, ,

Indiana Medicaid Releases Proposed Rule for Overhaul of Medicaid Integrity Requirements

By: Christa Roberts, PT, MPT, RAC-CT and Eleisha Wilkes RN, RAC-CT

The details of proposed rule LSA #18-251 were published on October 4, 2018 by the Indiana Family and Social Services Administration, and introduces plans to revamp the Medicaid program integrity requirements. LSA #18-251 is extensive and impacts the bulk of business facets for Indiana Medicaid providers, including claims filing time limits, medical record retention, provider enrollment, sanctions, audits, and provider appeals.

LSA #18-251 consolidates existing rules, clarifies requirements and adds new program integrity requirements affecting Medicaid providers. Some of the more significant changes are as follows:

  • Currently, providers have up to one year from the date of service to submit an original claim; however, under the proposed rule, providers would have to submit claims for payment within 180 days of the date of service or the claim would be denied (effective January 1, 2019).
  • Providers will be subject to a medical record retention for financial records period of 3 years following submission to Indiana Medicaid (there is currently no record retention policy).
  • The proposed rule consolidates and adds new provider enrollment requirements.
  • Medicaid payment suspension procedures authorized by Federal law are outlined.
  • A new section is added regarding provider exclusions and readmissions (specifically, the rule lists various offenses that could result in an exclusion and sets a duration of up to 3 years for such exclusion).
  • A new section describes prepayment review processes and procedures (previously only available in agency manuals).
  • The proposed rule revises existing Medicaid overpayment provisions to align with changes in Indiana law (adds a 3-year look back period for audits initiated after July 2, 2019, though may be extended to 7 years under certain circumstances).
  • Administrative appeals procedures are consolidated and changed to align with Indiana law.

LSA #18-251 is open for public comment until the public hearing, which is preliminarily scheduled for October 26, 2018. A copy of the proposed rule can be reviewed at: www.in.gov/legislative/iac/20181003-IR-405180251PRA.xml.pdf

 

 

Speak with your doctor to find out how therapy could benefit you!

/0 Comments
, , , , ,

Hospitals hit with fines over patient readmissions

Indiana hospitals are racking up millions of dollars in penalties for having too many patients return for care within a month of discharge.

Sixty-six Hoosier hospitals—including 17 in central Indiana—will see their Medicare payments docked next year by a total of about $12 million as a result of having patients readmitted within 30 days. That’s up from $9 million in penalties three years ago.

The federal government says readmissions are often unnecessary and cost taxpayers tens of billions of dollars a year for treatments that should have been caught the first time around, or were not followed up adequately.

So for the seventh consecutive year, it is using the pressure of lower reimbursements to get hospitals to improve their numbers.

Hospitals, for their part, say they are working with patients every way they can think of to keep readmissions at a minimum.

Many are sending patients home with a thick, detailed packet of discharge instructions and a month’s worth of medications. Hospitals send nurses and aides to discharged patients’ homes to see how they are doing. In some cases, patients are given vouchers for cabs or van shuttles to get to their primary care physicians for follow-up visits.

Still, the penalties keep climbing.

“It’s getting more difficult,” said Brian Tabor, president of the Indiana Hospital Association. “Hospitals have picked a lot of the low-hanging fruit in terms of strategies. And so the work gets harder and harder.”

Click here to continue reading this article.

Hospitals are going to be looking to post-acute providers now more than ever to step-up their game. This spring, HTS launched THRIVE a turn-key system to promote successful care transitions following a post-acute stay. Our proprietary clinical programs are just another way that we move our clients forward as leaders of rehabilitation in the markets they serve. Contact us today to learn how partnering with HTS can help improve outcomes and reduce readmissions.

 

October is National Physical Therapy Month!
National Physical Therapy Month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapy may be necessary for those recovering after an illness, a fall, injury, surgery or chronic condition. Physical therapists work hard to help patients retain and regain their quality of life.

 

Speak with your doctor to find out how therapy could benefit you!

