Long-term Care Skilled Services: Applying Medicares Rules to Clinical Practice

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HC Pro, Inc., Apr 6, 2011 - Medical - 148 pages
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Long-Term Care Skilled Services: Applying Medicare's Rules to Clinical Practice


Avoid common mistakes that compromise compliance and payment

Take the mystery out of skilled services and know when to skill a resident based on government regulations, Medicare updates, the MDS 3.0, and proven strategies. "Long-Term Care Skilled Services: Applying Medicare's Rules to Clinical Practice" illustrates the role played by nurses, therapists, and MDS coordinators in the application and documentation of resident care. Don't miss out on the benefits and reimbursement you deserve, as author Elizabeth Malzahn delivers clear, easy-to-understand examples and explanations of the right way to manage the skilled services process.

This book will help you:

  • Increase your skilled census and improve your facility's reputation with the support of your entire staff
  • Avoid under- and overpayments from Medicare with easy-to-understand explanations of complex rules and regulations
  • Provide necessary skilled services to each resident through a complete understanding of eligibility requirements
  • Accurately document skilled services using proven, time-saving solutions
  • Properly assess skilled services under the MDS 3.0
  • Improve communication to increase resident and family satisfaction
  • Reduce audit risk and prove medical necessity through accurate documentation
Table of Contents
  • Rules and Regulations
    • Original law - Social Security and Medicare Act
    • CMS publications
      • Manuals
      • Transmittals
      • MLN matters
      • National and local coverage determinations
      • "RAI User's Manual "
      Hierarchy of oversight
      • CMS-MAC/FI, OIG, GAO, etc.
      Technical Eligibility for Skilled Services in LTC
      • Eligibility basics
      • Verification of current benefits
        • How enrollment in other programs impacts coverage under traditional Medicare
          • Hospice
          • HMO/managed care/Medicare Advantage
          • Medicaid/Medi-Cal
          Hospital stay requirement30-Day transfer rule for hospital or SNFUnderstanding benefit periodsCare continuation related to hospitalizationHow does a denial of payment for new admissions impact Medicare SNF admissions?Meeting the Regulatory Guidelines For "Skilled" Services
          • Skilled services defined
            • Regulatory citations and references
            • Clinical skilled services
            • Therapy skilled services
            Physician certifications and recertificationPresumption of coverageUnderstanding "practical matter" criteria for nursing home placement
            • Impact of a leave of absence on eligibility
            MDS 3.0 - Assessments, Sections and Selection...Oh My!
            • Brief history of MDS 3.0
            • Types of MDS assessments
            • The assessment schedule
              • Items to consider
              • Importance of timing
              Review of each care-related section of the MDS 3.0Proper Communication During the Part A Stay
              • Medicare meeting
                • Timinng
                • Agenda
                • What to discuss for each resident
                Ending skilled services
                • Notification requirements
                • Discharging
                Other notification requirements and communicationOther Important Things to Know
                • Medicare myths
                • Consolidated billing
                • Medical review
                Audience

                Administrators, CFO/CEOs, directors of nursing, MDS coordinators, directors of rehab, therapy directors, PT/OT/ST, DONs.

 

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Contents

MDSLTCS_01
1
MDSLTCS_02
27
MDSLTCS_03
45
MDSLTCS_04
67
MDSLTCS_05
99
MDSLTCS_06
123
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About the author (2011)

Elizabeth Malzahn is the health and wellness finance manager for Covenant Retirement Communities (CRC). CRC includes a group of 14 continuing care retirement communities across the country. Malzahn has been with CRC since August of 2009. Prior to joining CRC, she worked for 10 years at a mid-size accounting firm as a manager in the Health Care Consulting Group, specializing in skilled nursing facility (SNF) operations, reimbursement and receivables.

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