• The Centers for Medicare and Medicaid Services has announced it will cut Medicare payments...

    Monday August 29, 2011

    The Centers for Medicare and Medicaid Services has announced it will cut Medicare payments to skilled nursing facilities by $3.9 billion next year to recover overpayments it made to companies that inflated their costs. CMS says its newly recalibrated classification system, known as "Resource Utilization Groups Version 4," or RUG-IV, will eliminate skilled nursing facilities' ability to bill for a higher level of care than they actually provide to patients. According to a July 29 statement ...

    http://money.msn.com/retirement/article.aspx?post=a6d41859-804e-49f4-9568-e4cf43be63b3

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  • New Quality Indicator Survey (QIS) Documents

    Thursday August 11, 2011

    Click on the link below to download the QIS documents:

    QIS Brochure April 2011

    QIS Checklist Final July 2011

    QIS Implementation Map April 2011

    QIS Memo Checklist Changes July 2011

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  • Same Sex Partners and Medicaid Liens, Transfers of Assets, and Estate Recovery โ€“ June

    Monday August 8, 2011

    The purpose of this letter is  to ensure that States are informed of the existing options and flexibilities regarding the application of Medicaid liens, transfer of assets, and estate recovery. Specifically, this letter is intended to advise States of existing choices and options regarding spousal and domestic partner protections related to liens, transfer of assets, and estate recovery.

    Same Sex Partners MCD Liens Transfers Estate Rec 06 11

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  • Government Report: Report Examines High Cost of Medicare Hospice in Nursing Homes

    Friday August 5, 2011
    A federal audit of Medicare hospice spending for nursing home residents has revealed that spending has jumped nearly 70 percent since 2005, as some for- profit hospices gained higher enrollment and reimbursement rates at long-term- care facilities. The Office of the Inspector General issued recommendations that the Centers for Medicare and Medicaid Services reduce Medicaid payments for hospice care provided in nursing facilities and closely monitor hospice agencies.
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  • Potential Risk Factors Regarding Mechanical Lifts & Slings

    Wednesday August 3, 2011
    Due to a recent event and in an effort to keep our customers informed of risk management issues, we wanted to communicate potential risk factors regarding mechanical lifts and slings.  There are numerous brands of lifts (Hoyer, Invacare, Reliant, EZ-Access, etc.) There are also numerous brands of slings and in most cases, each sling will contain a warning label that states to utilize the sling only with the same brand of lift.  Therefore, please look at your lift program to determine if the appropriate slings are being utilized with the appropriate lifts.  (Note:  Some distributers may sell some slings as universal slings but the warning labels may still have a disclaimer to only utilize with the same brand of lift.)  Also, each lift manufacturer may have their own fit guide to determine how to measure residents for the appropriate size of sling.  Therefore, if your facility has several different brands of lifts then your staff may have to be knowledgeable of the different fit guides to determine the appropriate size of sling.  Also, your staff should be knowledgeable on guidelines to determine what type of sling should be utilized for the resident, i.e. bathing, transfers, etc.  Will your staff be able to answer questions on how to measure residents for the appropriate fit of a sling for each brand?  Will your staff be able to communicate how they assess a resident to determine which type sling is appropriate for the resident?  How will your facility be able to show how you communicate to your staff the correct size sling and type of sling for each resident?
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  • Arbitration News

    Tuesday August 2, 2011
    Only the resident signed the arbitration provisions contained in the admission agreement. Suit was filed before her death and later amended to include wrongful death. Although currently on appeal before the 11th circuit, the trial court ruled that a personal representative of a resident's estate cannot be compelled to arbitration. They opined that Alabama courts have consistently held that wrongful death claims do not belong to a decedent (Ala. Code ยง 6-5-462). As such, her wrongful death claim belongs to the person representative because as a survival action, the claim would have belonged to the decedent through her estate. The outcome is currently pending on appeal but may have far reaching results. Stay tuned.
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  • Overhaul of Nursing Home Compare website is complete

    Tuesday August 2, 2011

    The redesign of the federal Nursing Home Compare website, which lets consumers file complaints more easily and compare facilities based on quality measures, is complete.

    www.medicare.gov/nhcompare/

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  • Wilson v. State Farm: One Small Victory for Primary Payers in the MSP Arena

    Tuesday August 2, 2011
    A federal court in the Western District of Kentucky recently provided much awaited clarification on one of many troubling dilemmas faced by defendants, insurers and their  attorneys who are working to adhere to the requirements of Medicare Secondary Payer ("MSP") law.  Despite the challenges associated with complying with MSP law, all of those involved in the settlement of a claim that involves personal injury damages must be diligent to avoid the post-settlement potential for liability to the Centers for Medicare & Medicaid Services ("CMS").
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  • Government Report: Report Examines High Cost of Medicare Hospice in Nursing Homes

    Tuesday August 2, 2011
    A federal audit of Medicare hospice spending for nursing home residents has  revealed that spending has jumped nearly 70 percent since 2005, as some for- profit hospices gained higher enrollment and reimbursement rates at long-term-care facilities. The Office of the Inspector General issued recommendations that  the Centers for Medicare and Medicaid Services reduce Medicaid payments for hospice care provided in nursing facilities and closely monitor hospice agencies.
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  • Rehab facilities see reimbursement increase tied to quality measures

    Tuesday August 2, 2011

    Inpatient rehab facilities will see a 2.2% payment rate increase under the IRF Prospective Payment System in fiscal year 2012. The system will also establish a new quality reporting system authorized by the Affordable Care Act.

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  • Provider shares take a hit on news of CMS reimbursement

    Tuesday August 2, 2011
    Shares of major skilled nursing facility operator stocks took a nosedive Monday morning following Friday's announcement that the Centers for Medicare & Medicaid Services are cutting Medicare reimbursements to SNFs by 11.1%, starting Oct. 1. Operators Sun Healthcare, Skilled Healthcare and Kindred Healthcare lost more than a quarter of their market value on Monday, according to published reports.
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