/0 Comments

Getting Around Safely Using a Cane or Walker

The use of a cane or walker has become the norm for most seniors today to help prevent falls. Ironically, these tools can be just as dangerous as they are helpful if they are not used properly. The CDC estimates nearly 50,000 seniors end up in the emergency room each year after falling while using a cane or walker. Health professionals are urging adults who use canes and walkers as walking aids to be properly assessed and fitted by a therapist to avoid fall-related injuries. Physical Therapists are trained professionals that are able to assess your individual needs to ensure that you are using the proper walking aid as well as make sure it is in proper working condition.

Tips for Using Canes & Walkers

  1. The walker or cane should be about the height of your wrists when your arms are at your sides.
  2. In order to be properly supported by a cane, you should be using it on the side of your body opposite from your injury or weakness.
  3. When using a walker, your arms should be slightly bent when holding on, but you shouldn’t have to bend forward at the waist to reach it.
  4. Periodically check the rubber tips at the bottom of the cane or walker. Be sure to replace them if they are uneven or worn.
  5. Wear flat shoes to provide a good base of support.

 

Therapy Can Help Reduce Falls & Improve Balance

Maintaining proper balance and sense of body position is critical to preventing falls. A Physical Therapist works with individuals to identify risk factors and designs an individualized program of exercises and activities with an emphasis on strength, flexibility, and proper gait. Occupational Therapists work with you to discuss changes and modifications that can be made around your home to help prevent falls from occurring. If you have concerns about your balance, ask your doctor if you could benefit from therapy.

/1 Comment
, , , , , , ,

Collaborating for a successful transition to the new Medicare payment model

HTS is excited to collaborate with our partners for a successful transition to the new Medicare payment model. Our ongoing focus on clinical quality, patient-centered programs, and functional outcomes has prepared our staff in advance to succeed under PDPM. In addition to implementing proprietary clinical program efficacy analysis, HTS has assessed the financial impact of PDPM and is committed to supporting our partners through the challenges of adapting to the new reimbursement model.

HTS will be providing PDPM solutions that include:

  • Staff Education and Training in Critical Areas such as Section GG and ICD.10 Coding
  • PDPM Live Trainings for Partners and Staff in Multiple Locations
  • Internal System Transitions
  • RUGs IV to PDPM Facility-specific Impact Analysis

Our alliance with Proactive Medical Review, the PDPM experts currently providing education on this topic to 25 states, allows us to uniquely provide our partners with additional support for strategic planning, MDS coding efficacy, and nursing best practices.

Patient-Driven Payment Model (PDPM) training dates:

  • Friday, September 21 – Evansville, IN
  • Thursday, October 4 – Fort Wayne, IN
  • Thursday, October 11 – Louisville, KY
  • Tuesday, October 16 – Greenwood, IN
  • Tuesday, October 23 – Kokomo, IN
  • Friday, November 9 – Edmonton, KY
  • Thursday November 15—Phelps, KY

We remain optimistic considering the enormous changes we are facing with this new payment model. As partners in therapy, you can be confident in our resources and unmatched expertise to navigate this change while working together toward a successful transition.

If you have any questions at all about this information, please contact us directly.

/0 Comments
, , , , ,

October is Physical Therapy Month

National Physical Therapy Month is a celebration held each October by the American Physical Therapy Association (APTA). PT month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapists are movement experts who can help you overcome pain, gain and maintain movement, and preserve your independence, often without the need for surgery or long-term use of prescription drugs. Physical therapy is a cost-effective treatment that allows patients to participate in a recovery plan designed for their specific needs.

Goals of physical therapy include:

  • Restore physical function
  • Improve the ability to ambulate
  • Strengthen the body affected by injury/illness
  • Reduce pain and inflammation
  • Education and prevention

We offer comprehensive rehabilitation services including physical, occupational and speech therapy. Our therapists are experts in treating conditions affecting adults ages 50+. Therapy is a cost-effective treatment that allows patients to participate in a recovery plan designed for their specific needs to regain function and independence for a better quality of life.

For more information, contact www.htstherapy.com.

