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Summary of Provider Relief Fund Payments

Posted by Admin Posted on July 15 2020

Summary of Provider Relief Fund Payments.

General Distribution Payment:
Two separate payments on April 10-17 and April 24
Attestation deadline for April 10-17 payment was July 9
Attestation deadline for April 24 payment is July 23

Targeted SNF-Only Distribution:
Payment sent on May 22
Attestation deadline for May 22 payment is August 20

Targeted Medicaid/CHIP Distribution:
Eligible for Medicaid providers who have not received General Distribution payment
Applications must be submitted by July 20

Do I have to submit a quarterly report to HHS for April, May and June 2020 quarter?

No. All Recipients of the Provider Relief Fund payments who attest and agree to the Terms and Conditions, do not need to submit a separate quarterly report to HHS or the Pandemic Response Accountability Committee. HHS will submit a report containing all information necessary to comply with the reporting requirements of the CARES Act. However, HHS will be requiring recipients to submit future reports of how the Provider Relief Funds were spent. HHS will notify recipients of the content and due date.

What type of Documentation do I need to provide for the Provider Relief Fund Payments?

All expenses and lost revenues should be linked to COVID-19. Providers should not only track the expense but record what the item was used for and how it related to COVID-19. HHS has clarified that the Provider Relief Fund payments can be used for expenses incurred after January 1, 2020. These expenses must be related to COVID-19. HHS has said it will reconcile payments to expenses and lost revenues at the end of the pandemic.

What if I have excess Provider Relief Fund Payments that I do not spend?

HHS will provide directions on how to return the unused funds.   

 

KENTUCKY LEVEL OF CARE SYSTEM (KLOCS)

Posted by Admin Posted on July 15 2020

KENTUCKY LEVEL OF CARE SYSTEM (KLOCS)

Starting August 3, 2020, all nursing and ICF/IID facilities will be required to use Kentucky Level of Care System (KLOCS) to submit Level of Care (LOC) applications and receive payment. Every facility will need a Kentucky Online Gateway (KOG) account to access KLOCS. Below is the TAKE ACTION NOW email that Department for Medicaid Services (DMS) has sent out.   

Your facility must provide the Department for Medicaid Services (DMS) the names of individuals (2 max) responsible for managing your organization and its users in Kentucky Online Gateway (KOG). DMS will assign those individuals the KOG role of Organization Administrator. The Organization Administrator is responsible for granting and removing access to KLOCS on behalf of your organization.

How do I provide DMS this information?

Email KLOCSOrgAdmin@ky.gov the following information by 7/17/2020:

- Organization
- Name First and Last Name (2 people max per facility)
- Their email addresses

Guides for KOG Account Creation, the Organization Administrator Role, and Multi Factor Authentication (MFA) Set-Up will be available on the DMS KLOCS training page prior to the August 3, 2020 go-live.

What happens if my facility does not identify an Organization Administrator?

Without an Organization Administrator, your staff will NOT be able to access KLOCS to submit new LOC applications, initiate a request for PASRR Level II evaluations, nor manage active LOCs. This will impact your facility’s ability to receive payment.

If you have already provided DMS this information, please follow-up to confirm they received the initial request.   

 

Resources: KLOCS, Medicaid Rates, PBJ and PDPM updates

Posted by Admin Posted on July 08 2020

Frequently Asked Questions about Taxation of Provider Relief Payments

The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), enacted on March 27, 2020, appropriated $100 billion for the Public Health and Social Services Emergency Fund (Provider Relief Fund). The Paycheck Protection Program and Health Care Enhancement Act, enacted on April 24, 2020, appropriated an additional $75 billion to the Provider Relief Fund. This funding will be used to reimburse eligible health care providers for health care-related expenses or lost revenues that are attributable to the COVID-19 pandemic.   

Click here for details.​

 

Kentucky Department for Medicaid Services Update on MDS Requirements

Effective October 1, 2020, Kentucky Medicaid will be requiring the reporting of the PDPM payment codes on the OBRA assessments when not combined with a 5‐day SNF PPS assessment.  

Click to view the full details from Myers and Stauffer.​

 

CMS plans to end the emergency blanket waiver

CMS announced plans to end the emergency blanket waiver requiring all nursing homes to resume submitting staffing data through the Payroll-Based Journal (PBJ) system by August 14, 2020. The memorandum also provides updates related to staffing and quality measures used on the Nursing Home Compare website and the Five Star Rating System.   

