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 requirement
  • 30-Day transfer rule for hospital or SNF
  • Understanding benefit periods
  • Care continuation related to hospitalization
  • How 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 recertification
  • Presumption of coverage
  • Understanding “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 3.0
• Proper 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 communication
• Other 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.

About the Author

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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