 

October is National Physical Therapy Month!
National Physical Therapy Month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapy may be necessary for those recovering after an illness, a fall, injury, surgery or chronic condition. Physical therapists work hard to help patients retain and regain their quality of life.

 

Speak with your doctor to find out how therapy could benefit you!

 

Resource: APTA, www.apta.org

/3 Comments
, ,

Prevent and Manage Functional Decline in Active Adults – Including Fall Risk Management

As the average age of entry for licensed assisted living is 85 years of age, senior living providers are very focused on keeping their residents as independent for as long as possible. As a provider of contract physical, occupational and speech therapy in Assisted Living and Continuing Care Retirement Communities (CCRCs), our goal is to proactively address functional and cognitive decline so that residents can maintain their highest level of ability. From what we see on a daily basis, and reviewing ER admissions and national reports, most functional declines in active adults happen because of five primary reasons:

Lack of muscle building exercise

  1. Environmental factors
  2. Chronic illness
  3. New injury or illness
  4. Medications

Functional decline means that a person shows a decreased ability to do daily tasks properly compared to their ability to do these same tasks three months prior. A decline often signifies the presence of an acute onset, a new underlying medical condition or exacerbation of an existing condition.

Falls are the single largest reason of decline among active adults. Falls can happen any due to any of the five primary reasons listed above. Think of a fall as the ultimate loss of balance. There are multiple factors to a fall that present themselves well before a fall takes place. Through QAPI, standardized therapy testing and formalized Fall Risk Management programs, we are able to peel back the layers to determine “root cause” for the fall. A strong Fall Risk Management program is often tailored to treating the root cause factor that caused the fall, rather than all of the risk factors a patient has for falling. Falls are due to intrinsic factors (illness or medications) may not be prevented easily. Falls due to extrinsic factors (environmental factors) can be prevented or significantly reduced with extra precautions and education.

Provision of safety devices such as: grab bars & handles, high friction floors and footwear, as well as even (meaning no shadows to throw off depth perception) high power lighting can prevent or reduce a significant number of environmental falls. Regular exercise focused on core and lower body strength, consistent monitoring of and review of medications and therapeutic interventions for ongoing medical problems can significantly help to reduce the number of falls associated functional decline.

Functional Decline could be physical and/or cognitive in nature. When partnering with senior living providers, we take special care to train all staff including environmental, housekeeping and dietary to identify functional and cognitive decline. This could be anything from “furniture walkers”, increased maintenance calls to someone coughing through a meal in the dining room. There are consistent characteristics for a resident at risk for falling:

  • Functional decline include difficulty with ADLs (Activities of Daily Living) such as dressing or undressing safely.
  • Lack of balance, any unexplained bruises
  • Loss of flexibility
  • New pain, taking more medication than usual
  • New medication
  • Significant weight loss within 30 days
  • Speech impairment or inability to follow simple commands
  • Signs of anti-social behavior or depression, not participating in life enrichment as usual
  • Decreased activity tolerance or coordination, lack of attention
  • Decreased stamina or strength.

Everyone working around active adults should be trained and be able to report a decline to the clinical team. Although prevention is best for any decline, recognizing and reporting resident declines in a timely manner helps to manage the decline efficiently. Timely intervention will help the resident maintain or regain functional independence.

Aretoula Nahas is a Physical Therapist Assistant (PTA) and the Director of Outpatient Services for Healthcare Therapy Services, Inc. (HTS). HTS is an independent, therapist-owned contract provider of physical, occupational, speech therapy and wellness for assisted living, skilled nursing facilities and hospitals. HTS currently employs over 1,800 therapists and provides contract rehabilitation to over 100 clients in Indiana, Kentucky, Tennessee, Michigan and Ohio. For more information, contact www.htstherapy.com.

 

October is National Physical Therapy Month!
National Physical Therapy Month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapy may be necessary for those recovering after an illness, a fall, injury, surgery or chronic condition. Physical therapists work hard to help patients retain and regain their quality of life.

 

Speak with your doctor to find out how therapy could benefit you!