Click here to visit the CMS website for details.

 

KLOCS Go-Live and Training

Kentucky Level-of-Care Systems (KLOCS) Go-Live and Training: AUGUST 3, 2020 Go to the following link for postings regarding web-based trainings.

Click here for details.

 

Important Update: MEDICAID RATES - July 1

*Estimated Medicaid 1.5% Inflation Adjustment effective July 1, 2020
*DMS will not apply rate sanctions to the per diem rates effective July 1, 2020 and October 1, 2020, unless the Public Health Emergency ends prior to these dates.

CMS Issued an Emergency Grant Program

Posted by Admin Posted on July 08 2020

CMS Issued an Emergency Grant Program

CMS issued an emergency grant program, Communicative Technology Project, to assist in alleviating communication limitations due to COVID-19. Certified nursing facilities can apply for a Civil Money Penalty (CMP) fund grant for up to $3,000 to cover the costs of certain communicative technology devises and accessories.

Reminder that the CMP Grant opportunity is set to expire in July 2020.

Click here for the website and application.

Blog by Rhonda Houchens, Director of Operations

 

 

Resources: Kentucky Department for Medicaid Services Update on MDS Requirements

Posted by Admin Posted on July 02 2020

Kentucky Department for Medicaid Services Update on MDS Requirements 

Click to view the full details from Myers and Stauffer.​

Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)

CMS provided clarification on provider utilization of the three day waiver and the benefit period waiver. Additional billing instructions have been provided for troublesome benefit period waiver claims.  

Click here to visit the CMS website for details.

Provider Guidance: Phased Reduction of Restrictions for Long Term Care Facilities

This guidance is provided in accordance with the phased approach to resuming currently suspended services encouraged by the Centers for Medicare and Medicaid Services (CMS).

Click for details.

Resources: CMS-R-131

Posted by Admin Posted on July 02 2020

CMS-R-131

The ABN, Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. The use of the renewed form with the expiration date of 06/30/2023 will be mandatory on 8/31/2020. 

Click here to view the ABN form and instructions.

HHS - Medicare

Posted by Admin Posted on June 09 2020

HHS - Medicare

SIGN ATTESTATION

1.  Have you completed Attestation Process via HHS website for Tranche 1, Tranche 2 and SNF Relief Fund Pmt?
2.  Would you like for us to do this?
3.  If yes, send the following info
- Tax ID Number
- Last 6 digits of Bank Account Number that money was deposited in
- Exact amount of Tranche 1 pmt, Tranche 2 pmt and - SNF Relief Fund Pmt
4.  Sign the Attestation via the link:  https://covid19.linkhealth.com/#/step/1

SUBMIT FINANCIAL DATA

1.  Have you submitted Financial Data via HHS website? (Due by June 3, 2020)
2.  Would you like for us to do this?
3.  If yes, send the following info:
- Tax ID Number
- Last 6 digits of Bank Account Number that money was deposited in
- Exact amount of Tranche 1, Tranche 2 and SNF Relief Fund Pmt
- PD of most recently filed tax return to be uploaded
- Estimated Lost Revenue for March 2020
- Estimated Lost Revenue for April 2020
4.  Submit your revenue information to be verified via the portal: https://covid19.linkhealth.com/#/step/1

TRACK HHS FUNDS

1.  Do you want our assistance with HHS funds tracking?
2. Funds should be used on PREPARING, PREVENTING or RESPONDING to COVID-19 

 

Contact us to learn more:

www.hargisandassociates.com
accountants@hargisandassociates.com
(270) 726-4033

 

CARES Act Provider Relief Fund

Posted by Admin Posted on June 09 2020

What is eligible for reimbursement?

HHS has distributed money to SNFs to help them combat the devastating effects of this pandemic. A very common question has been, “What expenses or lost revenues are considered eligible for reimbursement?”

The HHS.gov website has a shared a list of Frequently Asked Questions concerning the CARES Act Provider Relief Fund, including a response to this question on page 6.

Click here to learn more.

Blog by Sarah McIntosh, Director of Operations

 

 

Resources: HHS Relief for Skilled Nursing Facilities (SNFs)

Posted by Admin Posted on June 01 2020

HHS Releases $4.9 billion in COVID-19 Relief for Skilled Nursing Facilities (SNFs)​

SNFs received a baseline payment of $50,000, plus an additional $2,500 per bed.  

