The document summarizes a presentation about accountable care organizations (ACOs) and strategies for interdisciplinary management. It discusses the goals of ACOs to improve quality of care while reducing costs through voluntary groups of healthcare providers. It also outlines strategies for interdisciplinary team-based care, including developing an integrated physician model, using data to inform evidence-based medicine, and rethinking physician leadership. Case studies on managing osteoporosis and maintaining coverage for chronic conditions under Medicare are presented to illustrate ACO processes and strategies.
This document provides an overview of health care agencies and long-term care facilities. It discusses that health care agencies offer services to meet people's health needs, with the person as the focus of care. A variety of agency types are described, including hospitals, rehabilitation facilities, nursing homes, assisted living facilities, and home care agencies. It also outlines how these agencies are organized, with governing boards and interdisciplinary health care teams. Standards and regulations for agencies are discussed, including requirements for licensing, certification, and accreditation.
Skilled Nursing Facilities have seen a significant increase in Medicare Part A and Part B Therapy denials. The goal of medical review is to determine whether the services are reasonable and necessary, delivered in the appropriate setting, and coded correctly, based on appropriate documentation. The speaker will begin this seminar by discussing recent national trends in Medical Review, Reasons for increased review and the various Medical Review programs. The speaker will present specific denial trends with examples of denial statements. The presentation will culminate in a review of the keys to responding to a medical record request and appeal tips and strategies.
Under the scrutiny of review, rehabilitation and nursing documentation must support skilled coverage criteria. This presentation covers skilled coverage criteria and documentation by rehabilitation professionals and nursing to support clinically appropriate levels of care.
1. Learn to define skilled coverage criteria.
2. Learn to define key elements of documentation.
3. Learn examples of rehabilitation and nursing documentation to support Medicare coverage criteria.
The document provides information about a presentation on case mix leadership given by Joyce Sadewicz and Kerri Dutton. It includes bios of the speakers outlining their relevant experience. The objectives of the presentation are to identify requirements for MDS assessment scheduling, documentation strategies, rehabilitation case management strategies, and RUG qualifiers. The presentation also covers various aspects of case mix theory including RUG groupers, snapshot dates, average CMI, and common grouper elements like activities of daily living.
This document discusses missed opportunities in skilled nursing facilities related to therapy services. It identifies nurses having control over documentation as the number one missed opportunity, since nursing documentation is essential for justifying skilled care. Rehabilitation departments are identified as the number two missed opportunity, as they function as a business within the business but are often underutilized. Incomplete therapy documentation is identified as the number three missed opportunity, as it can result in denied claims and violates standards of practice. The document provides tips for improving documentation to support skilled care and medical necessity.
Coding of activities of daily living (ADLs) on the MDS is complex and often misunderstood by those engaged in completing the assessment. In addition to affecting care, public information and survey, this area of the MDS has a tremendous financial impact. This presentation defines late loss ADLs and provide insights aimed at helping facility staff document resident status accurately. Calculating the ADL score for the RUG-IV system is reviewed and implications of inappropriate coding will be demonstrated.
“Documentation not supportive of the RUG-IV classification billed…” is cited as the reason for multiple post-payment medical record review denials. Accurate and concise documentation to support the RUG-IV classification billed is a critical element in gaining accurate reimbursement, and supporting that reimbursement level during a medical review. This presentation covers the technical and clinical requirements for Medicare coverage, and requirements of skilled nursing documentation. The presentation identifies areas of the MDS 3.0 that are vulnerable to error and critical to accurate RUG-IV classification and identify strategies for better supporting these areas in medical record documentation. The correlation between the MDS 3.0 assessment and publicly reported information for the Quality Measures and 5 Star Quality Reporting are discussed.
1. Learn to describe the technical and clinical requirements for Medicare coverage.
2. Understand the goal of supportive skilled nursing documentation.
3. Develop a clear understanding of accurate coding in Section M.
4. Learn to identify sections of the MDS 3.0 assessment that are vulnerable to error and articulate strategies to support these areas in medical record documentation.
5. Learn to identify the correlation between medical record documentation, the MDS 3.0, and publicly reported information for the Quality Measures and 5 Star Quality Rating.
The document summarizes a presentation about accountable care organizations (ACOs) and strategies for interdisciplinary management. It discusses the goals of ACOs to improve quality of care while reducing costs through voluntary groups of healthcare providers. It also outlines strategies for interdisciplinary team-based care, including developing an integrated physician model, using data to inform evidence-based medicine, and rethinking physician leadership. Case studies on managing osteoporosis and maintaining coverage for chronic conditions under Medicare are presented to illustrate ACO processes and strategies.
This document provides an overview of health care agencies and long-term care facilities. It discusses that health care agencies offer services to meet people's health needs, with the person as the focus of care. A variety of agency types are described, including hospitals, rehabilitation facilities, nursing homes, assisted living facilities, and home care agencies. It also outlines how these agencies are organized, with governing boards and interdisciplinary health care teams. Standards and regulations for agencies are discussed, including requirements for licensing, certification, and accreditation.
Skilled Nursing Facilities have seen a significant increase in Medicare Part A and Part B Therapy denials. The goal of medical review is to determine whether the services are reasonable and necessary, delivered in the appropriate setting, and coded correctly, based on appropriate documentation. The speaker will begin this seminar by discussing recent national trends in Medical Review, Reasons for increased review and the various Medical Review programs. The speaker will present specific denial trends with examples of denial statements. The presentation will culminate in a review of the keys to responding to a medical record request and appeal tips and strategies.
Under the scrutiny of review, rehabilitation and nursing documentation must support skilled coverage criteria. This presentation covers skilled coverage criteria and documentation by rehabilitation professionals and nursing to support clinically appropriate levels of care.
1. Learn to define skilled coverage criteria.
2. Learn to define key elements of documentation.
3. Learn examples of rehabilitation and nursing documentation to support Medicare coverage criteria.
The document provides information about a presentation on case mix leadership given by Joyce Sadewicz and Kerri Dutton. It includes bios of the speakers outlining their relevant experience. The objectives of the presentation are to identify requirements for MDS assessment scheduling, documentation strategies, rehabilitation case management strategies, and RUG qualifiers. The presentation also covers various aspects of case mix theory including RUG groupers, snapshot dates, average CMI, and common grouper elements like activities of daily living.
This document discusses missed opportunities in skilled nursing facilities related to therapy services. It identifies nurses having control over documentation as the number one missed opportunity, since nursing documentation is essential for justifying skilled care. Rehabilitation departments are identified as the number two missed opportunity, as they function as a business within the business but are often underutilized. Incomplete therapy documentation is identified as the number three missed opportunity, as it can result in denied claims and violates standards of practice. The document provides tips for improving documentation to support skilled care and medical necessity.
Coding of activities of daily living (ADLs) on the MDS is complex and often misunderstood by those engaged in completing the assessment. In addition to affecting care, public information and survey, this area of the MDS has a tremendous financial impact. This presentation defines late loss ADLs and provide insights aimed at helping facility staff document resident status accurately. Calculating the ADL score for the RUG-IV system is reviewed and implications of inappropriate coding will be demonstrated.
“Documentation not supportive of the RUG-IV classification billed…” is cited as the reason for multiple post-payment medical record review denials. Accurate and concise documentation to support the RUG-IV classification billed is a critical element in gaining accurate reimbursement, and supporting that reimbursement level during a medical review. This presentation covers the technical and clinical requirements for Medicare coverage, and requirements of skilled nursing documentation. The presentation identifies areas of the MDS 3.0 that are vulnerable to error and critical to accurate RUG-IV classification and identify strategies for better supporting these areas in medical record documentation. The correlation between the MDS 3.0 assessment and publicly reported information for the Quality Measures and 5 Star Quality Reporting are discussed.
1. Learn to describe the technical and clinical requirements for Medicare coverage.
2. Understand the goal of supportive skilled nursing documentation.
3. Develop a clear understanding of accurate coding in Section M.
4. Learn to identify sections of the MDS 3.0 assessment that are vulnerable to error and articulate strategies to support these areas in medical record documentation.
5. Learn to identify the correlation between medical record documentation, the MDS 3.0, and publicly reported information for the Quality Measures and 5 Star Quality Rating.
The document discusses healthcare reform in the United States with the goal of cutting costs by 50% while improving quality and access. It argues that no single entity currently "owns" the regional healthcare system due to the separation of hospitals, insurance companies, and economic development agencies. The document proposes a model of integrated accountable care organizations that coordinate care across the entire population of a region through tools like medical homes, population health programs, and shared health information technology. The goal is an integrated system that achieves the cost and quality targets of healthcare excellence by 2015.
The management of the Minimum Data Set (MDS) 3.0 assessment schedule is complex and time consuming. Combining scheduled MDS assessments with unscheduled Prospective Payment System (PPS) Other Medicare Required Assessments (OMRAs) correctly will lead to accurate reimbursement and can ease the MDS workflow burden on the entire team, and save the facility costly mistakes due to noncompliance. Practitioners need to know what to do if the MDS schedule is not followed correctly, and how to regain compliance with the schedule as quickly as possible. This presentation reviews the scheduled and unscheduled PPS assessment requirements and describe how to select and set Assessment Reference Dates (ARDs) strategically and accurately. The presentation also discusses implications of not following the assessment schedule correctly, and how to regain compliance once an error in assessment scheduling is discovered. The Correction Process of existing MDS assessments, including modification, inactivation, and manual correction request will be discussed. This all-important information will help the MDS coordinator to maintain and regain federal compliance with the PPS assessment schedule.
1. Learn to outline the scheduled PPS assessment schedule and unscheduled PPS assessment requirements and explain the correct Assessment Reference Date selection for each assessment type.
2. Learn to state the correct application of default or provider liable days for an early, late, or missed scheduled or unscheduled assessment.
3. Learn to identify the appropriate use of the Start of Therapy OMRA, End of Therapy OMRA, End of Therapy-Resumption OMRA, and Change of Therapy OMRA.
4. Learn the eight criteria for a Medicare Short-Stay assessment.
5. Learn to identify the difference between a MDS modification and a MDS inactivation and recognize when to choose modification or inactivation.
Coding of activities of daily living (ADLs) on the MDS is complex and often misunderstood by those engaged in completing the assessment. In addition to affecting care, public information and survey, this area of the MDS has a tremendous financial impact. During this session, the speaker will define the late loss ADLs and provide insights aimed at helping facility staff document resident status accurately. Calculating the ADL score for the RUG-IV system will be reviewed and implications of inappropriate coding will be demonstrated. Using dollar-impact case studies, the attendee will learn why this section is critical for the facility’s financial success.
The MDS 3.0 has an impact on every aspect of care in a LTC or SNF. Reimbursement, Quality Measures, Five Star rating, Care Planning, and resident-centered care all begin with an accurate, standardized, and reproducible assessment.
Download the MDS 3.0: A Guide To Coding Accuracy by Beckie Dow, RN, RAC-MT for an overview of MDS 3.0. Beckie reviews the MDS 3.0 sections most vulnerable to error, while highlighting strategies for increased accuracy. Beckie also provides the MDS scheduling clinical qualifiers for each of the 66 RUG-IV categories and examples of potential financial losses due to inaccurate coding.
Learn How To:
1. Identify three MDS 3.0 Sections vulnerable to error.
2. Identify strategies for accurate reimbursement through the MDS 3.0 process.
3. Articulate three recent MDS 3.0 Coding instruction updates.
Skilled Nursing Facilities have seen a significant increase in Medicare Part A and Part B Therapy denials. The goal of medical review is to determine whether the services are reasonable and necessary, delivered in the appropriate setting, and coded correctly, based on appropriate documentation. The speaker will begin this seminar by discussing recent national trends in Medical Review, reasons for increased review and the various Medical Review programs. The speaker will present specific denial trends associated with Medicare Part B Claims. The presentation will culminate in a review of the keys to responding to a medical record request and appeal tips and strategies.
This document provides information about the Medicare appeals process from additional development requests (ADRs) to administrative law judge (ALJ) hearings. It includes biographies of the two speakers, Elisa Bovee and Carrie Mullin, who have extensive experience in long-term care and denials management. The document outlines the different levels of the Medicare appeals process and provides guidance on responding to ADRs and preparing appeal packages to contest claim denials.
Keep your MDS Coordinators and nursing staff up to speed in understanding the significance of accurate coding in section M and the required corresponding documentation. This presentation enables healthcare providers to provide quality healthcare through an understanding of wound coding in relationship to skin presentation for Section M on the MDS assessment.
1. Gain an understanding of the RAI User’s Manual intent of Section M.
2. Gain an understanding of the documentation required to support Coding in Section M.
3. Develop a clear understanding of accurate coding in Section M.
4. Learn to identify the significance of care planning and utilizing an interdisciplinary approach.
Cincom Synchrony is a software solution that helps healthcare organizations overcome challenges from US healthcare reform through three key capabilities: 1) Intelligent Guidance that provides real-time guidance for customer interactions; 2) a unified customer view that presents holistic patient information; and 3) cross-channel continuity across communication channels. The solution aims to improve care quality and reduce costs in line with reform goals through smarter customer interactions.
This New York Medicaid Nursing Facility Case Mix Seminar discusses the necessary documentation needed to support the assigned Medicaid RUG to ensure accurate reimbursement for care provided. New York OMIG Auditors are focused on auditing "high risk" Medicaid Case Mix MDSs for Nursing Facilities with a change in CMI by more than five percent for 2012.
1. Learn to identify the specific components of NY RUG-III 53 categories.
2. Learn to identify high risk NY RUG-III 53 categories.
3. Learn to identify documentation requirements to support the RUG components.
4. Learn to identify strategies for organization of the Medical Record in preparation for OMIG Audits.
Skilled Nursing Facilities have seen a significant increase in Medicare Part A and Part B Therapy denials. The goal of medical review is to determine whether the services are reasonable and necessary, delivered in the appropriate setting, and coded correctly, based on appropriate documentation. As a Skilled Nursing Facility leader, are you confident in your ability to appeal any and all denied claims that may arise in your building?
This document discusses various topics related to health care planning, including identifying sources of health care plans and types of coverage provided. It describes major provisions of plans and policies, as well as the purpose of disability income insurance. The document provides tips for reducing personal health care costs through prevention. It also discusses health insurance as financial protection and as part of risk management. Various types of health care providers, coverage, and policies are defined.
Cypress Benefit Administrators is a full service Third Party Administration (TPA) company. We specialize in helping companies outsource Flexible Spending Accounts (Section 125), HRA, HSA, and COBRA. Additionally, we provide expertise in self-funded medical plan administration.