 

Resource: APTA, www.apta.org

/0 Comments
, , , ,

An On-site Outpatient Therapy Program Specialized for Assisted Living

Finding the right therapy provider for your building can be a challenge. As assisted living providers handle increasing clinical complexity, you need quality rich, expertly delivered rehabilitation to meet the unique needs of each resident.

You need a therapy partner with expertise in the senior care industry that collaborate with your staff, doctors, hospitals and home care providers to provide a well‐rounded, strategic approach to aging in place.

Experts in Therapy for Senior Living Providers

Your Complete On-site Outpatient Therapy Program Includes:

  • Physical, Occupational & Speech Therapy Up To 7 Days a Week
  • Complete Management, Staffing, Scheduling and Billing
  • Therapy Exercise Equipment & Technology
  • Patient Satisfaction & Outcome Measures
  • Comprehensive Value—Added Services and Programs
  • Close Collaboration with Physician—Therapy is Directed by the Physician and Progress is Noted at Each Session and Communicated.

Set Your Community Apart

60+ Clinical Pathways
We utilize current practice standards and evolve clinical programs to achieve the maximum potential for even the most clinically complex patients.

  • Fall Prevention
  • Bone & Joint Recovery
  • Cardiac Recovery
  • Stroke/CVA
  • Pain Management
  • Arthritis

Dementia Specialization
HTS therapists are highly trained in maximizing each person’s ability with a dementia diagnosis. Our Embracing the Cognitive Spectrum Dementia Care modules are designed to provide person‐centered and intentional care delivery, while coaching your staff on programming and care mapping.

All Staff Training & Care Collaboration
Prevent and decrease resident falls with root cause-based programming. Improve strength, self care and confidence. Reduce hospital readmissions. Utilize training to all of your staff to address resident decline at every level. Work closely with home health care and other providers to develop and execute a collaborative care plan.

Improve Census & Outreach
Help create your message to share the benefits of having on-site outpatient therapy. Full marketing collaboration to increase your occupancy and provide a competitive advantage over your competition. Customized marketing strategies to strengthen outreach efforts to hospitals, physicians and community.

Whole-Person Wellness
We provide you with your own customized whole‐person wellness program including health and wellness assessments and workshops to create a powerful all‐campus program that improves the lives of every resident in your building. Wellness software that provides measurable outcomes. Library of specialty classes including personal training.

Keep Your Residents Strong, Independent & Living to the Fullest

  • Proactively Prevent and Reduce Risk for Falls
  • Maintain & Improve Mobility
  • Address Even the Subtlest Declines in Physical and Cognitive Health
  • Improve Activities of Daily Living
  • Improve Cardiopulmonary Health
  • Improve Muscle Strength & Stamina
  • In-depth Cognition Testing for Those Challenged with Memory Impairment
  • Reduce Effects of Progressive Conditions, like MS, Parkinson’s & Dementia
  • Improve Confidence in Social Situations
  • Teach Compensation Skills to Residents, Caregivers & Families
  • Initiate Wellness & Promote Successful Aging

 

 

October is National Physical Therapy Month!
National Physical Therapy Month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapy may be necessary for those recovering after an illness, a fall, injury, surgery or chronic condition. Physical therapists work hard to help patients retain and regain their quality of life.

 

Speak with your doctor to find out how therapy could benefit you!

/0 Comments

Balance & Fall Prevention

Balance disorders are very common in older adults and are a major cause of falls. Balance problems can lead to injury, disability, loss of independence, and a limited quality of life. Maintaining proper balance and sense of body position is critical to preventing falls.

Therapy Can Help Reduce and Prevent Falls

Improve Balance: A Physical Therapist will assess your ability to balance while performing many activities. They will work with you on specific exercises that will train you on balancing while doing things such as catch a ball or reach for an item.

Build Endurance: Getting fatigued while walking can increase your risk of falling. Therapy can help you gain endurance through supportive exercises.

Increase Strength: Therapy will focus on strengthening your leg, hip and core muscles. These muscles are essential to mobility and will lessen your likelihood of falling.

