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.
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. 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 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. 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).
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.
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 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.
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.
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. 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 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. 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).
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.
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 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.
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.
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.
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.
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. 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.
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.
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.
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?
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.
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.
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.
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.
“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.
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.
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.
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.
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.
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.
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.
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.
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.
Security breaches have strong foot on healthcare industry this year. Nearly half of the organizations in healthcare were hit by security threats at least once this year and it is expected to increase in the forthcoming years.
The security breaches under HIPAA Violations could be classified as
• Stealth of Devices
• Process loopholes
• Employee Snooping
• Software defects
• Hacking
1Anthem Inc. HIPAA ViolationJune 21, 2021EttaBenton28
1
Anthem Inc. HIPAA Violation
June 21, 2021
Anthem Inc. HIPAA Violation
Case Analysis
Anthem, a healthcare insurance provider situated in the US, is among some of the organizations that have violated HIPAA laws. Based on OCR (2018) illustrations, the incorporation paid sixteen million US Dollars and committed to take extensive remedial measures to address alleged HIPAA breaches after a sequence of hacks resulted to the biggest infringement of U.S. health information in ever. An estimate of 79 million Electronic Protected Health Information (ePHI) which included name and medical IDs were stolen.
HIPAA Privacy and Security Rules Violated
Some of HIPAA regulations desecrated by Anthem Inc. included hackers (unauthorized persons) accessing PHI through Anthem’s database, failing to carry out a risk analysis as well as managing confidentiality, integrity and availability risks of PHI and failing to device defense mechanisms that wound ensure the discretion, integrity and availability of PHI. Additionally, ePHI belonging to the 79 million patients were not encrypted or Anthem didn’t apply equivalent measures that would help in preventing the hackers from accessing the data. The attacks began on 2014 and were discovered in 2015 and yet Anthem didn’t implement adequate access measures that would help in preventing ePHI from being accessed. Information stolen by hackers included the names of individuals and their health insurance IDs.
Penalties Imposed
Several penalties were imposed to Anthem Inc. including paying sixteen million Dollars to the office of civil rights (OCR) in the 2018. Also, because of the filed litigations and lawsuits following the breach, for patients whose health information was stolen the company had to pay one hundred and fifteen million Dollars. The total cost paid by Anthem Inc. for violating HIPAA privacy and security laws including HIPAA state laws was one hundred and seventy-nine million Dollars. The sanction included a $48.2 million cash penalty. OCR required Anthem Inc. to include preventive measures to enhance data security standards.
Health System Improvement Plan
Components
Subcomponents and roles
Anthem Health system leadership and governance
Responsible for electronic health information, legal and regulatory framework, information requirements and health system leadership and management
Anthem Health system management
Evaluating and monitoring of health system, mobilizing resources, and continuous professional development.
ICT infrastructure
Responsible for maintaining, infrastructure and communication networks
Interoperability of systems and data
Includes data management, network segmentation, data encryption and surveillance of information system doings.
Quality of data
Assurance of quality data
Data usage
Strategies on how data should be used, accessed, use proficiencies and impacts
Risk analysis strategy
Threat
Vulnerability
Asset
Consequences
Likelihood
Control
Data breach
Less protection
...
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.
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.
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. 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.
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.
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.
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?
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.
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.
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.
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.
“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.
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.
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.
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.
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.
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.
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.
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.
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.
Security breaches have strong foot on healthcare industry this year. Nearly half of the organizations in healthcare were hit by security threats at least once this year and it is expected to increase in the forthcoming years.
The security breaches under HIPAA Violations could be classified as
• Stealth of Devices
• Process loopholes
• Employee Snooping
• Software defects
• Hacking
1Anthem Inc. HIPAA ViolationJune 21, 2021EttaBenton28
1
Anthem Inc. HIPAA Violation
June 21, 2021
Anthem Inc. HIPAA Violation
Case Analysis
Anthem, a healthcare insurance provider situated in the US, is among some of the organizations that have violated HIPAA laws. Based on OCR (2018) illustrations, the incorporation paid sixteen million US Dollars and committed to take extensive remedial measures to address alleged HIPAA breaches after a sequence of hacks resulted to the biggest infringement of U.S. health information in ever. An estimate of 79 million Electronic Protected Health Information (ePHI) which included name and medical IDs were stolen.
HIPAA Privacy and Security Rules Violated
Some of HIPAA regulations desecrated by Anthem Inc. included hackers (unauthorized persons) accessing PHI through Anthem’s database, failing to carry out a risk analysis as well as managing confidentiality, integrity and availability risks of PHI and failing to device defense mechanisms that wound ensure the discretion, integrity and availability of PHI. Additionally, ePHI belonging to the 79 million patients were not encrypted or Anthem didn’t apply equivalent measures that would help in preventing the hackers from accessing the data. The attacks began on 2014 and were discovered in 2015 and yet Anthem didn’t implement adequate access measures that would help in preventing ePHI from being accessed. Information stolen by hackers included the names of individuals and their health insurance IDs.
Penalties Imposed
Several penalties were imposed to Anthem Inc. including paying sixteen million Dollars to the office of civil rights (OCR) in the 2018. Also, because of the filed litigations and lawsuits following the breach, for patients whose health information was stolen the company had to pay one hundred and fifteen million Dollars. The total cost paid by Anthem Inc. for violating HIPAA privacy and security laws including HIPAA state laws was one hundred and seventy-nine million Dollars. The sanction included a $48.2 million cash penalty. OCR required Anthem Inc. to include preventive measures to enhance data security standards.
Health System Improvement Plan
Components
Subcomponents and roles
Anthem Health system leadership and governance
Responsible for electronic health information, legal and regulatory framework, information requirements and health system leadership and management
Anthem Health system management
Evaluating and monitoring of health system, mobilizing resources, and continuous professional development.
ICT infrastructure
Responsible for maintaining, infrastructure and communication networks
Interoperability of systems and data
Includes data management, network segmentation, data encryption and surveillance of information system doings.
Quality of data
Assurance of quality data
Data usage
Strategies on how data should be used, accessed, use proficiencies and impacts
Risk analysis strategy
Threat
Vulnerability
Asset
Consequences
Likelihood
Control
Data breach
Less protection
...
Protecting ePHI: What Providers and Business Associates Need to KnowNetwork 1 Consulting
HIPAA defined 18 Protected Health Information (PHI) identifyers. Electronic PHI (ePHI) is the computer version of PHI. What are the risks of not protecting ePHI? And what are the best practices and tips for protecting ePHI.
PYA Principal Barry Mathis presented “Hot Topics in Privacy and Security,” at the Florida Hospital Association's 14th Annual Health Care Corporate Compliance Education Retreat.
The presentation explored:
• Changes in the privacy and security ecosystem.
• Emerging technology risks and hot topics.
• What happens to hacked data.
• How to best protect data.
This document provides an overview of a mandatory training session on HIPAA confidentiality requirements. The training covers what protected health information is, employees' responsibilities to maintain security and privacy of electronic PHI, and examples of HIPAA violations and consequences. The goals are to increase knowledge of PHI, enhance awareness of roles in following HIPAA rules, and inform about reporting responsibilities and penalties for violations.
Regulatory frameworks like HIPAA, HITECH, and Meaningful Use establish standards for protecting patient health information and incentivizing adoption of electronic health records. Security frameworks such as NIST and ISO provide best practices for information security controls. Recent case studies show common HIPAA violations include unencrypted devices, email phishing, and improper access controls. Current topics in healthcare cybersecurity include implementing the basics of risk assessment, policies, and technical controls; evaluating risks from business partners; and protecting against ransomware through regular patching and backups.