Unleashing Patient’s Power in Improving Health and CareHealth Catalyst
We know that patient engagement has a powerful effect on outcomes, but we haven’t yet truly harnessed patient’s power. Maureen Bisognano, former president and CEO of the Institute for Healthcare Improvement (IHI) discusses the effect of patient engagement across the IHI Triple Aim: improving the experience of patient care, improving the health of populations, and lowering costs.
She shares examples of how increased patient engagement can help improve healthcare outcomes and deliver a better care experience while reducing costs. Such examples from her experience in the field include how lessons from the “flipped classroom” can be translated to healthcare, how technology can improve patient accountability and decision making, and other impactful stories.
The document discusses strategies for coping with serious illness for individuals and families. It notes that the US healthcare system is broken, with high rates of medical errors and adverse drug events. It also discusses the high costs of chronic diseases. The document advocates engaging health advocates and care managers to help navigate the healthcare system, create contingency plans, and coordinate care and resources. It provides an overview of factors to consider for an individual's health including physical, mental, emotional and spiritual health.
A comprehensive review of the Medicare appeal process. Appropriate for all SNF nursing staff, management, and therapy professionals. The presentation discusses the various levels of Provider Medicare appeal rights. The presentation further explains how facilities can thoroughly manage the appeal process and participate in a successful ALJ hearing.
Telemedicine Healthcare Solutions for Caregivers and Care CentersRaymond Lavine
Remember when you could speak with a doctor on the phone, It's Back!!! Care for those who need it at home or in a care center allows residents and caregivers to have access to a doctor to talk about routine or even more serious care questions.
The benefit of membership telemedicine -- Monthly subscription with no additional payments. Medical information is in a secure web link so that when a member speaks with a doctor, there is no delay to make an appointment and have to spend time providing health care information.
www.telemedicine4you.com
Managing the medical complexities of patients with cognitive and behaviors requires an interdisciplinary approach to care. The presentation details strategies and hands-on examples of management techniques for practical application in the SNF setting to ensure patients receive medically necessary Rehabilitation and Nursing Service.
1. Learn to identify underlying deficits leading to Behaviors.
2. Learn to define interdisciplinary assessment techniques.
3. Learn Management Strategies.
A detailed review of changes and updates discussed to the MDS 3.0 item set effective October 1, 2013. The course will provide an overview of the most recent MDS 3.0 User’s Manual updates. The speaker will review key elements for MDS coding, which will impact reimbursement based on the Federal Regulations in the FY 2014 Final Rule.
Vivian Anugwom presented on Allina Health's strategy to address health equity and eliminate health disparities. She discussed how Allina uses data analytics to identify disparities by patient race, ethnicity, language, and other factors. For example, data showed minorities are less likely to use hospice care. Allina provided implicit bias training to physicians to address potential biases influencing low hospice referral rates for African Americans. Vivian also outlined Allina's commitments in various roles to advance diversity, equity, and inclusion.
Information related to the impact of healthcare reform (Affordable Care Act) for 2014 and beyond. It takes an in-depth look at the ACA and its specific impact on California physicians. It further discusses opportunities presented as a result of the ACA and examples of how physicians and their practices can participate in these opportunities.
This document provides an overview and agenda for a presentation on successfully preventing and appealing denied Medicare claims. The presentation will cover audit triggers, contractor findings, medical record review preparedness, appeal tools, and strategies for successful appeals. It will discuss the admission documentation requirements, skilled care qualifications, and appeal processes to facilitate preventing and appealing denied claims.
The document discusses Accountable Care Organizations (ACOs) and strategies for interdisciplinary management. It begins by outlining the objectives of understanding ACO goals, examples of the ACO process, and strategies for interdisciplinary management. It then provides an overview of ACOs as voluntary groups that assume responsibility for patient care and can share in savings if costs are reduced. The rest of the document discusses building integrated team medicine through physician-friendly data and leadership models, using data to better manage patients, and taking a community-wide approach to primary care and prevention.
The document discusses healthcare reform in the United States with the goal of cutting costs by 50% while improving quality and access. It argues that no single entity currently "owns" the regional healthcare system due to the separation of hospitals, insurance companies, and economic development agencies. The document proposes a model of integrated accountable care organizations that coordinate care across the entire population of a region through tools like medical homes, population health programs, and shared health information technology. The goal is an integrated system that achieves the cost and quality targets of healthcare excellence by 2015.
The management of the Minimum Data Set (MDS) 3.0 assessment schedule is complex and time consuming. Combining scheduled MDS assessments with unscheduled Prospective Payment System (PPS) Other Medicare Required Assessments (OMRAs) correctly will lead to accurate reimbursement and can ease the MDS workflow burden on the entire team, and save the facility costly mistakes due to noncompliance. Practitioners need to know what to do if the MDS schedule is not followed correctly, and how to regain compliance with the schedule as quickly as possible. This presentation reviews the scheduled and unscheduled PPS assessment requirements and describe how to select and set Assessment Reference Dates (ARDs) strategically and accurately. The presentation also discusses implications of not following the assessment schedule correctly, and how to regain compliance once an error in assessment scheduling is discovered. The Correction Process of existing MDS assessments, including modification, inactivation, and manual correction request will be discussed. This all-important information will help the MDS coordinator to maintain and regain federal compliance with the PPS assessment schedule.
1. Learn to outline the scheduled PPS assessment schedule and unscheduled PPS assessment requirements and explain the correct Assessment Reference Date selection for each assessment type.
2. Learn to state the correct application of default or provider liable days for an early, late, or missed scheduled or unscheduled assessment.
3. Learn to identify the appropriate use of the Start of Therapy OMRA, End of Therapy OMRA, End of Therapy-Resumption OMRA, and Change of Therapy OMRA.
4. Learn the eight criteria for a Medicare Short-Stay assessment.
5. Learn to identify the difference between a MDS modification and a MDS inactivation and recognize when to choose modification or inactivation.
Coding of activities of daily living (ADLs) on the MDS is complex and often misunderstood by those engaged in completing the assessment. In addition to affecting care, public information and survey, this area of the MDS has a tremendous financial impact. During this session, the speaker will define the late loss ADLs and provide insights aimed at helping facility staff document resident status accurately. Calculating the ADL score for the RUG-IV system will be reviewed and implications of inappropriate coding will be demonstrated. Using dollar-impact case studies, the attendee will learn why this section is critical for the facility’s financial success.
The MDS 3.0 has an impact on every aspect of care in a LTC or SNF. Reimbursement, Quality Measures, Five Star rating, Care Planning, and resident-centered care all begin with an accurate, standardized, and reproducible assessment.
Download the MDS 3.0: A Guide To Coding Accuracy by Beckie Dow, RN, RAC-MT for an overview of MDS 3.0. Beckie reviews the MDS 3.0 sections most vulnerable to error, while highlighting strategies for increased accuracy. Beckie also provides the MDS scheduling clinical qualifiers for each of the 66 RUG-IV categories and examples of potential financial losses due to inaccurate coding.
Learn How To:
1. Identify three MDS 3.0 Sections vulnerable to error.
2. Identify strategies for accurate reimbursement through the MDS 3.0 process.
3. Articulate three recent MDS 3.0 Coding instruction updates.
Skilled Nursing Facilities have seen a significant increase in Medicare Part A and Part B Therapy denials. The goal of medical review is to determine whether the services are reasonable and necessary, delivered in the appropriate setting, and coded correctly, based on appropriate documentation. The speaker will begin this seminar by discussing recent national trends in Medical Review, reasons for increased review and the various Medical Review programs. The speaker will present specific denial trends associated with Medicare Part B Claims. The presentation will culminate in a review of the keys to responding to a medical record request and appeal tips and strategies.
This document provides information about the Medicare appeals process from additional development requests (ADRs) to administrative law judge (ALJ) hearings. It includes biographies of the two speakers, Elisa Bovee and Carrie Mullin, who have extensive experience in long-term care and denials management. The document outlines the different levels of the Medicare appeals process and provides guidance on responding to ADRs and preparing appeal packages to contest claim denials.
Keep your MDS Coordinators and nursing staff up to speed in understanding the significance of accurate coding in section M and the required corresponding documentation. This presentation enables healthcare providers to provide quality healthcare through an understanding of wound coding in relationship to skin presentation for Section M on the MDS assessment.
1. Gain an understanding of the RAI User’s Manual intent of Section M.
2. Gain an understanding of the documentation required to support Coding in Section M.
3. Develop a clear understanding of accurate coding in Section M.
4. Learn to identify the significance of care planning and utilizing an interdisciplinary approach.
Cincom Synchrony is a software solution that helps healthcare organizations overcome challenges from US healthcare reform through three key capabilities: 1) Intelligent Guidance that provides real-time guidance for customer interactions; 2) a unified customer view that presents holistic patient information; and 3) cross-channel continuity across communication channels. The solution aims to improve care quality and reduce costs in line with reform goals through smarter customer interactions.
This New York Medicaid Nursing Facility Case Mix Seminar discusses the necessary documentation needed to support the assigned Medicaid RUG to ensure accurate reimbursement for care provided. New York OMIG Auditors are focused on auditing "high risk" Medicaid Case Mix MDSs for Nursing Facilities with a change in CMI by more than five percent for 2012.
1. Learn to identify the specific components of NY RUG-III 53 categories.
2. Learn to identify high risk NY RUG-III 53 categories.
3. Learn to identify documentation requirements to support the RUG components.
4. Learn to identify strategies for organization of the Medical Record in preparation for OMIG Audits.
Skilled Nursing Facilities have seen a significant increase in Medicare Part A and Part B Therapy denials. The goal of medical review is to determine whether the services are reasonable and necessary, delivered in the appropriate setting, and coded correctly, based on appropriate documentation. As a Skilled Nursing Facility leader, are you confident in your ability to appeal any and all denied claims that may arise in your building?
This document discusses various topics related to health care planning, including identifying sources of health care plans and types of coverage provided. It describes major provisions of plans and policies, as well as the purpose of disability income insurance. The document provides tips for reducing personal health care costs through prevention. It also discusses health insurance as financial protection and as part of risk management. Various types of health care providers, coverage, and policies are defined.
Cypress Benefit Administrators is a full service Third Party Administration (TPA) company. We specialize in helping companies outsource Flexible Spending Accounts (Section 125), HRA, HSA, and COBRA. Additionally, we provide expertise in self-funded medical plan administration.
Unleashing Patient’s Power in Improving Health and CareHealth Catalyst
We know that patient engagement has a powerful effect on outcomes, but we haven’t yet truly harnessed patient’s power. Maureen Bisognano, former president and CEO of the Institute for Healthcare Improvement (IHI) discusses the effect of patient engagement across the IHI Triple Aim: improving the experience of patient care, improving the health of populations, and lowering costs.
She shares examples of how increased patient engagement can help improve healthcare outcomes and deliver a better care experience while reducing costs. Such examples from her experience in the field include how lessons from the “flipped classroom” can be translated to healthcare, how technology can improve patient accountability and decision making, and other impactful stories.
The document discusses strategies for coping with serious illness for individuals and families. It notes that the US healthcare system is broken, with high rates of medical errors and adverse drug events. It also discusses the high costs of chronic diseases. The document advocates engaging health advocates and care managers to help navigate the healthcare system, create contingency plans, and coordinate care and resources. It provides an overview of factors to consider for an individual's health including physical, mental, emotional and spiritual health.
A comprehensive review of the Medicare appeal process. Appropriate for all SNF nursing staff, management, and therapy professionals. The presentation discusses the various levels of Provider Medicare appeal rights. The presentation further explains how facilities can thoroughly manage the appeal process and participate in a successful ALJ hearing.
Telemedicine Healthcare Solutions for Caregivers and Care CentersRaymond Lavine
Remember when you could speak with a doctor on the phone, It's Back!!! Care for those who need it at home or in a care center allows residents and caregivers to have access to a doctor to talk about routine or even more serious care questions.
The benefit of membership telemedicine -- Monthly subscription with no additional payments. Medical information is in a secure web link so that when a member speaks with a doctor, there is no delay to make an appointment and have to spend time providing health care information.
www.telemedicine4you.com
Managing the medical complexities of patients with cognitive and behaviors requires an interdisciplinary approach to care. The presentation details strategies and hands-on examples of management techniques for practical application in the SNF setting to ensure patients receive medically necessary Rehabilitation and Nursing Service.
1. Learn to identify underlying deficits leading to Behaviors.
2. Learn to define interdisciplinary assessment techniques.
3. Learn Management Strategies.
A detailed review of changes and updates discussed to the MDS 3.0 item set effective October 1, 2013. The course will provide an overview of the most recent MDS 3.0 User’s Manual updates. The speaker will review key elements for MDS coding, which will impact reimbursement based on the Federal Regulations in the FY 2014 Final Rule.
Vivian Anugwom presented on Allina Health's strategy to address health equity and eliminate health disparities. She discussed how Allina uses data analytics to identify disparities by patient race, ethnicity, language, and other factors. For example, data showed minorities are less likely to use hospice care. Allina provided implicit bias training to physicians to address potential biases influencing low hospice referral rates for African Americans. Vivian also outlined Allina's commitments in various roles to advance diversity, equity, and inclusion.
Information related to the impact of healthcare reform (Affordable Care Act) for 2014 and beyond. It takes an in-depth look at the ACA and its specific impact on California physicians. It further discusses opportunities presented as a result of the ACA and examples of how physicians and their practices can participate in these opportunities.
This document provides an overview and agenda for a presentation on successfully preventing and appealing denied Medicare claims. The presentation will cover audit triggers, contractor findings, medical record review preparedness, appeal tools, and strategies for successful appeals. It will discuss the admission documentation requirements, skilled care qualifications, and appeal processes to facilitate preventing and appealing denied claims.
The document discusses Accountable Care Organizations (ACOs) and strategies for interdisciplinary management. It begins by outlining the objectives of understanding ACO goals, examples of the ACO process, and strategies for interdisciplinary management. It then provides an overview of ACOs as voluntary groups that assume responsibility for patient care and can share in savings if costs are reduced. The rest of the document discusses building integrated team medicine through physician-friendly data and leadership models, using data to better manage patients, and taking a community-wide approach to primary care and prevention.
This document provides an overview of skilled nursing care criteria under Medicare. It discusses the objectives of reviewing Medicare medical review and identifying strategies for appealing denied claims. It defines skilled care as requiring professional health personnel and being needed daily. Specific skilled services are covered, including those involving inherent complexity, skilled observation and assessment, and management and evaluation of a care plan. Examples are provided for each category to illustrate when skilled care criteria would be met.
