Pre-Conference

Introducing AANAC’s New “Medicare University” Taught by Ron Orth, RN, NHA, RAC-MT and Judy Wilhide Brandt, RN, BA, RAC-MT, C-NE

DAY ONE:

1. Medicare Basics: Introduction to the Medicare Program, different types of Medicare benefits in a Skilled Nursing Facility, understanding the SNF Benefit Period, Technical Eligibility, Skilled Coverage Requirements, ensuring regulatory compliance with meeting the daily skilled need, direct and indirect skilled services defined, SNF Beneficiary Notices Initiative.
2. Managing Medicare A in a SNF, Pre-Admission, the Admissions Process, making correct coverage decisions, best practices for facility interdisciplinary responsibility in daily management of SNF program, Discharge Planning, Strategies for success in growing and keeping SNF market share, understanding and proactively managing publicly reported data: 5 Star Rating and other Nursing Home Compare Data, how ‘culture change’ can benefit the post acute SNF.
3. Managing the SNF documentation process: Examine reasons for consistent, sound documentation, consistently show SNF need, discussion of Facility best practices, resource guides, charting guidelines for nursing, social services, dietary, activities, tips/tools for auditing daily/weekly/ monthly/quarterly, examine the PPS meeting as a management tool.

DAY TWO:

4. Rehabilitation Therapy under PPS, define what constitutes qualified therapy service, In-House vs. Outsourced therapy, coordinating therapy disciplines and schedules, therapy documentation requirements, RUGS Management. Once thought to be the sole domain of Rehabilitation Professionals, it is now apparent that SNF management at all levels needs to understand and oversee these critical processes. We’ll also examine and explain management of Part B therapy in a nursing facility.
5. The PPS System of MDS assessment scheduling: Examine the concept of SNF ‘bundled services’ in the daily PPS rate, explain the components of the daily rate, discuss current CMS initiatives and their potential effect on the SNF PPS in the future, i.e. STRIVE, RUGs Refinement, MDS 3.0, explain the PPS assessment schedule and payment periods for each type of assessment, financial penalties for non-compliance with the PPS schedule, strategically setting ARDs to appropriately capture the care and services given.
6. Resource Utilization Groups: Explain how the RUGS-53 grouping system accounts for the “resident acuity” portion of the PPS daily rate, learn how to compute the all-important ADL Score, discuss Hierarchy vs. Case Mix Index Maximization, discover precisely what items on the MDS comprise each RUG, tactics for capturing all services provided on each PPS MDS assessment. This crucial element of the process cannot be left to MDS Coordinators and Rehab Directors. The entire PPS team must be able to recognize and react to daily events in the course of a beneficiary’s SNF stay that impact reimbursement, to ensure those services are reflected appropriately in the RUG.

DAY THREE:

7. Consolidated Billing for the Facility Management Team: Recognize the major categories of consolidated billing, know how to determine if a service is included or excluded from consolidated billing, clarify the common CB issues that arise every day in a SNF: Who pays for the transportation? Why does it matter where the MRI, radiation, etc. was given? Is chemo excluded or not? Do we really have to pay for [insert expensive, necessary equipment here] that apparently got lost on the ambulance trip over? Identify strategies for ensuring that the SNF pays what it owes and does not pay if the service is excluded from consolidated billing.
8. Medical Review/Additional Development Requests: Describe the Medicare Medical Review Process including types of review and outcomes, how to respond to Additional Development Requests, Provider appeal rights and the Medicare Appeals Process.
9. Review of key points of entire Seminar, Questions and Answers.

Course Schedule for Each Day: