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
Bed need discussed at meeting of interested parties  –  The Academy met with legislators, state officials, and other interested parties to discuss the possibility of removing nursing home beds from the system. The group discussed the current bed need formula and its shortcomings as a method of determining the state's need for beds. Ideas for a "bed buy back" program were also discussed, including an auction method with sealed bids. The group determined that better analysis of the data would aid in determining how many beds need to be removed and how best to proceed. The state agencies agreed to collaborate and analyze the current data.

MyCare Ohio: Claims update  —  The plans continue to process SNF claims with varying success. Most of the plans have indicated that they plan on keeping the current process of not applying certain edits for at least a little while longer. Below is a broad update of what we know as of today. The plans continue to work through billing issues such as PA1 and PA2 billing, bed holds, and hospice claims. If you have a specific issue you need addressed, please contact us so we can facilitate the process.
Buckeye: They are still working through some system fixes, although the patient liability (PL) and Medicare EOB denials should now be processing. Buckeye pays based on the PL amount submitted by the provider, so most claims should not have PL problems. If so, Buckeye will reconcile at a later date. Buckeye will be faxing providers the prior authorization (PA) numbers within the next few weeks. These should be used for August claims submission (July services).
CareSource: CareSource continues to have edits turned off, resulting in some payment errors. Providers are asked to wait while CareSource works through the various claims to determine the best approach at reconciliation. CareSource is still creating PAs for their members and providers can continue to use the member ID number if no PA is available. For Medicare EOB of the long-term Medicaid only population, CareSource will use the admission date on the claim (actual admission date should be in that field) to determine if Medicare benefits have been exhausted.
Molina: Molina has indicated that the claims process is slower than expected as they make adjustments to their systems or manual adjust claims. It may take longer than usual for claims to pay. Molina considers Medicaid the primary payer for their Medicaid only members, so no Medicare EOB is necessary.
UHC: Providers are asked to reconcile PL errors either online via the provider call center or by submitting a claims reconsideration form with the appropriate documentation. UHC continues to encourage providers to get PAs for all of their residents.
Look for an Academy Update early next week containing more information on MyCare.

Antipsychotic reduction program shows success; AliveInside  —  The Steering Committee for the Partnership to Improve Dementia Care met this week to review the early results of the quality improvement program to reduce the use of antipsychotics in nursing homes. The QI program had facilities track their use of antipsychotics in Advancing Excellence and implement techniques for reducing their use. As seen in the chart, the participants were able to reduce the use of antipsychotics by a greater amount than the average decline in Ohio. The data has not been analyzed enough to determine if the change is because of program participation. A clear result of the program was the decline in participation through time. One hundred and three facilities started and only 40 finished the program six months later. There was a steady decline in participation throughout the six months. The committee determined it was worthwhile to investigate why facilities didn't participate or stopped participating to improve future projects.

On a related note, ODA Director Burman noted a movie that focused on the benefits of using music therapy for individuals with dementia. The movie, AliveInside, won the Audience Award at the 2014 Sundance Film Festival. Director Burman noted that this was an example of person centered care with amazing results. The department will be encouraging nursing homes across the state to integrate music therapy into their provision of services for dementia residents. (Back to top)

  • Click Here to read The Academy Weekly in PDF format