Safety Awareness: Your therapist can make recommendations on how to make your living space safer in order to prevent falls. Also, help you with learning to walk with a cane or walker and adjust it to fit your height specifications.

October is National Physical Therapy Month!
National Physical Therapy Month is designed to recognize the impact that physical therapists and physical therapist assistants make in restoring and improving motion in people’s lives. Physical therapy may be necessary for those recovering after an illness, a fall, injury, surgery or chronic condition. Physical therapists work hard to help patients retain and regain their quality of life.

 

Speak with your doctor to find out how therapy could benefit you!

 

Resource: APTA, www.apta.org

/0 Comments

Maintaining Balance As You Age

Good balance is being able to easily control and maintain your body’s position. Maintaining good balance and sense of body position is critical to preventing falls. Falling is the ultimate loss of balance and the leading cause of debilitating injury and premature death in older adults. Good balance is being able to easily control and maintain your body’s position. Maintaining good balance and sense of body position is critical to preventing falls. Falling is the ultimate loss of balance and the leading cause of debilitating injury and premature death in older adults.  Each year, 1 in 3 adults over 65 fall each year. With millions of people falling each year, less than half will contact their doctor for help.

Common Risk Factors of Poor Balance:

  • Lower Body Weakness
  • Foot Pain / Poor Footwear
  • Difficulty Walking & Balancing
  • Vision Issues
  • Medications Causing Dizziness
  • Hazards in Your Home

What You Can Do to Prevent Falls?

Falls can be prevented. By following these tips, you can reduce your risk for falling.

  1. Ask your healthcare provider to review your medications.
  2. Begin an exercise program to improve your leg strength and balance.
  3. Get an annual eye exam. Replace eyeglasses as needed.
  4. Make your home safer. Remove clutter and tripping hazards.

Therapy Can Help Reduce Falls & Improve Balance

A physical therapist works with individuals to identify risk factors and designs an individualized program of exercises and activities with an emphasis on strength, flexibility, and proper gait. Balance may be improved with exercises that strengthen the core, back, ankle, knee, and hip muscles along with exercises that improve the function of the balance system. Occupational therapists work with you to discuss changes and modifications that can be made around your home to help prevent falls from occurring.

If you have concerns about your balance, ask your doctor if therapy can help. When you receive a doctor’s order for therapy, our physical therapy team can start immediately to help your balance and fear of falling.

Resource: www.cdc.gov/steadi/; www.healthinaging.org

/0 Comments

CMS Issued the FY2019 SNF PPS Final Rule

As anticipated, the change to the Patient-Driven Payment Model (PDPM) was finalized to go into effect October 1, 2019 (FY 2020). CMS noted that this allows providers one year to prepare for this fundamental change from the RUG-IV case-mix model to the new PDPM methodology which is based on patient condition and care needs. Preparations will involve staff education and training, internal system transitions, software development, and impact analysis. The final version of PDPM is largely the same as proposed earlier this year.

Additionally, the rule finalizes the 2.4% market basket increase for SNFs as required by the Bipartisan Budget Act of 2018 which will result in an overall increase in Medicare payments to SNFs of $820 million (effective 10/1/18). There were no new measures adopted for the SNF Quality Reporting Program (SNF QRP); however, CMS is including an added factor to consider for removal of measures for the SNF QRP.

CMS will publicly display the four assessment-based quality measures and increase the number of years of data used to display the two claims-based SNF QRP measures from one year to two years (Discharge to the Community and Medicare Spending Per Beneficiary). The SNF Value-Based Purchasing Program using the one claims-based measure (all cause 30-day hospital readmission measure) continues with updates to policies and an adjustment to the scoring methodology and an Extraordinary Circumstances Exception (ECE) policy.

Links for CMS details:

FY 2019 SNF PPS Final Rule Fact Sheet:
www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-07-31-3.html

FY 2019 Final Rule (pre-publication copy):
https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-16570.pdf

This fall HTS will offer extensive education and training for our therapy staff and our partners in multiple locations to prepare for PDPM. Look for upcoming details.

/0 Comments