How do YOU rate? Are YOU ready for scrutiny? Medicare Administrative Contractors (MACs) kickoff widespread 5-claim targeted probe and educate medical reviews or TPEs, beginning June 5th. The Centers for Medicare and Medicaid Services (CMS) issued guidance (Change Request 13164) regarding the review, intended to lower the skilled nursing facility (SNF) improper payment rate. The … Continue reading
Celtic President and CEO, Maureen McCarthy, chats with McKnight’s Long-Term Care News Newsmakers podcast about the key takeaways from the Medicare Advantage (MA) final rule and the future of MA denials. Celtic is a post-acute care advisory firm, delivering operational, clinical, and financial support to health care providers. Our team of subject matter experts provide … Continue reading
Celtic President and CEO interviewed by McKnights Long-Term Care News; discusses Medicare Advantage (MA) final rule, offers the “most valuable sentence” providers should use when dealing with managed care. The MA final rule released in April by the Centers for Medicare and Medicaid Services (CMS), details new requirements for MA plans to better align coverage … Continue reading
Celtic Consulting President and CEO, Maureen McCarthy, presented “Operationalizing Oct. 1, 2023, MDS Changes” at the American Association of Post-Acute Care Nursing (AAPACN) 2023 Annual Conference in Las Vegas. Attendees had excellent questions, participated in thoughtful discussion, and left with “next steps” to modify processes for the new … Continue reading
The Centers for Medicare and Medicaid Services (CMS) released the draft Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) User’s Manual, effective 10/1/23. This version of the MDS 3.0 RAI Manual “contains substantial revisions” per CMS’s announcement, including standardized assessment items collected across post-acute care and updated language throughout to be gender neutral. Final … Continue reading
Effective 10/1/23, MassHealth will shift to a Minimum Data Set (MDS 3.0) based Medicaid reimbursement system. Management Minutes Questionnaire (MMQ) will finally be eliminated! The Medicaid reimbursement system will be based on a Patient Driven Payment Model (PDPM) system and utilize the MDS 3.0 assessment as the acuity measurement tool to determine payment for MassHealth … Continue reading
How did you perform? FY 2024 SNF VBP Program March 2023 Quarterly Reports are available to download. March 2023 Interim Quarterly Confidential Feedback Reports for Fiscal Year (FY) 2024 SNF Value Based Purchasing (VBP) program are available to download in the QIES/CASPER reporting system. Reports include interim stay-level data for the SNF 30-Day All-Cause Readmission … Continue reading
MDS assessment submissions are transitioning to iQIES next month. Crucial Points: Failure to register for a new iQIES account before the go live date will impact your ability to submit MDS records. MDS assessment submission and reporting functionality will transition to the Internet Quality Improvement and Evaluation System (iQIES) on 4/17/23. The QIES Assessment Submission … Continue reading
Providers brace for schizophrenia MDS audits; potential for Five-Star rating downgrades and Quality Measure (QM) rating suppression penalties. CMS released memo QSO-23-05-NH, addressing QM ratings based on erroneous schizophrenia coding and processes for posting citations under dispute.CMS has identified a trend of MDS coding residents as having schizophrenia, without supportive documentation. The Five-Star QM percentage … Continue reading
Beginning next week, Kepro appeal notification process changes for post-acute care providers in 29 states. On 1/17/23, post-acute care facilities and Medicare health plans will receive notifications when a new appeal has been filed by FAX ONLY and will no longer receive phone calls for appeal notifications. Notifications will be faxed to the number used … Continue reading