The Centers for Medicare and Medicaid Services (CMS) released its proposal detailing access to QIO appeal process for Medicare Advantage (MA) denials; a BIG step towards leveling the playing field for beneficiaries and providers. Celtic’s President & CEO, Maureen McCathy, spoke with McKnights Long-Term Care News about the fantastic news. Coupled with significant progress achieved … Continue reading
Myers and Stauffer released a memo this week with HUGE changes for Connecticut SNF providers, effective on Sunday (10/1/2023). CT Providers – did you know: Beginning 10/1, you will need to complete an Optional State Assessment (OSA) MDS for ALL PAYERS, for all federally required MDSs (excluding stand-alone Discharges, stand-alone End of PPS Stay NPEs, … Continue reading
CMS released the Five-Star Technical Users’ Guide, finalizing how 10/1 MDS changes will impact Five-Star rating and Quality Measure (QM) calculations. Substantial changes included in the MDS 3.0 version 1.18.11 resulted in several changes to the Five-Star rating system: 4 QMs impacted by the removal of Section G and transition to Section GG Updates to … Continue reading
Mark your calendars CT providers; valuable Myers and Stauffer Quality Program webinar announced for 9/6/23 at 1:30pm. Representatives from M&S will review: Quality Measures, Quality Program calculation, and Quality Program reporting. Providers can join the webinar here. Are you looking for advisory support for Quality Measures? Celtic frequently provides QM reviews to determine and address … Continue reading
CMS released the final MDS 3.0 Resident Assessment Instrument (RAI) User’s Manual version 1.18.11; officially cementing significant changes for the MDS assessment effective 10/1/23. Celtic has partnered with SNFs for over 20 years; supporting facility teams through many changes impacting reimbursement, regulatory compliance, operations, and accuracy. Our associates’ decades of experience allow them to recognize … Continue reading
CMS released the FY 2024 SNF PPS Final Rule. Let’s cut to the chase – what do providers need to know? The Centers for Medicare and Medicaid Services (CMS) issued the Fiscal Year (FY) 2024 final rule for Skilled Nursing Facilities (SNFs) Prospective Payment System late Monday (7/31/23) afternoon. Among its 451 pages, key takeaways … Continue reading
SNF QRP Non-Compliance letters were released, impacting those facilities’ reimbursement for FY 2024. The clock is ticking for non-compliant providers to submit a request for reconsideration. Last week (7/20/23), CMS provided Non-Compliance Letters for Quality Reporting Program (QRP) requirements for CY 2022, affecting the FY 2024 Annual Payment Update (APU) for facilities determined to be … Continue reading
New York providers prepare for BIG changes – Medicaid payments will shift to a PDPM reimbursement system over the next few months! Removal of Section G from the MDS assessment effective 10/1/23 forced state Medicaid directors to consider moving to a Patient Driven Payment Model (PDPM) reimbursement system for Medicaid payments. New York State Department … Continue reading
The Centers for Medicare and Medicaid Services (CMS) announced targeted probe and educate reviews (TPEs), intended to lower the skilled nursing facility (SNF) improper payment rate. The Comprehensive Error Rate Testing (CERT) program projected a significant increase in improper payment rate for SNFs in 2022. Missing documentation was found to be the primary root cause … Continue reading
Starting 10/1/23, Connecticut nursing facilities will need to complete an additional assessment – the Optional State Assessment (OSA) – to obtain a RUG calculation for Medicaid reimbursement. Does your team have a plan to implement the OSA into your operations? Celtic offers support for facilities transitioning to the OSA; to advance your team’s knowledge of … Continue reading