with needs. 2. Effective Software Implementation Manage Patient (Pt.) Volumes: Implement software solutions to efficiently handle pt. volumes. OP CDI Calculator: Utilize a calculator to determine Full-Time Equivalent (FTE) needs. Data Analytics and Reporting: Emphasize the importance of continuous improvement via data analytics. 3. Workflow Creation Establish Robust Workflows: Create strong workflows before integrating reviewers. 4. Collaboration & Communication Promote Strong Collaboration: Encourage robust communication between key stakeholders. Leverage Software: Use technology to reduce physician burnout & streamline communication. 5. Patient-Centered Approach Address social determinants of health (SDOH) & ensure accurate documentation of conditions and care plans. Patient Outcomes: Keep patient care at the center of all doc. & workflow processes. 6. Regulatory Compliance Adhere to Guidelines: Follow regulatory requirements such as CMS guidelines on Hierarchical Condition Categories (HCC) coding to avoid penalties and enhance credibility. 7. Measurable Outcomes Set Clear Goals: Aim for measurable outcomes like improved HCC recapture rates, enhanced RAF scores, better HEDIS measures, and addressing SDOH needs. 8. Stakeholder Engagement Involve All Stakeholders: Ensure that executives, clinicians, and other relevant parties are involved in planning and implementation process. Success Stories Recently, I helped several CDI directors validate their cases for OP CDI programs within Accountable Care Organizations (ACOs). By engaging with population health leadership, we identified key issues such as RAF gaps and HEDIS measures, and tailored processes to address them. For instance, a CDI director I guided successfully identified HCC and HEDIS recapture as their biggest pain points. With strategic solutions in place, they are now ready to implement the project for the 2025 budget yr., aiming to improve their HCC recapture rate by 20%, leveraging data analytics for outcomes and improvement needs. Benefits of Implementing These Strategies Align Risk Stratification: Properly align risk stratification with chronic conditions and healthcare needs. Quality Measures: Improve quality measures and address SDOH. Collaborative Team: Ensure success with a collaborative team supported by technology. Overall, these strategic actions will enhance patient care and operational efficiency. #Healthcare #Leadership #CDI #PatientCare #ValueBasedCare #HealthcareInnovation

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Service line evaluation is not just a financial exercise; it's a strategic imperative for hospitals. Read the blog post to learn about best practices to help hospitals optimize their service offerings.

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Complaints, Appeals, and Grievances (CAG) Software – GHIT Digital POV   What is Appeals and Grievances (ANG)? Appeals and Grievances (ANG) refer to the processes through which members of health plans or patients voice concerns about their healthcare services, claims, or administrative decisions. These mechanisms are critical to ensuring compliance, transparency, and member satisfaction. ·        Grievances: A formal complaint made by a member about non-claim-related issues, such as poor service, delayed responses, or inadequate care. Example: A patient complains about long wait times for approval of a pre-authorization request. Appeals: A request by a member or provider to review and overturn a denied claim or service. Example: A patient files an appeal to get coverage for a procedure that their health plan initially denied. What is Complaint, Appeals, and Grievances (CAG)? CAG expands the scope by explicitly incorporating complaints into the workflow, distinguishing them from grievances. This is more commonly adopted in systems where complaint handling is segregated as a lower-threshold concern. Click the link below to read the complete POV or reach out to us for ANG / CAG Software Demo Monika Vashishtha (MBA, PMP, ITIL) [email protected] 646.734.6482 https://lnkd.in/ef5UzY9Q

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I’m thrilled to announce the launch of the ILS Care Regulatory Solution YouTube Channel! 🎉 After 20+ years in the hospice and home health industry, I’ve seen firsthand how challenging it can be to stay on top of compliance and documentation standards. That’s why I’ve created a space where professionals like you can gain actionable insights, practical tips, and expert advice—all in one place! 🎥 What to Expect: -Navigating CMS, Joint Commission, and CHAP compliance with ease -Proven strategies for chart auditing and documentation best practices -Helpful tips for preparing your agency for surveys And so much more! Whether you’re a nurse, clinical manager, or agency leader, I’m here to share what I’ve learned to help you succeed. 💼 👉 Ready to learn more? Subscribe to my channel and join me as we tackle the most pressing challenges in hospice and home health together! Let’s stay compliant, deliver quality care, and be survey-ready—always. 🔗 https://lnkd.in/eVPTxdht Looking forward to your support and engagement! Let's grow and learn together. 💡 #HospiceCare #HomeHealth #RegulatoryCompliance #DocumentationBestPractices #ChartAuditing #HealthcareProfessionals #SurveyReadiness

