1. Medicare Call – February 2018
Kerry Dunning, MHA, MSH, CPAR, RAC-CT
Kerry Dunning LLC

2. Review October 1 changes (including MDS)
Updated regulatory translation as of 1/26
ADLs
How to check on your program compliance
Importance of accurate tracking of ADLs

3. Changes are Coming!
Between now and October 1 PPS changes and CMS updates will keep SNFs and PPS Swing Bed programs busy.
CAH Swing Bed programs must pay attention to the changes because it signals Medicare intent for skilled nursing programs
Example: Just because the caps are off OP Part B Therapy doesn’t mean length of stay and charges should increase.
CMS will change to MAC audits to rein in unnecessary therapy

4. October 1 RCS – 1 replaces the RUG payment system
As it draws closer more details will be shared on this monthly call
What has occurred is a new MDS item set is available for download. All programs (CAH included) should download the information and begin to get familiar with the changes

5. FAQs Related to Regulations
CMS updated answers on 1/26/18 in a document: “Frequently Asked Questions Related to Long Term Care Regulations, Survey Process, and Training
Changes are in “red”, so they easily found in the document
Selected areas for review:
Resident Rights related to patients refusing to be weighed
Admission, Transfer and Discharge
Comprehensive Resident Centered Care Plans
Pharmacy Services (also check page 21 of the document)
This serves as a guidance to surveyors for LTC/SNF
Swing Bed Programs will be expected to comply with the regulatory interpretation

6. Scoring your Programs
There are multiple ways C-Suites can get an idea of how well their swing bed programs are recording important data (clinically and financially)
One of the most important is the tracking of patient ADLs – they are the KEY to skilled care which is the post-acute level trying to get patients home safely and returning to quality of life.
Ask your Program leaders:
How do you track ADLs? (Show us)
Do you see repeated patterns that make no sense (i.e., night shift always scoring all patients the same way)?
Ask the for the documentation comparing patient ADL function at admission vs. short term goals vs. discharge actual goals obtained
START THERE AND YOU WILL OFTEN FIND A SIGNIFICANT TRAINING GAP THAT IS DIRECTLY RELATED TO PPS REIMBURSEMENT AND MEDICALLY NECESSARY DOCUMENTATION FOR CAHS

7. ADL Tracking

8. Biggest issue? Not capturing ADLs on a 24 hour basis, 7 days a week
Impacted by NOT having night ADL support scored
Impacted by “weekend” staff not being trained or not being asked to make sure scoring occurs

9. Questions?
If you have questions about this course, please contact: or Kerry Dunning