As with other rounds of CARES Act funding, SNFs must agree to the terms and conditions in order to accept the cash.  

SNF’s must also comply with future audit and reporting rules.  Below is the link to the terms and conditions posted on HHS website. 

Click here to view the HHS website.

Articles referencing Relief funds:

Click here to learn more from McKnights Long-Term Care News.

Click here to learn more from Skilled Nursing News.

Small Business Administration (SBA) Payroll Protection Program (PPP)

Posted by Admin Posted on May 18 2020

Small Business Administration (SBA) Payroll Protection Program (PPP)​

Every borrower should begin preparing for the loan forgiveness process.  Make sure that you are documenting how you spend you PPP proceeds and have proper documentation.

Below is a list of some information that will be needed:

•  The number of full-time equivalent (FTE) employees on your payroll as of the following time periods
     1.  8 week “covered period”
     2.  2/15/19 to 6/30/19
     3.  1/1/20 to 2/29/20
•  Dollar amount of Payroll cost during the “covered period”
•  Dollar amount of non-payroll cost incurred during the “covered period”
•  Did you receive an SBA Economic Injury Disaster Loan (EIDL)

Click here to view the updated SBA Q&As.

The Department of Health & Human Services

Posted by Admin Posted on May 18 2020

HHS Provider Letters

The Department of Health & Human Services recently sent letters to providers regarding submitting revenue data to the General Distribution Provider Portal for verification. The letter states “All providers, including those paid based on the revenue data already submitted in CMS cost reports, are required under the Terms and Conditions to submit revenue information to the General Distribution Provider Portal for verification.“

There has been much confusion if Providers are required to submit their revenue information. The provider letter states that ALL providers must submit their revenue information. Click here to view the Provider Letter. 

 

Steps all Providers need to complete:

1. Sign the Attestation via the link:  https://covid19.linkhealth.com/#/step/1

Info needed:
A.  Tax ID number
B.  Last Six Digits of Bank Account Number
C.  Exact amount of the Relief Fund Payment

2. Submit your revenue information to be verified via the portal:  https://covid19.linkhealth.com/docusign/#/step/1

Info needed:    
A.  Tax ID number
B.  Last Six Digits of Bank Account Number
C.  Exact amount of the Relief Fund Payment
D.  Gross receipts of sales 
     a.    Box 1a of IRS Form 1120
     b.    Box 1a of IRS Form 1120S
     c.    Box 1a of IRS Form 1065
     d.    Part I, 9 “Program Services Revenue” of IRS Form 990
E.  Estimated Lost Revenue for March 2020
F.  Estimated Lost Revenue for April 2020
G.  Copy of IRS Form 1120 to upload

Resources: Relief Programs, CMS and Medicaid Updates

Posted by Admin Posted on May 13 2020

CARES Act Provider Relief Fund​

President Trump is providing support to healthcare providers fighting the COVID-19 pandemic through the bipartisan CARES Act and the Paycheck Protection Program and Health Care Enhancement Act that provide $175 billion in relief funds to hospitals and other healthcare providers on the front lines of the coronavirus response. This funding supports healthcare-related expenses or lost revenue attributable to COVID-19 and ensures uninsured Americans can get testing and treatment for COVID-19. 

Click here to learn more.

Nursing Home Five Star Quality Rating System updates, Nursing Home Staff Counts, and Frequently Asked Questions​

CMS is committed to taking critical steps to ensure America’s nursing homes are prepared to respond to the threat of the COVID-19.
Nursing Home Compare website & Nursing Home Five Star Quality Rating System: We are announcing that the inspection domain will be held constant temporarily due to the prioritization and suspension of certain surveys, to ensure the rating system reflects fair information for consumers.
Posting of surveys: CMS will post a list of the surveys conducted after the prioritization of certain surveys, and their findings, through a link on the Nursing Home Compare website.
Nursing Home Staff: CMS is publishing a list of the average number of nursing and total staff that work onsite in each nursing home, each day. This information can be used to help direct adequate personal protective equipment (PPE) and testing to nursing homes.
Frequently Asked Questions (FAQ): We are releasing a list of FAQs to clarify certain actions we have taken related to visitation, surveys, waivers, and other guidance.

Click here to learn more.