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Keep our rurals open but if you really want to help get the foreign equity owned GPO that sets the pricing for our hospitals BANNED from our state. Economies of scale are used by Vizient against Oklahoma rural hospitals. If you have 13 tiers, hidden tiers, and tier maxes…that’s not a contract, that a free for all nightmare of a scam we all fell for. Their awful written tiered agreements force our rurals to pay more for the exact same items that our large hospitals pay less for. Example box of gloves a large hospital system in the state will pay 6-8 bucks for a box of 250 exam gloves. That same box for a rural EMT? 24 bucks. There is no price transparency and you are forcing patients who live in rural areas to pay more because of the lack of infrastructure by the corporations serving them to effectively and economically get goods and services to these hospitals. And distributors who whine about the cost of delivering to rural hospitals all while posting BILLIONS in profit every quarter are the first on my 💩 list. Let’s keep our rurals open but let’s make them more profitable so that they can continue to add much needed services and gainfully employ more community members.

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👀 Interesting Read from Hospice News👀 https://lnkd.in/gisxG3_W Hospice leaders face immense challenges, from regulatory demands to evolving patient needs, all while striving to deliver quality end-of-life care. Medalogix Muse supports hospice agencies by providing near real-time patient risk assessments and clinically relevant insights, helping them navigate complex regulations with data-driven, evidence-based care. Muse enables agencies to make well-documented, timely decisions, prioritize patient needs, and optimize resources—all of which support compliance and quality, even in a more stringent regulatory landscape. Learn more about Muse: https://lnkd.in/gnafj9u6 #HospiceCare #DataScience #PatientCare #HealthcareInnovation

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🚨 Update on Baptist Health and Florida Blue Negotiations 🚨 Negotiations between Baptist Health and Florida Blue are ongoing and remain tense as the September 30 contract deadline approaches. Discussions have been underway since February 2024, but no agreement has been reached. The core issue is payment rates: Baptist Health seeks increases to cover rising costs, arguing that current rates are below market, while Florida Blue contends that these demands are excessive and significantly above inflation. With the potential for Baptist Health services to become out-of-network for Florida Blue members on October 1, many patients in Northeast Florida are left uncertain about their healthcare options. Both sides are committed to finding a resolution, but time is running out. 🔗 Sources: Action News Jax, Baptist Health, Health News Florida

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Kickstart your week by staying ahead on compliance! 📝 These 5 simple planning steps will help you stay organized, reduce stress, and ensure your assisted living facility meets all regulatory standards. Set clear compliance goals, schedule staff training, and conduct a facility walkthrough to identify any gaps. 🏥 Get your resident care plans in order and prioritize upcoming deadlines so you can run a smooth, compliant facility all week long. 💼 #CompliancePlanning #AssistedLivingSuccess #ALFCompliance #StaffTraining #Regulations #ResidentCare #ALFOperations #FacilityManagement #StayCompliant

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Is your hospice emergency-ready? An effective emergency preparedness plan meets all areas of preparedness according to key regulations: risk assessment, policies and procedures, communication plan, training and testing, and integrated healthcare system . 📍 Download this FREE hospice checklist to determine any areas for improvement: https://rpb.li/PUe We understand the specific challenges hospices face during emergencies. Hart Healthcare Solutions can craft a comprehensive emergency preparedness plan for your hospice, ensuring compliance with key regulations and addressing all critical areas.

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A new Milbank Memorial Fund report shows more nurse practitioners (NPs) and physician associates (PAs) are moving into specialty care. From 2008 to 2016, specialty practices employing NPs and PAs grew by 22%. Key stats: NPs in primary care (2016-2021): 30.6% to 34% PAs in primary care (2016-2021): 25.2% to 29.7% Physicians in primary care: Down from 27.9% (2016) to 26.6% (2021) This trend highlights the evolving roles of NPs and PAs in our healthcare system. 📈🔄 #Healthcare #NursePractitioners #PhysicianAssistants #CHGHealthcare #ECS #APP

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ASCs are flourishing nationwide, with payers, patients, and health systems taking note of the cost-saving potential. Many states are amending certificate-of-need laws, opening the door for new ASC development. Read more about a state taking action in this article from Becker’s.

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