The document is a presentation by Kris Mastrangelo, President and CEO of Harmony Healthcare International, about an OIG report on Medicare billing by skilled nursing facilities in 2009. The summary found that 24.9% of claims had billing errors, with 20.3% being upcoded for more expensive treatments than were provided, 2.5% being downcoded, and 2.1% being billed for non-covered conditions. Specifically, the report found 22.8% of claims had inaccurate billing codes assigning the patients to higher reimbursement levels, and SNFs misreported therapy information on the MDS form for 47% of claims.
FY 2014 is under way and providers continue to struggle to provide quality care in an audit climate. The key to Medicare compliance is understanding the requirements. This presentation overviews the trends in the Skilled Nursing Facility (SNF) industry related to the provision of quality Medicare services. The presentation also covers the recently released Centers for Medicare and Medicaid Services(CMS) and Office of Inspector General (OIG) announcements, reports and manuals impacting the provision Medicare of services in a Skilled Nursing Facility setting. Learn what is happening with the JIMMO Settlement as the CMS January 24th deadline has passed. Are you ready to receive your next PEPPER report? Are you ready for ICD-10? What is the OIG 2014 work plan? Harmony Healthcare International (HHI) summarizes the need to know information to ensure providers are prepared for FY2014.
This presentation provides a comprehensive review and forecast of the trends in Medicare Medical Review by numerous Medicare Contractors and is appropriate for all SNF Management, nursing staff, and therapy professionals. The presentation provides insight on the tidal wave of newly exposed compliance issues at the eye of the storm, leading to remote and on-site audits in the long-term care industry. Presentation highlights the historical drought in audits and the tornado effect the current scrutiny is causing amongst the SNF providers. Learn strategies to prepare records before the impending audit storm. Avoid slip ups on the seemingly invisible black ice of Medicare non-compliance. Become aware of the most recent CMS updates impacting the RAI process and subsequently reimbursement. Create an anemometer for Managers and staff to read the winds of change and create clear visibility for accurate and compliant records.
1. Learn to summarize the multiple types of Medicare Contractor Audits and associated Compliance themes.
2. Understand the trends and triggers in Compliance Audits and Common Provider Pitfalls.
3. Learn strategies for appealing Medicare Claim Denials.
This document summarizes a presentation about healthcare compliance for skilled nursing facilities (SNFs). It discusses the impact of Office of Inspector General (OIG) audits finding high rates of billing errors in SNF Medicare claims. It reviews the Program for Evaluating Payment Patterns Electronic Report (PEPPER), which analyzes SNF claims data to identify outlier facilities. It emphasizes the importance of SNFs developing compliance programs to regularly audit claims and ensure appropriate billing. It also notes increased government scrutiny of healthcare fraud and changes to false claims acts that expand liability for incorrect billing.
The Skilled Nursing Facility (SNF) “Program for Evaluating Payment Patterns Electronic Report” (PEPPER) was released in April 2014 by CMS. Join Keri Hart, MS, CCC-SLP, CHHRP-QT, RAC-CT, in this in-depth interpretation of the elements of the PEPPER. Keri will detail how to interpret your PEPPER and discuss the practical application of this critical information to your Skilled Nursing Facility’s practice. Follow along with your own PEPPER report to develop an action plan to ensure compliance with Medicare regulatory requirements and ensure accurate reimbursement for clinically appropriate care provided.
CMS introduced this new annual report for Skilled Nursing Facilities in August 2013. PEPPER data is shared with both Medicare Administrative Contractors (MACs) and the Medicare Recovery Audit Contractors (RACs). This important report details your facility-specific Medicare claims data in certain targeted areas and compares your facility to other SNFs Nationally, by State and by Jurisdiction (Medicare Administrative Contractors/Fiscal Intermediaries).
This presentation includes a detailed review of changes and updates discussed to the MDS 3.0 item set effective October 1, 2013. The presentation provides an overview of the most recent MDS 3.0 User’s Manual updates and reviews key elements for MDS coding, which will impact reimbursement based on the Federal Regulations in the FY 2014 Final Rule.
The document summarizes a settlement from a lawsuit called Jimmo v. Sebelius that challenged Medicare's use of an "improvement standard" for determining coverage. Key points include:
- The lawsuit was brought on behalf of Medicare beneficiaries who had services denied because they were not deemed likely to improve.
- The settlement prohibits denying coverage solely based on lack of improvement and requires consideration of individual needs and medical complexity.
- Services must require the skills of a therapist or nurse rather than being tasks that can be provided by others. Documentation must support the need for skilled care.
A comprehensive review of the Medicare appeal process. Appropriate for all SNF nursing staff, management, and therapy professionals. The presentation discusses the level of Medicare appeal, how facilities can thoroughly and timely manage the appeal process, and how facilities can participate in a successful ALJ hearing.
As digitization of the healthcare industry increases, the need to safeguard electronic patient data is also becoming increasingly important. Electronic protected health information (ePHI) is not just in the electronic medical records (EMRs). It also resides in emails, in documents and images on computers, servers, printer hard drives and mobile devices like laptops, cell phones, tablets and USB memory sticks. Healthcare professionals are also using texting and online file sharing services to conveniently share confidential information. The loss of this confidential patient health information is disastrous for patients and healthcare organizations.
The Centers for Medicare and Medicaid Services (CMS) recently released S&C Memo 13-35-NH, which discusses the use of psychopharmacological medications and behavioral management in America’s Nursing Homes. The management of behavioral or psychological symptoms of dementia (BPSD) is a challenge in Nursing Homes. In this presentation viewers will learn valuable behavioral management techniques that can be utilized to decrease patient dependency on psychopharmacological medication. Important government initiatives, including The Partnership to Improve Dementia Care in Nursing Homes are discussed. The presentation also discusses the recent updates to interpretive guidelines of F309 (Quality of Care) and F329 (Unnecessary Drugs), and details the Seven Dementia Care Principles provided by CMS to assist nursing homes to manage behavioral or psychological symptoms of BPSD.
1. Learn the content of S&C Memo 13-35-NH and the implications of this memo on daily resident care
2. Learn to articulate the intent and impact of F309 and F329 on resident health and well-being, and identify strategies to maintain compliance with the regulatory intent of these regulations
3. Learn about the seven Dementia Care Principles provided by CMS to assist nursing homes to manage behavioral or psychological symptoms of BPSD
4. Identify the seven Dementia Care Principles provided by CMS to assist nursing homes to manage behavioral or psychological symptoms of BPSD
We live in a world where our decisions are impacted by the results Google displays to us. When we need a second opinion we turn to our favorite Social Media outlet. You might not think that the world being described impacts the Skilled Nursing Facilities you run; but it does. Learn how the Best-In-Class Skilled Nursing Facilities are using Google and Social Media to position themselves for success in the age of digital marketing.
Managing the medical complexities of patients with cognitive and behaviors requires an interdisciplinary approach to care. The presentation details strategies and hands-on examples of management techniques for practical application in the SNF setting to ensure patients receive medically necessary Rehabilitation and Nursing Service.
On July 31, 2014, the Centers for Medicare and Medicaid Services (CMS) issued the Final Rule under the Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities to be implemented on October 1, 2014. This seminar will discuss the impact of Fiscal Year 2015 Medicare payment rate increases for Skilled Nursing Facilities (SNFs) and will review the most recent Office of Management and Budget (OMB) statistical area delineations affecting the SNF PPS Wage Index. Learn about the revision to the existing COT OMRA policy. Additionally attendees will be apprised of updates to Chapter 8, Section 30 of the Medicare Benefit Policy Manual (Pub. 100-02) which directs providers on coverage decisions for reasonable and necessary treatment of patient’s illness or injury.