CMS Reevaluates Accelerated Payment Program and Suspends Advance Payment Program​

On April 26, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that it is reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B suppliers effective immediately. The agency made this announcement following the successful payment of over $100 billion to healthcare providers and suppliers through these programs and in light of the $175 billion recently appropriated for healthcare provider relief payments.

Click here to learn more.

Kentucky News

See the latest news and updates from Governor Beshear.

Click here to learn more.

MEDICAID PROVIDER LETTER

This memo from the Kentucky Department for Medicaid Services gives details for the following updates.

Effective April 1, 2020, Medicaid Rate add-on of $270 for COVID-19 positive patients. 
Effective April 24, 2020, Medicaid is implementing a temporary process for Medicaid eligibility. 
Effective April 1, 2020 Medicaid will be increasing the bed reservation days to 30 per calendar year through the state of emergency.

Click here to learn more.

Resources: Long Term Care Provider News

Posted by Admin Posted on May 13 2020

COVID-19 Emergency Circumstances LTC Bed Change Requests​

As a result of the COVID-19 pandemic, CMS has demonstrated unprecedented flexibility to long-term care facilities in order to protect residents during the pandemic. CMS has released the “COVID-19 Long-Term Care Facility Guidance”, issued blanket waivers for certain CMS requirements of participation for LTC facilities, as well as offered flexibility regarding timeframes for COVID-19 emergency bed change requests. In response to the relaxed requirements offered by CMS and Governor Andy Beshear’s Executive Order 2020-215 declaring a state of emergency in the Commonwealth, a new bed change request process has been developed. The COVID-19 Emergency Circumstances LTC Bed Change Request Process allows for the faster processing of temporary bed change requests due to emergency circumstances related to the COVID-19 pandemic. This process waives all licensure and architectural review fees, allows for architectural desk reviews, removes the typical CMS timeframe requirements and eliminates the requirement for color coded floor plans when requesting certification status changes.

Click here to learn more.

Emergency CMP Grant Project​

It is with great pleasure that the Cabinet for Health & Family Services (CHFS) announces an emergency Civil Money Penalty (CMP) Grant Project opportunity for all certified nursing facilities within the Commonwealth. Specifically, CMS has notified the CHFS office that a grant program, Communicative Technology Project, has been approved to assist in alleviating communication limitations due to COVID-19. This grant program will allow Medicare-certified nursing facilities to apply for a CMP fund grant for up to $3,000 to cover the costs of certain communicative technology devices and accessories. More information can be found on the OIG Civil Money Penalty Funds website.

Click here to learn more.

Department for Medicaid Services Update on Optional State Assessment

On March 19, 2020, CMS announced that changes to the Minimum Data Set (MDS) 3.0 v1.18.1 are being delayed, therefore, an Optional State Assessment (OSA) is not needed on October 1, 2020, as originally anticipated, in order to continue Resource Utilization Group (RUG) based Medicaid reimbursement.
 
We continue to expect that in the future, CMS will remove items from the MDS item set that are needed for maintaining RUG case mix reimbursement. As CMS modifies the items on the MDS assessments in the future, DMS will evaluate if OSAs will be needed to continue its RUG‐III reimbursement system. Communications regarding any future OSA requirement will be issued at that time. We will continue to publish information as it becomes available.
 
Should you have any questions, please contact Jacob Wilson at (502) 564-8196, extension 2103. Questions regarding the coding of the MDS assessments may be directed to Chrystal Daugherty, RAI Coordinator with the Office of Inspector General at 606-330-2030, extension 283.

PDPM v1.0004​

A revision to the PDPM DLL Package (V1.0004 FINAL) was posted, and the previous version (V1.0003 FINAL) was removed. This version adds support for the new ICD-10-CM code for Coronavirus, U07.1. Note that this code is ONLY in effect for assessments with target date 04-01-2020 and later. The package contains updated test files and documentation.
 
Also, the lookup file for the allowable ICD codes in item I0020B has been updated to include U07.1, and it is posted as a separate ZIP file. Again, please note that this code is ONLY in effect for assessments with target date 04-01-2020 and later. The files are located in the Downloads section of the MDS 3.0 Technical Information site. 

Click here to learn more.

Audits are the new normal.