The document discusses MBM eHealthCare Solutions' HIPAA and HITECH compliance consulting services. It provides an overview of the HIPAA Privacy and Security Rules and their requirements regarding protected health information. MBM offers compliance assessments, risk analyses, audits, and training to help covered entities meet HIPAA's standards for privacy, security, and electronic health records.
Understanding the Importance of HIPAA Compliance in Medical Billing Software.pdfOmniMD Healthcare
These days, it is essential that medical billing software be compliant with the Health Insurance Portability and Accountability Act, 1996 (HIPAA). This is because of several reasons. Mainly, HIPAA compliance ensures the safety and privacy of electronic health information. The act also lays the foundation for creating national standards to safeguard private patient information.
The Importance of HIPAA Compliance in ensuring the Privacy and Security of PHI!Shelly Megan
All the healthcare applications dealing with PHI data must comply with HIPAA rules and regulations as sensitive patient data is vulnerable to security threats and violations. HIPAA compliance ensures high security and privacy of sensitive healthcare patient data by enforcing measures such as access control, encryption, data disposal, data backup, automatic logging-off, auditing, etc.
Running head Information security threats 1Information secur.docxwlynn1
Running head: Information security threats 1
Information security threats 7
Information security threats
Khaleem Pasha Mohammad
Campbellsville University
Introduction
The development of technology has been greatly embraced in hospitals, saved innumerable lives, and improved the quality of care provision. Not exclusively has technology changed patients knowledgeable and of their families but further consideration has had a significant impact on the strategy and practices of practitioners. One in every five of the areas that have greatly embraced technology is care data. Technology has helped inside the treatment of care records through the introduction of electronic health records, that's exchange paper records. With the availability of electronic care record (EHR) systems, a nurse can merely check for patients’ allergies, case history, weight, age, and prescription through the press of a button. However, the most quantity as institutions are clasp technology to stay up their health records, there are series of risks associated with these technologies. Since the start of technology inside the upkeep of care records, the care trade has been a primary target for cyber crimes. The motives behind cyber-attacks on care are clear as insurance firms, hospitals, care clinics, and totally different care suppliers keep health records that contain valuable information. The use of America Department of Health and Human Services for Civil Rights has acknowledged that over 100 million people square measure suffering from care data security breach. Gregorian calendar month 2015 was a foul month for electronic data jointly of the most important hacks on health care records on Anthem Blue Cross resulting in over seventy-eight million patients’ health data was taken. The cyber-attack scarf sensitive data that contained social securities, names, and residential addresses of people. Constant year, Premera Blue Cross reported that a cyber-attack has exposed medical information of over eleven million customers. Back in 2011, over 4.9 million health records were taken electronically from Science Application International Corporation. These are few cases of a care data breach with sensitive data falling into the hands of third parties. In guaranteeing that there are privacy and security in care records, bureau insurance mobility and responsibility (HIPPA) is providing legislation that hospital and totally different institutions that handle patient’s data to adopt in guaranteeing that varied security measures are enforced in protecting data.
HIPPA and Security Compliance
As much as institutions are clasp technology in storing care data, it is vital for institutions like HIPPA to regulate these bodies to substantiate that shopper rights are protected. The HIPAA Security Rule provides that electronic records of patients got to be protected in any respect times from any unauthorized access nonetheless the information being at rest or in transit.
Dental Compliance for Dentists and Business Associatesgppcpa
This presentation will discuss covered entities, protected health information (PHI) as it relates to dental practices and business associates of those practices.It will update you on major legislation relating to patient privacy laws and explain why PHI Information is important and the consequences for non-compliance with state and federal laws.
HIPAA Compliance For Small Practices: According to the American Health Information Management System (AHIMA), an average of 150 people from nursing staff to x-ray technicians, to billing clerks, have access to patient’s medical records during the course of typical hospitalization.