The Skilled Nursing Facility (SNF) “Program for Evaluating Payment Patterns Electronic Report” (PEPPER) was released in April 2014 by CMS. CMS introduced this new annual report for Skilled Nursing Facilities in August 2013. PEPPER data is shared with both Medicare Administrative Contractors (MACs) and the Medicare Recovery Audit Contractors (RACs). This important report details your facility-specific Medicare claims data in certain targeted areas and compares your facility to other SNFs Nationally, by State and by Jurisdiction (Medicare Administrative Contractors/Fiscal Intermediaries).
Improve participation and functional outcomes through creativity out of the gym. Functionally based treatment will ensure patients receive medically necessary physical therapy, occupational therapy and speech services. The presentation reviews practical application to Medicare requirements.
1. Learn to identify creative treatment strategies.
2. Learn to define Medicare coverage and Medicare documentation.
3. Learn to identify the clinical benefits of Functional Based Therapies.
The document summarizes key findings from an OIG report on Medicare billing errors by skilled nursing facilities (SNFs) in 2009. The report found that 24.9% of SNF claims had billing errors, with 20.3% being upcoded for more expensive treatments than were provided. SNFs also misreported therapy amounts on 47% of claims. The OIG made recommendations to increase medical reviews of SNF claims and monitor facilities more closely for inaccurate billing."
In February 2013, the Office of Inspector General (OIG) released a report entitled Skilled Nursing Facilities Often Fail to Meet Care Planning and Discharge Planning Requirements, in which they found that 26% of facilities fail to meet care planning and discharge planning requirements. Is your facility meeting federal guidelines for care planning?
Download the ABC’s of Care Planning presented by Beckie Dow, RN, RAC-MT for an overview of Care Planning in the Skilled Nursing Facility. Beckie discusses the important link between the MDS 3.0, the Care Area Assessments (CAAs) and the Care Plan.
Learn the essential components of a resident-centered care plan and how to develop a care plan that supports the clinical care that is provided to the patient. Beckie also discusses strategies for completing the CAAs more effectively and using the CAA process to create a more resident-specific care plan.
Learn How To:
1. Define the purpose of a Care Plan.
2. Define the purpose of the Discharge Care Plan and Summary.
3. Identify the correlation between the MDS 3.0 Assessment, the Care Area Assessments (CAAs), accurate RUG-IV Classification, and the Care Plan.
4. List three components of a Resident-centered Care Plan.
The ethics of performance monitoring-private sector perspectiveDavid Quek
Increasingly medical practice is coming under intense scrutiny as to what is appropriate and affordable care, including serious considerations of patient safety issues and protection. Medical professionalism must be consciously adhered to as we try and find the best health care for our patients at the best value and outcomes for our patients themselves, and also for society at large. In view of escalating health care costs, physician autonomy to practice as he or she likes or deems fit has now come under siege with more and more performance monitoring, not just for appropriateness, but also for outcomes, necessity and cost-effectiveness. Physician' vested interests must be tempered with evidence-based benefits or at least be associated with no increase in harm or incur affordability issues. Fraudulent physician malfeasance are now being uncovered via whistle-blowers, or through greater more meticulous audit of various validated performance measures, and those physicians found to have flouted these due to pecuniary self-interests, overuse of tests or procedures have been found guilty and sanctioned with heavy fines, return of reimbursements as well as imprisonment, and erasure from medical registries and the removal of license to practice.
United Health Group Summary Annual Report for period ended December 31, 2007finance3
The document is UnitedHealth Group's 2007 annual report. It contains the mission statement, letters from the CEO, and descriptions of programs aimed at improving healthcare access. The high-level points are:
1) UnitedHealth Group's mission is to help people lead healthier lives by improving healthcare quality, access, and affordability.
2) In 2007, the company saw increases in revenue across all business segments and solid financial results.
3) The CEO letter discusses UnitedHealth Group's role as stewards of the healthcare system and their goals of increasing consumer choice, personalizing care, and simplifying the system.
Partnering for Population Health: Strategies to Promote Collaboration Among t...Conifer Health Solutions
A patient-centered approach to care delivery will bring the best health outcomes for individuals, as well as the community. While it is clear that effective population health management is integral to better health, providers can no longer be the sole proprietors of data and information. Improving a population’s health will depend on strong alliances with community stakeholders that generally have not experienced a strong history of collaboration. In the new healthcare landscape, providers, payers and employers must partner to reduce cost, boost quality and improve the health of their shared populations. These new partnerships may start with a few glitches. However a strategic plan, clear objectives and an engaged, informed patient will smooth the path to improved outcomes.
The document discusses the growing interest in coordinated and integrated healthcare delivery through models like patient-centered medical homes (PCMHs) and accountable care organizations (ACOs). It notes the potential benefits of these models, including improved quality of care and reduced costs. Specifically, it cites evidence that Geisinger Health System achieved a 9% reduction in total healthcare costs and lower hospital admission and readmission rates through implementing a PCMH-based accountable care model. The long-term goal is for PCMHs and ACOs to transform healthcare delivery in the US to a more coordinated, high-value system focused on primary care.
dr seema dixit ppt on dental ethics - Copy.pptSeema Dixit
This document discusses the key principles of dental ethics:
1) It provides an introduction to dental ethics and its importance in guiding moral conduct for dentists in their treatment of patients.
2) It outlines six main international principles of dental ethics: non-maleficence, beneficence, autonomy, justice, veracity, and confidentiality.
3) These principles guide dentists' obligations to do no harm, provide benefit, respect patient autonomy and informed consent, promote fairness and justice, be truthful, and maintain confidentiality.
TDI Startup Insurtech Award - doc_doc-deck_digital-insurer_insurtech-awardThe Digital Insurer
The document discusses how DocDoc is transforming insurance through patient empowerment and the right care at the right time. It summarizes DocDoc's AI-powered doctor discovery tool called HOPE, which provides personalized recommendations for doctors based on predicted outcome, price, and experience. It also outlines DocDoc's services which include discovery consultations, telemedicine support, and cashless payments to empower policyholders in their healthcare decisions. DocDoc has built Asia's largest doctor network and aims to change health insurance by supporting both agents and policyholders.
Dr. Y misdiagnosed and overprescribed medication to patient X, which led to their death from a heart attack. This was a case of medical malpractice and unintentional tort. As a healthcare ethics consultant, I would provide training to Dr. Y on the four principles of healthcare ethics: autonomy, beneficence, non-maleficence, and justice. Training should cover informed consent, doing what is best for the patient, avoiding harm, and fairness. The goal is to prevent future ethical violations and protect patient safety.
The document provides an overview of Imara Healthcare, a company aiming to revolutionize healthcare by making it easily accessible through technology, expertise, and compassion. The summary highlights:
- Imara Healthcare's vision is to become the leading hallmark of the healthcare industry in emerging markets.
- Its goal is to provide accessible and affordable healthcare through state-of-the-art infrastructure, advanced technology, and a team of dedicated healthcare professionals.
- It operates various healthcare services including pharmacies, clinics, medical centers, and plans to establish multi-specialty hospitals and centers of excellence in the future.