Posted by Admin Posted on May 06 2020

Audits are the new normal

CMS uses Comprehensive Error Rate Testing (CERT) audits to see if MACs are properly paying claims. CERT audits focus on logistical issues, such as whether or not the coding and billing are correct. CERT is looking for errors in payments made by carriers. Providers are affected because the CERT looks into a claim via Medical Records request. If the CERT uncovers an error, the CERT will recoup money from the provider. CERTs receive set amount outlined in their contract, regardless of the amount of payment errors they find.  

Recovery Audit Contractors focus on errors created by the providers. The primary purpose of RAC is to detect and correct improper payments. RACs are paid through contingency fees (money they uncover). The contingency fee payment system encourages RACs to find errors.   

Zone Program Integrity Contractors (ZPICs) are the most complex audits. ZPICs compare providers billing with similar providers. ZPIC reviews are not random. They are conducted under a presumption of fraud. ZPICs can be initiated by data analysis, frequency, whistleblowers or referred by MACs. Once an error is found they extrapolate the data in order to determine the amount of misappropriated funds. 

Blog by Sarah McIntosh, Director of Operations

 

 

Resources and Important Updates: Medicaid

Posted by Admin Posted on May 05 2020

MEDICAID​

All DCBS offices are closed for appointments.  Individuals may apply for Medicaid by calling the Kentucky Healthcare Customer Service line at (855)459-6328, visit the Benefind website (benefind.ky.gov) or by calling the DCBS Call Center at (855)306-8959.
 
During the COVID-19 State of Emergency, individuals who need special healthcare coverage should go to the kycovid19.ky.gov website and click on Services.  The special healthcare coverage is temporary and ends on 06/30/2020 unless an application for regular Medicaid is submitted.

Click here to learn more.

Resources and Important Updates

Posted by Admin Posted on Apr 13 2020

CARES ACT Provider Relief Fund to infuse $30 billion into healthcare system. ​

All facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible for this initial rapid distribution.  These are payments, not loans, to healthcare providers, and will not need to be repaid.  The payments should be arriving via direct deposit beginning April 10, 2020.

Click here to learn more.

Fiscal Year 2021 Proposed Medicare Payment and Policy Changes

CMS projects aggregate payments to SNFs will increase by $784 million, or 2.3 percent, for FY 2021 compared to FY 2020.

Click here to learn more.

Kentucky and Ohio Part A News from CGS​

CGS is aware that certain eligible provider types may not have received the maximum eligible amount for their accelerated payment. We are identifying providers impacted by the 3-6 month max issue and determining a resolution. Please continue to monitor the CPIL for updates.

Click here to learn more.

Kentucky Department for Medicaid Services Update on Cost Report Extensions

CMS has directed MAC's to further extend the cost reporting deadlines for the following cost reporting fiscal year ends (FYE) for all provider types:

Cost Reporting Period Ending -- Extended Due Date
10/31/2019 -- 06/30/2020
11/30/2019 -- 06/30/2020
12/31/2019 -- 08/31/2020*
01/31/2020 -- 08/31/2020*
02/29/2020 -- 09/30/2020*
*Please note, these are new extensions.

While we have been told that CMS is considering the 03/31/2020 FYE providers that are currently due 08/31/2020, no extension has been posted at this time. 

The Advance Beneficiary Notice of Noncoverage​

The Advance Beneficiary Notice of Noncoverage (ABN) Form CMS-R-131 is issued by providers to Original Medicare beneficiaries when Medicare payment is expected to be denied. Skilled Nursing Facilities (SNFs) issue the ABN to transfer potential financial liability for items/services expected to be denied under Medicare Part B only.  

Form CMS-R-131, will expire 03/2020. The form is currently awaiting OMB approval for renewal. CMS will provide instructions when it does get approved. In the meantime, continue to use the current form until further instruction is provided.  

CMS Flexibilities to Fight COVID-19​

CMS is waiving 42 CFR 483.70(q) to provide relief to long term care facilities on the requirements for submitting staffing data through the Payroll-Based Journal system.

Click here to learn more.

Tracking COVID-19 Related Costs

Posted by Admin Posted on Apr 03 2020

COVID-19 Expenses

In this unprecedented time, our firm strongly recommends that all additional costs, related to COVID-19, be tracked separately from all other costs/departments. We recommend setting up a "new" department in your general ledger (financial statements) to track as many COVID-19 related expenses as possible. In these uncertain times, we want to be cautious and proactive. Facilities might have to verify the additional costs due to, but not limited, to the following.