HIPAA-Compliant App Development Guide for the Healthcare Industry.pdfSuccessiveDigital
This is an article about HIPAA-compliant app development for the healthcare industry. It discusses the importance of HIPAA compliance and the risks of non-compliance. The article also outlines the steps involved in developing a HIPAA-compliant app. Some of the important points from this article are that HIPAA compliance is an ongoing process and that there is no certification required to build a HIPAA-secure app.
It is now more important than ever to ensure your breach security is on par or better than the rest of the industry. Review these slides to ensure you understand the regulations surrounding patient privacy and how to prevent future breaches.
This document discusses HIPAA compliance and the HITRUST framework. It provides an overview of HIPAA requirements including the Privacy Rule, Security Rule, and Breach Notification Rule. It outlines fines and penalties for non-compliance. It then discusses the mission and objectives of HITRUST, which provides a certifiable framework to demonstrate HIPAA compliance. Key components of HITRUST's CSF Assurance Program include standardized tools and processes to assess risk and compliance through a HITRUST report. Challenges in demonstrating HIPAA compliance and the case for using HITRUST are also reviewed.
The document discusses HIPAA compliance and the HITRUST framework. It provides an overview of HIPAA requirements including the Privacy Rule, Security Rule, and breach notification. It outlines fines and penalties for non-compliance. It then discusses the mission and objectives of HITRUST, which provides a certifiable framework to demonstrate HIPAA compliance. The document argues that organizations can use HITRUST certification to address challenges in demonstrating HIPAA compliance through its standardized tools and processes.
The document discusses HIPAA compliance requirements and how organizations can demonstrate compliance through HITRUST certification. It provides an overview of HIPAA, HITECH, and Omnibus Rule regulations regarding privacy, security, breach notification and business associate responsibilities. It then outlines the mission and objectives of HITRUST to establish trust in healthcare information sharing through a certifiable compliance framework. The document explains how organizations can address HIPAA compliance gaps and demonstrate compliance to auditors by pursuing HITRUST certification.
Electronic Health Records Protecting Assets With A Solid Security Plan Wp101207Erik Ginalick
EHR systems provide significant benefits but also require proper security plans to protect patient data. A solid security plan includes:
1) Conducting a risk analysis to identify vulnerabilities and ensure compliance with HIPAA security rules.
2) Implementing administrative safeguards like security policies, employee training, and systems to monitor threats.
3) Using technical security like firewalls, encryption, and authentication controls to restrict access and protect hardware and software.
This will allow organizations to maximize the benefits of EHR while safeguarding protected health information.
Data and Network Security: What You Need to KnowPYA, P.C.
PYA Principal Barry Mathis served on a panel discussion at the American Medical Informatics Association iHealth 2017 Clinical Informatics Conference.
The panel explored the state of cybersecurity in healthcare organizations and related legal considerations, including the HIPAA privacy and security rules. It considered institutional preparedness, provided examples, and offered preventive measures. The panel also discussed ransomware attacks, including tactics for negotiating with hackers, and provided best practices for organizations to avoid such attacks.
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.
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.
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.
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.
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.
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
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
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.
More from Harmony Healthcare International (HHI) (10)
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - ...rightmanforbloodline
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
Healthy Eating Habits:
Understanding Nutrition Labels: Teaches how to read and interpret food labels, focusing on serving sizes, calorie intake, and nutrients to limit or include.
Tips for Healthy Eating: Offers practical advice such as incorporating a variety of foods, practicing moderation, staying hydrated, and eating mindfully.
Benefits of Regular Exercise:
Physical Benefits: Discusses how exercise aids in weight management, muscle and bone health, cardiovascular health, and flexibility.
Mental Benefits: Explains the psychological advantages, including stress reduction, improved mood, and better sleep.
Tips for Staying Active:
Encourages consistency, variety in exercises, setting realistic goals, and finding enjoyable activities to maintain motivation.
Maintaining a Balanced Lifestyle:
Integrating Nutrition and Exercise: Suggests meal planning and incorporating physical activity into daily routines.
