Skilled Care Reimbursement: Recipe for Reimbursement

I visit dozens of facilities in Minnesota and I am always amazed at the facilities that are not tracking and monitoring their MA/Private Pay case mix reimbursement as well as their Medicare/Insurance reimbursement. The MDS assessment is your invoice for getting paid and unless you are occasionally checking the coding of your “invoices” you might be losing out on significant revenue.

Some suggested ways for your team to capture revenue include:

> Ensure the staff are trained and understand what specific diseases, conditions, treatments and activities of daily living (ADL) support count toward reimbursement.

> The interdisciplinary team should meet 2 weeks prior to the MDS due date to ensure:

• The provider has documented the active diagnosis that are coded on the MDS in the past 60 days

• ADL documentation from the nurse aides is reflective of care or allows time for interviews and clarifications

• Allows time for review of behaviors (Increased revenue with no other conditions or treatments and a low ADL score)

• Review documentation of wounds

• Review if a respiratory diagnosis that a thorough respiratory assessment is performed by a trained RN. The capture of Special Care High Nursing category is if a resident has a chronic respiratory diagnosis and also is short of breath with their head lying flat in the bed. (Consider use of recliners for sleep, use of multiple pillows due to discomfort with breathing, fear of lying flat, use of additional treatments for SOB such as oxygen or CPAP/BiPap.) Refer to MDH SOB assessment guidelines. www.health.state.mn.us/facilities/regulation/casemix/clarifshortbreath

• If respiratory therapy is captured with the use of nebulizer treatments, ensure nurses are trained and have proven competency and proficiency with respiratory assessment. See MDH www.health.state.mn.us/facilities/regulation/casemix/cmmdsraiinfo

For Medicare/Advantage plans, I recommend that the team really focus on the SLP component. The requirements are a neurological diagnosis, a SLP related co-morbidity/diagnosis such as hemiplegia, dysphagia, a BIMS score of 10 or less, (Ensure social workers watch CMS video on administering the BIMS assessment), a swallow disorder or a mechanically altered diet. The entire team should be trained on how to recognize a swallowing disorder. Have all staff trained to report difficulty chewing or swallowing meds, food or fluids that fall from the mouth when eating or drinking, pocketing of food, (train nurse aides and nurses to report pockets of food when assisting with oral cares), awareness of complaints of difficulty swallowing and/or complaints of pain with chewing or swallowing. These areas can result in a daily SLP increase of $30-$122/day during the Medicare/Insurance stay. (Urban rates)

Operational strategies include: ensure close monitoring and observation of the dining room, reporting of chewing/swallowing difficulties and the financial and clinical importance. You may want to include the swallowing questions in section K of MDS in POC or in your Medicare charting. In addition, if resident is on Speech therapy, it is imperative that the RD and SLP are in communication weekly at a minimum. Allow the RD access to SLP documentation in the EHR.

For more information on skilled nursing or assisted living reimbursement, please contact consult@srcaresolutions.net

Michelle Stober RN, BSN, PHN

CEO Senior Care Solutions

Reimbursement Action Plan Tool

Read More:

The Benefits of Mock Surveys in Hospice

Mock surveys rehearse official inspections for hospices, pinpointing areas for improvement before real surveys. This helps staff prepare, identifies weaknesses, and boosts confidence.

Lores Consulting and Senior Care Solutions Proudly Announce their Strategic Partnership!

Senior Care Solutions (SCS) announces a partnership with Lores Consulting, expanding into Home Care and Hospice services. Lores Vlaminck, a retiring expert, joins forces with SCS's Michelle Stober. Both are passionate about quality care and aim to serve a wider client base. SCS is also affiliating with relevant industry groups in Minnesota.

Hospice Compliance and Oversight

A recent surge in concerns about hospice care quality led to stricter regulations. The Hospice Act of 2021 requires tighter oversight, improved quality metrics, and stronger patient protections.

Nursing Home OSHA Ergonomics Program Law Effective 1/01/24

The 2023 Legislative Session passed a law effective January 1st , 2024 stating healthcare entities must have an ergonomics program (healthcare entity includes Nursing Homes).

The Heart of the Holidays: Meals in Assisted Living

Assisted living holiday meals are social events, but food safety is crucial. Staff should prioritize proper hygiene, temperature control, storage, and kitchen checks. Consider adaptations for resident needs while maintaining festive flavors. By following these tips, communities can celebrate safely and spread holiday cheer.

Navigating the Holidays through Grief

The holidays can be tough for those grieving. This blog post offers tips for coping, like acknowledging your feelings, creating new traditions, and setting boundaries. It also suggests honoring your loved one and practicing self-care. Remember, grief is personal, so be kind to yourself.

Five Creative Ideas for Leaders to Help Keep Your Team Engaged

We offer tips for leaders to bring fun into the workplace. Ideas include holding meetings in new locations, having team lunches, taking walks, incorporating fun elements into stand-up meetings, and organizing monthly team-building activities. It emphasizes that having fun boosts morale and shows investment in employees.

How Supplemental Nurses and Caregivers Can Help Your Assisted Living Staffing Plan

This blog post tackles healthcare staffing shortages. It highlights the use of supplemental staffing agencies and offers 3 key tips for facilities: 1) Verify agency accreditation, 2) Ensure staff meet facility requirements, and 3) Conduct thorough agency orientations. These steps help maintain quality care and compliance during staffing shortages.

Is Your Coffee Too Hot?

This blog post warns about the burn risk from hot coffee in healthcare facilities. While coffee should ideally brew at 195°F, safe drinking temperature is much lower (155°F can burn in 1 second!). Lowering brewing temperature sacrifices flavor. The solution is to prevent spills with locked machines, air pots, travel mugs, etc. pen_spark

Latest Updates on the MDH Assisted Living License Survey Trends

This blog post by Julie Dietz, a senior assisted living consultant, summarizes the most common deficiencies found in recent Minnesota assisted living facility inspections.

Get Updated on the 2022 Legislative Changes to the Assisted Living License

This blog by Julie Dietz summarizes changes to Minnesota's assisted living laws. Key changes include updating resident rights regarding privacy and adding contact info for complaint reporting. The assisted living contract must now include termination grounds and the facility ID number.

Reduce Immediate Jeopardy Tags With Appropriate Sling Use

High staff turnover and COVID-19 focus on infection control have led to more regulatory scrutiny in nursing homes. Inappropriate sling use is a growing concern. Facilities should ensure proper sling size, documented plans, staff training, and regular audits to prevent resident injuries.