Loans (SBA and others) - example:  8 week tracking period for SBA loan
Potential Medicaid additional add-ons (currently under discussions)
Others

Below are examples of possible additional expenses:

Payroll - example:  new staff hired for infection control, replacement workers for those sick, OT, additional labor for cleaning, hazard pay to maintain staff, etc.
Personal Protective Equipment (PPE) - masks, gloves
Screening costs for employees to enter the building
Cleaning supplies and additional costs for everyday supplies
Building retro fittings - example:  putting in dividers to separate employees, staff, etc.

Please inform those responsible for your general ledger/financial statements. If you have any questions or need assistance, please contact our office. 

Blog by Robin Parker, CPA, Sr. Accountant

 

 

RESOURCES: Important Updates Concerning COVID-19

Posted by Admin Posted on Apr 01 2020

IMPORTANT UPDATE: From UnitedHealthcare

Suspension of prior authorization requirements to a post-acute care setting through May 31, 2020. Details: Waiving prior authorization for admissions to: long-term care acute facilities (LTAC), acute inpatient rehabilitation (AIR), and skilled nursing facilities (SNF). Consistent with existing policy, the admitting provider must notify us within 48 hours of transfer and penalties still apply. Length of stay reviews still apply, including denials for days that exceed approved length. Discharges to home health will not require prior authorization. Prior authorization is not required for COVID-19 testing and COVID-19 testing related visits.

Click here to learn more.

IMPORTANT UPDATE: From Anthem Blue Cross Blue Shield

Anthem is committed to working with and supporting providers. As of March 16, Anthem is removing prior authorization requirements for skilled nursing facilities (SNF) for the next 90 days to assist hospitals in managing possible capacity issues. SNF Providers should continue admission notification to Anthem in an effort to verify eligibility and benefits for all members prior to rendering services and to assist with ensuring timely payments. In addition, Anthem is also extending the length of time a prior authorization is in effect for elective inpatient and outpatient procedures to 90 days. This will help prevent the need for additional outreach to Anthem to adjust the date of service covered by the authorization. This applies to members of all lines of business, as well as self-insured plan members.

Click here to learn more.

Kentucky Medicaid COVID-19 Information - Cabinet for Health and Family Services

The information on this page is specific to Medicaid beneficiaries and providers. For more information about COVID-19, refer to the state COVID-19 website.

Click here to learn more.

UPDATE: KLOCS Training

More information will be provided when the new "go-live date" is determined and training forums are rescheduled. Thank you for your understanding as well as your continued commitment to keep your communities and residents safe.

Click here to learn more.

Reference from PointClickCare: COVID-19 CMS Medicare Waivers

Posted by Admin Posted on Mar 20 2020

COVID-19 CMS Medicare Waivers

3/19/2020

Attention all Financial and Billing Staff

On March 13, 2020 the Centers for Medicare and Medicaid Services (CMS) issued a blanket waiver based on the declared public health emergency (PHE) COVID-19. This includes waivers for:
• 3 day qualifying hospital stay
• 60 day break in spell of illness. This extends an additional 100 day benefit period for residents who have recently exhausted Skilled Nursing benefits and must remain in a facility.

To view the full communication from CMS, click here.

PointClickCare is currently in communication with CMS to clarify billing and MDS requirements surrounding these waivers. To prepare for monthly billing, review the COVID-19 Waiver Billing Quick Reference Guide (QRG).

PointClickCare is currently working to bypass the UB Edit Check of missing occurrence span code 70 Qualifying Hospital Stay or the demonstration code if DR is on the claim. Continue to monitor the Home Page for more information.

Click here to view the COVID-19 Waiver Billing Quick Reference Guide (QRG) from PointClickCare.

If your SNF needs assistance with this setup, please contact our office.