Monitoring Progress: Recommends tracking food intake and exercise, regular health check-ups, and provides tips for achieving balance, such as getting sufficient sleep, managing stress, and staying socially active.
KEY Points of Leicester travel clinic In London doc.docxNX Healthcare
In order to protect visitors' safety and wellbeing, Travel Clinic Leicester offers a wide range of travel-related health treatments, including individualized counseling and vaccines. Our team of medical experts specializes in getting people ready for international travel, with a particular emphasis on vaccines and health consultations to prevent travel-related illnesses. We provide a range of travel-related services, such as health concerns unique to a trip, prevention of malaria, and travel-related medical supplies. Our clinic is dedicated to providing top-notch care, keeping abreast of the most recent recommendations for vaccinations and travel health precautions. The goal of Travel Clinic Leicester is to keep you safe and well-rested no matter what kind of travel you choose—business, pleasure, or adventure.
Under Pressure : Kenneth Kruk's StrategyKenneth Kruk
Kenneth Kruk's story of transforming challenges into opportunities by leading successful medical record transitions and bridging scientific knowledge gaps during COVID-19.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
PET CT beginners Guide covers some of the underrepresented topics in PET CTMiadAlsulami
This lecture briefly covers some of the underrepresented topics in Molecular imaging with cases , such as:
- Primary pleural tumors and pleural metastases.
- Distinguishing between MPM and Talc Pleurodesis.
- Urological tumors.
- The role of FDG PET in NET.
Stem Cell Solutions: Dr. David Greene's Path to Non-Surgical Cardiac CareDr. David Greene Arizona
Explore the groundbreaking work of Dr. David Greene, a pioneer in regenerative medicine, who is revolutionizing the field of cardiology through stem cell therapy in Arizona. This ppt delves into how Dr. Greene's innovative approach is providing non-surgical, effective treatments for heart disease, using the body's own cells to repair heart damage and improve patient outcomes. Learn about the science behind stem cell therapy, its benefits over traditional cardiac surgeries, and the promising future it holds for modern medicine. Join us as we uncover how Dr. Greene's commitment to stem cell research and therapy is setting new standards in healthcare and offering new hope to cardiac patients.
Can coffee help me lose weight? Yes, 25,422 users in the USA use it for that ...nirahealhty
The South Beach Coffee Java Diet is a variation of the popular South Beach Diet, which was developed by cardiologist Dr. Arthur Agatston. The original South Beach Diet focuses on consuming lean proteins, healthy fats, and low-glycemic index carbohydrates. The South Beach Coffee Java Diet adds the element of coffee, specifically caffeine, to enhance weight loss and improve energy levels.
We are one of the top Massage Spa Ajman Our highly skilled, experienced, and certified massage therapists from different corners of the world are committed to serving you with a soothing and relaxing experience. Luxuriate yourself at our spas in Sharjah and Ajman, which are indeed enriched with an ambiance of relaxation and tranquility. We could confidently claim that we are one of the most affordable Spa Ajman and Sharjah as well, where you can book the massage session of your choice for just 99 AED at any time as we are open 24 hours a day, 7 days a week.
Visit : https://massagespaajman.com/
Call : 052 987 1315
This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
Can Allopathy and Homeopathy Be Used Together in India.pdfDharma Homoeopathy
This article explores the potential for combining allopathy and homeopathy in India, examining the benefits, challenges, and the emerging field of integrative medicine.
Anxiety, Trauma and Stressor Related Disorder.pptx
How Safe is Your Patient Data?
1. How Safe is Your Patient Data?
Steps to Protect Electronic Health Information in Nursing Homes
A collaborative effort brought to you by
Harmony University
The Provider Unit of
Harmony Healthcare International, Inc. (HHI)
And
Kinara Insights
Presented by:
Sameer Sule, MS, MSc
Founder & President