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
Celtic President & CEO, Maureen McCarthy, gets real about the Medicare Advantage final rule, in the June 2023 Issue of McKnight’s Long-Term Care News. She cautions providers may need to fight MA plans for gains made by the new MA final rule, which went into effect earlier this month, “I think they’re going to go … Continue reading
Massachusetts nursing facilities will receive added behavioral health services this summer. The Executive Office of Health and Human Services announced details for increased support through Behavioral Health Community Partners (BHCP) program, Department of Mental Health (DMH) case managers, and Community Transitions Liaison program. Amid staffing shortages, Massachusetts providers can leverage this expanded support to improve … Continue reading
Massachusetts providers only have one opportunity to participate in MassHealth’s Trading Partner Testing (TPT)- registration due by 6/27/23. MassHealth will be hosting TPT beginning mid-August 2023; which will allow providers to test HIPAA transactions 8471 (institutional claims), 270/271 (eligibility/benefit inquiry and response), and Direct Data Entry for eligibility and claims, to ensure preparation for the … Continue reading
Myers & Stauffer releases Connecticut April case mix training FAQs; offers further clarification on supportive documentation requirements in effect for CT Medicaid nursing facilities, for assessments with an ARD dated on or after 5/1/23. Did your facility pass the review threshold? Consider an independent review of your supporting documentation to safeguard your revenue under audit … Continue reading
It’s official! Rhode Island Medicaid transitioning to the Optional State Assessment (OSA) effective 10/1/23; RI nursing facilities prepare for yet another change this fall. RI Medicaid plans to adopt a PDPM model for Medicaid reimbursement in October 2025. In order to continue RUG-IV based payments until then, RI nursing facilities will be required to complete … Continue reading
Final resident roster reports scheduled for release on 6/9/23 are expected to be delayed. What does this mean for CT providers? With the transition to the iQIES system, each individual was assigned a new Patient ID number, breaking the link between past and present (newly transmitted) MDS assessments for the same resident. Myers and Stauffer … Continue reading
SNF VBP Quarterly Reports are available in iQIES. Providers have a short window to submit corrections; data from June 2023 SNF VBP reports will impact FY 2024 incentive payments. June 2023 Quarterly Confidential Feedback Reports for FY 2024 SNF VBP program are available for download now. For the first time, providers will access their report … Continue reading