SNF Coronavirus waiver

Posted by Admin Posted on Mar 16 2020

President Trump declared a national emergency on March 13, 2020. CMS issued Coronavirus 1812(f) waiver of the 3-Day Stay inpatient hospital requirement for Skilled Nursing Facilities (SNF). According to Administrator Verma’s press conference on March 13, 2020, the waiver takes effect retroactively to March 1, 2020. https://www.cms.gov/newsroom/press-releases/emergency-declaration-press-call-remarks-cms-administrator-seema-verma

FAQ link from CMS. https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/MedicareFFS-EmergencyQsAs1135Waiver.pdf

For billing under this waiver, the Disaster Related (DR) condition code should be used by SNFs (institutional providers). The DR condition code is used at the claim level when all of the services billed on the claim are related to the emergency/disaster. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c38.pdf

PLEASE NOTE THAT AN ADMITTING RESIDENT MUST MEET SKILLED CRITERIA IN CHAPTER 8 OF THE MEDICARE BENEFIT POLICY MANUAL. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c08pdf.pdf

COVID-19 MEMO

Posted by Admin Posted on Mar 16 2020

Hargis & Associates (H&A) places the health and safety of our clients, employees, and our health care community as our highest concern. As we continue to serve you, we are continuously monitoring the growing COVID-19 situation and those recommendations from World Health Organization (WHO) and the Center for Disease Control & Prevention (CDC). 

At the present time, H&A has not experienced any interruption to our services or hours. We are encouraging all clients and employees to practice safe measures regarding health including cleaning for disinfection, hand washing, stay home if you are sick, limiting exposure, etc. 

H&A is diligently reviewing all CMS and State guidance affecting health care coverage, billing and coding, and payment to our clients.

Please reference this CMS link for current guidance on these issues: https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current- Emergencies/Current-Emergencies-page 

H&A recognizes the hardships you may be facing as a result of the COVID-19. We strive to continue to offer our services during these challenging times. If you find yourself needing assistance with billing or accounting functions due to staff shortages or the need to have all hands-on deck at your facility, please don’t hesitate to reach out to us for help. We are here to serve our elderly population every day and especially in times of crisis. 

H&A will provide updates regarding the above to our clients and health care community through numerous avenues including publications at our office, our website, social media, etc. For more information or assistance visit our website or call our office. 

Recurring Quarterly Submissions That SNFs Are Required to File

Posted by Admin Posted on Mar 06 2020

PBJ & Credit Balance Reports

Staffing Data Submission Payroll Based Journal (PBJ)

https://secure.emochila.com/swserve/siteAssets/site12840/images/HG_PBJ.png

 

Credit Balance Report (Form CMS-838)

A Medicare credit balance is an amount determined to b refundable to the Medicare program for an improper or excess payment made to a provider because of patient billing or claims processing errors. Each provider must submit a quarterly Credit Balance Report (Form CMS-838) If your facility has more than one provider number, a separate report should be submitted for each provider number. If you fail to submit a Credit Balance (CMS-838) form and/or certification page with all provider numbers identified, Medicare payments will be suspended as stated in 42 CFR 413.20(e) and 405.370. Providers with low Medicare utilization, as specified in the Provider Reimbursement Manual, CMS Pub. 15-1, Chapter 24 2414.4 B, or who file less than twenty-five Medicare claims per year, do not have to submit Form CMS 838. Providers that qualify should submit one, signed and dated certification page and a letter indicating that they are a low Medicare utilization provider. The following provides the reporting periods and associated due dates.

https://secure.emochila.com/swserve/siteAssets/site12840/images/HG_FormCMS838_1200x400.png

Has your facility received a letter from Alliant Health Solutions?

Posted by Admin Posted on Mar 06 2020

Quality Improvement Organizations (QIO)

Some nursing facilities have received a letter from Alliant Health Solutions and are questioning if Alliant is replacing KEPRO.  KEPRO is the CMS Beneficiary and Family Centered Care – Quality Improvement Organization (BFCC-QIO) for Kentucky. KEPRO assist Medicare patients in exercising their right to appeal discontinued Medicare benefits. KEPRO remains to be Kentucky’s BFCC-QIO.

Alliant is CMS Quality Innovation Network – Quality Improvement Organization (QIN-QIO). The QIN-QIO is responsible for working with health care providers and the community on data-driven projects to improve patient safety, reduce harm and improve clinical care at the local level.  

Click here for a reference to help providers to locate the BFCC-QIO and the QIN-QIO for each state. 

Blog by Sarah W. McIntosh, Director of Operations 

Don't Overlook Tax Credits & Incentives!

Posted by Admin Posted on Mar 04 2020

Build a Better Bottom Line with Our Tax Solutions

Our Services - Tax

Manage your tax department with the knowledge needed to efficiently and effectively build a better bottom line with our tax solutions. Reduce the risk of overlooking tax credits and incentives. Hargis & Associates works for your business to identify opportunities resulting in optimal tax savings. We do the work for you; saving you time and resources.