Permanente Medicine is a physician-led, prepaid healthcare model that aims to invent the future of medicine. It prioritizes quality, consumer experience, and cost containment over profit. Permanente physicians have state-of-the-art facilities, technology-enabled tools like advanced EMR systems, and a culture of collaboration and continuous improvement. This allows Permanente Medicine to consistently earn top honors in performance and deliver integrated, coordinated, and patient-centered care.
Dr. Y misdiagnosed and overprescribed medication to Patient X, which led to their death from a heart attack. This was a case of medical malpractice and unintentional tort. Patient X's family could sue Dr. Y for negligence, having to prove that Dr. Y deviated from the standard of care by misreading the medication instructions and that this caused Patient X's death. Healthcare ethics principles of autonomy, beneficence and non-maleficence were violated. Providers must respect patient autonomy, act in their best interest, and do no harm. Ongoing training in healthcare ethics is important to avoid such violations and ensure principles of justice, respect and fairness are followed.
This document provides an overview of basic concepts in healthcare quality. It defines key terms like effectiveness, efficacy, dimensions of quality care including safety, timeliness, efficiency and more. It also discusses healthcare organizations as complex adaptive systems and the importance of standards, guidelines and other resources to improve quality. Overall it aims to introduce foundational ideas around measuring, assuring and improving the quality of healthcare delivery.
Edwina Rogers, executive director of Patient-Centered Primary Care Collaborative, began her presentation by highlighting the movement to advance medical homes.
With the U.S. being the number one in the world for the cost of healthcare and ranked number 37 in the quality category, something needs to change. Rogers discussed the broad stakeholder support and participation for the movement, as well as the incredible volunteer involvement. The four ‘centers’ include: the Center to Promote Public-Payer Implementation, the Center for Multi-Stakeholder Demonstration, the Center for eHealth Information Adoption and Exchange and the Center for Health Benefit Redesign and Implementation. Medical Homes will provide superb access to care, patient engagament in care, clinical information systems, care coordination, team care, patient feedback and publically available information.
Edwards explained that the Obama administration believes the medical homes concept is the best way to approach healthcare reform. The U.S. House of Representatives has showed great support for the movement and is helping develop and allocate funds for a five-year pilot program. She expressed her enthusiasm for the movement and her prediction that the medical home model is certainly the future of health care.
A complete version of Rogers’ presentation on the Patient-Centered Primary Care Collaborative is available online.
The Joint Commission Has Instituted A Number Of Goals...Valerie Burroughs
The Joint Commission has instituted several goals nationally to improve patient safety. The goals focus on areas of concern in healthcare like patient identification, communication between caregivers, and medication safety. The Joint Commission accredits hospitals and other healthcare organizations to evaluate them based on performance standards related to patient care, safety, and rights.
Rock Report: Personalization in Consumer Health by @Rock_HealthRock Health
Overview of personalization in healthcare, including opportunities, barriers and case studies related to a market estimated to reach $450B+ by 2015. Purchase the report here: https://gumroad.com/l/XxcA
Imagine a healthcare system where people live long, healthy lives, receiving quality, affordable care, with clinicians nationwide collaborating to improve outcomes. That's Accountable Care! Learn the benefits of becoming an ACO in this insightful eBook.
The healthcare delivery model is being transformed and each stakeholder has an integral part to play in its much needed success. Healthcare delivery organizations, payers, and employers have typically shouldered much of this responsibility, and now patients are being added to the mix as their consumer influence and purchasing power grows. Porter Research President Cynthia Porter will explore this evolution and the industry trends that have turned previously backseat patients into some of healthcare's most powerful drivers.
Presented in April 2012 at Breakthrough 2013 - the Medecision Client Forum
The document discusses Qualis Health's mission to generate and disseminate knowledge to improve healthcare quality and outcomes. It describes some of Qualis Health's activities in 2006 to work towards healthcare safety, effectiveness, patient-centeredness, timeliness, efficiency and equity. These included supporting initiatives to reduce hospital errors and infections, applying evidence-based guidelines, providing individualized case management, helping implement electronic records, and working to reduce disparities. The document also summarizes some of Qualis Health's work with Medicare providers and beneficiaries around medication management, cultural competency training, and preventing pressure ulcers and physical restraints.
The document discusses various perspectives on quality healthcare including those of the government, patients, and healthcare providers. It outlines the government's national strategy for quality improvement and focuses on better care, healthy communities, and affordable costs. The patient perspective values compassionate care, time with physicians, timely appointments, and preventative programs. Providers value proven outcomes and reduced errors. The document also discusses opportunities to lower costs through standardized care and reducing unnecessary variations in treatment and costs. It provides examples of accountable care organizations and bundled payments that aim to improve care coordination and reduce costs.
This document summarizes the key requirements and components of a Physician Assistant program. It notes that PA programs require a bachelor's degree and healthcare experience. The typical program is 26 months and includes coursework in various medical subjects totaling over 800 hours. Clinical rotations are required in areas like internal medicine, pediatrics, psychiatry, and surgery. To become certified, one must complete an accredited PA program and pass the Physician Assistant National Certifying Examination.
5 The Physician–Patient Relationship Learning Objectives After.docxalinainglis
5 The Physician–Patient Relationship
Learning Objectives
After completing this chapter, you will be able to:
· 1. Define the key terms.
· 2. Describe the rights a physician has when practicing medicine and when accepting a patient.
· 3. Discuss the nine principles of medical ethics as designated by the American Medical Association (AMA).
· 4. Summarize “A Patient’s Bill of Rights.”
· 5. Understand standard of care and how it is applied to the practice of medicine.
· 6. Discuss three patient self-determination acts.
· 7. Describe the difference between implied consent and informed consent.
Key Terms
Abandonment
Acquired immune deficiency syndrome (AIDS)
Advance directive
Against medical advice (AMA)
Agent
Consent
Do not resuscitate (DNR)
Durable power of attorney
Human immunodeficiency
virus (HIV)
Implied consent
Informed (or expressed)
consent
Incompetent patient
In loco parentis
Living will
Minor
Noncompliant patient
Parens patriae authority
Privileged communication
Prognosis
Proxy
Uniform Anatomical Gift Act
THE CASE OF DAVID Z. AND AMYOTROPHIC LATERAL SCLEROSIS (ALS)
David, who has suffered with ALS for 20 years, is now hospitalized in a private religious hospital on a respirator. He spoke with his physician before he became incapacitated and asked that he be allowed to die if the suffering became too much for him. The physician agreed that, while he would not give David any drugs to assist a suicide, he would discontinue David’s respirator if asked to do so. David has now indicated through a prearranged code of blinking eye movements that he wants the respirator discontinued. David had signed his living will before he became ill, indicating that he did not want extraordinary means keeping him alive.
The nursing staff has alerted the hospital administrator about the impending discontinuation of the respirator. The administrator tells the physician that this is against the hospital’s policy. She states that once a patient is placed on a respirator, the family must seek a court order to have him or her removed from this type of life support. In addition, it is against hospital policy to have any staff members present during such a procedure. After consulting with the family, the physician orders an ambulance to transport the patient back to his home, where the physician discontinues the life support.
· 1. What were the primary concerns of the hospital?
· 2. What was the physician’s primary concern?
· 3. When should the discussion about the patient’s future plans have taken place with the hospital administrator?
Introduction
Few topics are as important as the physician–patient relationship. This relationship impacts the entire healthcare team. All healthcare professionals who interact with the patient must understand their responsibilities to both the patient and the physician. The patient’s right to confidentiality must always be paramount.
