The Academy of Senior
Health Sciences, Inc.
17 South High Street
Suite 770
Columbus, OH 43215
614.461.1922
800.999.6264
Fax: 614.461.7168
cmurray@seniorhealthsciences.org



 

The Academy of Senior Health Sciences, Inc. (formerly The Ohio Academy of Nursing Homes, Inc.) seeks to provide public education and awareness initiatives to the long-term care community in Ohio. Our membership represents a true cross-section of the skilled nursing facility profession, from small sole proprietorships to larger Ohio-based multi-facility companies, as well as those businesses that service our industry. Through our public education and awareness efforts, the Academy brings the collective influences of the members together into a single voice on vital issues affecting our profession.

Founded in 1966, the Academy then identified one of its core purposes as "To foster a spirit of goodwill among those persons engaged in the nursing home industry, to promote ethical practices in their relationships with each other, their employees, and the general public to the end that all interests may be served fairly..." Though the organization has undergone several transformations over the years, most notably in 2011, its dedication and commitment to Ohio's most frail and elderly remains the same.

 The Academy Weekly Headlines from 2 Weeks Ago
ICF-IID formula a done deal, funding increased, July 1 implementation  —  The workgroup charged with developing the new ICF-IID formula finished its work this morning. The group agreed to a new formula that will add an addition 5% of funding. The new formula creates substantial changes including a fair rental value capital component, new peer grouping, different weighting to the DDP, and plans for a quality incentive payment in the future. The goal is to have the new formula in effect July 1, 2018. A hold harmless provision will be in place that compares a provider's new rate to what their rate would have been under the old formula. The provider will receive the greater of the two rates. About 75 providers are expected to be impacted by the hold harmless. In related news, a new version of the cost reporting software is now available. The new version removes attachment 10 and makes changes related to the new formula. Please contact The Academy for more information.

Malnutrition commission reviews recommendations —  The Malnutrition Prevention Commission met this week to walk through a draft of their recommendations on how to tackle malnutrition among older adults. The group presented 15 draft recommendations and proceeded to go through each one and make changes. (Click here to download a PDF of the draft recommendations.) Most of the recommendations did not relate to SNFs or RCFs and instead focused on community resources, their availability, identifying those at risk, and linking them to those resources. For SNFs, the focus was on information sharing for both admission and discharge. Hospitals would be expected to provide information for those at risk of malnutrition while SNFs would be expected to address availability of meals during discharge planning. An example was given of a planned discharge on a weekend to a home without food and no delivery of meals until Monday. The facility would be expected to account for this and ensure availability of food during and after the transition to the community as part of the care plan.

CMS delaying therapy claims due to exception process expiring —  CMS provided information on how it will handle therapy claims related to the KX modifier as Congress failed to extend the exception review process: CMS is committed to implementing the Medicare program in accordance with all applicable laws and regulations, including timely claims processing. Several Medicare legislative provisions affecting health care providers and beneficiaries recently expired, including exceptions to the outpatient therapy caps, the Medicare physician work geographic adjustment floor, add-on payments for ambulance services and home health rural services, payments for low volume hospitals, and payments for Medicare dependent hospitals. CMS is implementing these payment policies as required under current law. For a short period of time beginning on January 1, 2018, CMS took steps to limit the impact on Medicare beneficiaries by holding claims affected by the therapy caps exceptions process expiration. Only therapy claims containing the KX modifier were held; claims submitted with the KX modifier indicate that the cap has been met but the service meets the exception criteria for payment consideration. During this short period of time, claims that were submitted without the KX modifier were paid if the beneficiary had not exceeded the cap but were denied if the beneficiary exceeded the cap. Starting January 25, 2018, CMS will immediately release for processing held therapy claims with the KX modifier with dates of receipt beginning from January 1-10, 2018. Then, starting January 31, 2018, CMS will release for processing the held claims one day at a time based on the date the claim was received, i.e., on a first-in, first-out basis. At the same time, CMS will hold all newly received therapy claims with the KX modifier and implement a “rolling hold” of 20 days of claims to help minimize the number of claims requiring reprocessing and minimize the impact on beneficiaries if legislation regarding therapy caps is enacted. For example, on January 31, 2018, CMS will hold all therapy claims with the KX modifier received that day and release for processing the held claims received on January 11. Similarly, on February 1, CMS will hold all therapy claims with the KX modifier received that day and release for processing the held claims received on January 12, and so on. Under current law, CMS may not pay electronic claims sooner than 14 calendar days (29 days for paper claims) after the date of receipt, but generally pays clean claims within 30 days of receipt.

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