Our dedicated and experienced staff successfully works with your team and the IRS during any tax auditing process. Faithfully rely on us to provide value-added insight.  

Click here to learn more about our services.

Hot Topics

Posted by Admin Posted on Feb 26 2020

Hot Topics

A few Hot Topics in the news.

Publication of FY 2022 SNF Annual Payment Update (APU) Overview Table (Click here to read.)

CMS posts MDS 3.0 QM User’s Manual V13.0, Quality Measure Reporting Module Table V1.8 (Click here to read.)

2020 Physicians fee schedule has been revised (Click here to read.)

IRS Creates New, Large Print Tax Form for Seniors (Click here to read.)
 
New Inspector General named (Click here to read.)

MACs will bypass the edit that requires an occurrence code 50 AND update the edit that ensures the default HIPPS code (Click here to read.)

Publication of FY 2022 SNF Annual Payment Update (APU) Overview Table

Posted by Admin Posted on Feb 14 2020

Publication of FY 2022 SNF Annual Payment Update (APU) Overview Table

Article from Centers for Medicare & Medicaid Services (CMS)

CMS published the FY 2022 SNF Annual Payment Update (APU) table. This table indicates the data elements CMS will use for FY 2022 SNF QRP APU determinations. The SNF APU table is available in the document titled “FY-2022-SNF-QRP-APU-Table-for-Reporting-Assessment-Based-Measures-and-SPADEs-Finalized.pdf” in the Downloads section of the SNF Quality Reporting Program Measures and Technical Information webpage.

Click here to view the FY 2022 SNF Annual Payment Update (APU) table.

Posted by Admin Posted on Feb 13 2020

Coding for HIV/AIDS Patient

Posted by Admin Posted on Feb 13 2020

Coding for HIV/AIDS Patient

When billing Medicare A it is important to make sure you are checking your diagnosis when you have an HIV/AIDS patient. That diagnosis needs to be present on the claim in the first 9 diagnosis or you could miss that extra reimbursement. For example, a resident with HIPPS KAXD would be paid roughly $4500 for 9 days. With the AIDS NTA bump and Nursing addon, the reimbursement increases to $6,426.18.

Click here to view the Reference Medicare Claims Processing Manual (100-04), Chapter 6, Section 120.4.

Click here to view the CMS website, under Fact Sheet, PDPM Payments for SNF Patients with HIV/AIDS.

Unlike other healthcare tax accounting firms, Hargis & Associates, LLC has a widely respected reimbursement team. We are dedicated to being on the forefront of the ever-changing financial climate. We understand the need for billing, training and accounts receivables management facing nursing facilities; that is why we ease the process through our advanced, healthcare billing department. With our proven billing services in place, clients improve cash flow by reducing days in outstanding accounts receivables.

Our Billing Services Include:

• Medicare A & B Billing

• Medicaid Billing

• Medicare Replacement/Managed Care Billing

• Medicare A and B Co-Insurance Billing

• Hospice Billing

• Filing of Medicare Credit Balance Report

• Medicare Bad Debt Log for Cost Report

• Online Billing Analysis, Rebilling, and Collections

• Posting of Cash receipts, adjustments, etc.

• Posting of Ancillary charges

• Accounts Receivable Analysis

• Appeals

• On-Site Training

• Billing Assistance Program

 

Blog by Leah Shoulders, Billing Manager 

Updated Five-Star Ratings Released Today

Posted by Admin Posted on Feb 04 2020

Updated Five-Star Ratings Released Today

Article from LongTermCareLeader.com

NHC is usually updated the fourth Wednesday of every month, but the updates on the first month of the quarter (i.e. January, April, July, October) are more noteworthy. They include updated quality and staffing data. Other monthly updates only include updated survey data.

- Quality Measure Data for 2018-Q4 to 2019-Q3 (Oct’18 – Sep’19) Released

- Payroll-Based Journal (PBJ) Staffing Data for 2019-Q3 (Jul’19 – Sep’19) Released

- Table of Expected Nursing Home Compare Releases with Updated Quality and Staffing Data in 2020

- Expect This Newer Data on LTC Trend Tracker Within a Week

Click here to read this entire article.

Posted by Admin Posted on Feb 04 2020

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