The first physicians were “medicine men,” witch doctors, or sorcerers. The physician–pa.
Can your Skilled Nursing Facility (SNF) afford to provide care to Medicare patients and not receive accurate and appropriate reimbursement? The resources utilized to respond to additional documentation requests, manage denials and the loss of revenue for care provided can have a devastating impact on your facilities budget. In addition, early identification of potential issues and prompt resolution of actual issues reduces a facilities risk of hefty fines and penalties related to non-compliance.
Skilled Nursing Facilities are required to have a compliance program effective March 2013. Compliance programs strengthen and document a SNFs efforts to prevent and reduce Medicare fraud and abuse and ensure accurate and appropriate reimbursement for quality care provided. Under SNF compliance regulations Medicare has redefined the definition of fraud. When a facility has not taken all the necessary steps to ensure all the technical and clinical qualifications are supported by your medical records to prevent improper billing, fines and penalties may be applied. The critical components of an effective compliance program include monitoring and auditing to ensure Skilled Nursing Facility provider's have a formalized and proactive approach towards detecting fraud, abuse, and waste of precious company resources.
This document discusses strategies for appealing denied Medicare claims. It begins with an introduction to the presenter, Carrie Mullin, and her experience reviewing denied claims. The objectives are then outlined as understanding Medicare medical review goals, identifying documentation to support skilled care, and strategies for appeals. The document goes on to list common denial reasons from Medicare and provides suggestions for additional documentation to address potential denial issues in an appeal. It emphasizes understanding Medicare guidelines and policies to effectively argue that skilled services were necessary.
The goal of medical review is to determine whether the services are reasonable and necessary, delivered in the appropriate setting, and coded correctly, based on appropriate documentation. The speaker will begin this seminar by discussing the goals of Medical Review and various Medical Review programs including Recovery Audit Contractor (RAC) and Carrier (Medicare Administrative Contractor or Fiscal Intermediary) Medical Review programs.
Survey preparation is a never ending process and with the new QIS survey process in transition, it represents a new paradigm shift. This presentation will provide insight into key elements, tips and strategies that providers should use as part of their quality assurance survey preparation efforts. Learn from this multi-level licensed nursing home administrator with expertise in regulatory compliance sharing his lessons learned through the years.
Preventing falls in the SNF environment can be a challenge. Learn how to become a fall CSI and inspire your interdisciplinary team to meet the challenge of Falls Reduction. Improve patient care and survey outcomes.
1. Learn to detail the Benefit of Root Cause analysis.
2. Gain an understanding of the Fall Investigation process.
3. Develop a clear understanding of accurate coding in Section M.
4. Learn how to verbalize the benefit of interdisciplinary involvement and follow-up for Fall Events.
In February 2013, the Office of Inspector General (OIG) released a report entitled Skilled Nursing Facilities Often Fail to Meet Care Planning Requirements, in which they found that 26% of facilities fail to meet care planning requirements. Is your facility meeting federal guidelines for care planning? This presentation discusses the important link between the MDS 3.0, the Care Area Assessments (CAAs) and the care plan. Learn the essential components of a resident-centered care plan, how to develop a care plan that supports the clinical care that is provided to the patient, and how to proactively maintain a care plan that will meet annual survey requirements. The presentation discusses strategies for completing the CAAs more effectively, and how the CAA process can be used to create a more resident-specific care plan. Learn to develop a resident centered known as ( I careplan) through a workshop discussing different elements of the careplan, from profile, interim, and diagnosis.
1. Gain an understanding of the purpose of a Care Plan.
2. Learn to define the purpose of the discharge Care Plan and Summary.
3. Learn to to articulate the link between the MDS 3.0 assessment, the nursing Care Plan, the discharge Care Plan, and accurate RUG-IV classification.
4. Understand the the correlation between the MDS 3.0 assessment, the Care Area Assessments (CAAs), and the Care Plan.
Provisions set forth in the Affordable Care Act (ACA) require the Centers for Medicare and Medicaid Services (CMS) to broaden quality improvement activities in nursing homes. Although the mandatory implementation date for nursing homes to provide evidence of a systematic Quality Assurance and Performance Improvement (QAPI) program has been delayed, but facilities should not delay in implementing a detailed and well-documented QAPI program. This presentation moves beyond the five elements of a QAPI and begins to drill down to practical concepts for “beefing up” an existing Quality Improvement program to meet QAPI standards. Learn how to objectively assess where your facility is in the QAPI journey, and gain a deeper insight into how practical implementation of QAPI activities can be a part of the culture of excellence that is part of all successful nursing homes.
1. Learn to detail the five elements of QAPI and correlate the five elements to the twelve step action plan for QAPI implementation.
2. Learn to articulate the steps to evaluating their facilities progress in QAPI efforts.
3. Understand Performance Improvement Projects (PIPs).
4. Learn the five steps of Root Cause Analysis (RCA) and learn how to apply the RCA process to adverse events in their facility routinely.
This presentation provides a comprehensive pro-active review of program development for long-term care patients in the SNF. The course outlines suggestions for how rehabilitation team members can strengthen the Medicare Part B programming in the nursing facility. An overview of the Medicare Part B Guidelines, Part B Caps, Functional Limitation G-Codes, and Manual Reviews is also provided. The presentation also discusses Medicare Part B documentation, goal writing and reasons for denied claims.
1. Gain an understanding of Proactive Medicare Part B Program Development and how to strengthen the program components.
2. Gain a better understanding of Medicare Part B documentation components, goal writing and potential risk for receiving denied claims.
3. Gain an understanding of Medicare Part B Guidelines, Medicare Part B Caps, Functional Limitation G-Codes and Medical Reviews.
The presentation details the value of standardized therapy assessment as it relates to patient care treatment planning and evidencing Medicare audits. Standardized assessments can help evidence your patients’ progress. In addition, standardized assessment can better define deficits and assist in treatment planning.
1. Learn to identify the Benefits of utilizing Standardized assessments
2. Learn to summarize appropriate use of standardized therapy assessments
3. Learn the reasons standardized assessments can be used to evidence progress and support Medicare Part G-codes
One of the major goals in MDS 3.0 is to give residents and families a more active voice in the care delivered. Interviewing processes are provided in the MDS 3.0 RAI user’s manual to help caregivers obtain quality, accurate information from patients with focused scripted interview questions. This presentation discusses techniques for interviewing that will assist with achieving more accurate data for physical therapy care and MDS coding. The presentation reviews key sections of the MDS that are coded based on direct patient interviews.
1. Learn to identify the MDS Sections which are coded based on scripted resident interview.
2. Learn to describe three specific techniques that can be used to achieve accurate interview results.
3. Gain an understanding of key RUG reimbursement and quality measure impacts of the resident interviews.
4. Learn to summarize strategies for utilization of resident interview data to drive quality of care and improve quality of life in the SNF.
Readmissions are a heightened focus under the Affordable Care Act. Initiatives are in place to reduce hospital admission through improving transition in care. During this course the speaker will discuss CMS quality initiatives, care transition, projects and barriers. This presentation reviews the key elements to tackling Avoidable Readmissions.
1. Learn to summarize the CMS quality initiative for healthcare reform related to hospital readmissions
2. Learn to identify underlying causes and barriers related to readmissions
3. Learn to state current CMS research projects and pilot programs
4. Learn to identify hospital and SNF strategies for collaboration
More from Harmony Healthcare International (HHI) (11)
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.