Blog

February 13, 2020

Take a crash course in post-acute data and network management best practices for Hospitals and ACOs. By Karen O’Driscoll All stakeholders in a collaborative or network need to work as partners and use data to speak a common language concerning performance and goals. This means that there are a lot of people along the care…

February 3, 2020

What CMS changes to MDS sections G and D will impact SNF care planning and reimbursement this fall? by Pam Kaiser, MSN, RN Okay, I will admit that this one almost got by me. Caught up in the Patient-Driven Payment Model (PDPM) whirlwind, I was focused on the post mortem of the first full quarter…

January 16, 2020

By Paola DiNatale, MSN, RN, NHA Why is it important for Accountable Care Organizations (ACOs) to understand the connection between clinical documentation and key performance metrics? — ‘If it hasn’t been documented, it hasn’t been done.’  Lessons learned and forever rooted in our clinical training.  Clinical documentation must meet level of ‘attention to detail’ to…

November 14, 2019

In the 80s we wanted our MTV; now in 2020, QAPI program managers want their pain quality measures. By Janine Savage, RN, RAC-CT, CHC The Centers for Medicare & Medicaid Services (CMS) announced in October that it has removed the Short-Stay Pain and Long-Stay Pain Quality Measures from the Five-Star program and from being reported…

November 11, 2019

By Steven Scott This year on Veteran’s Day, on behalf of the PointRight team, I wanted to take a moment to recognize the people who serve veterans every day. We’re a proud supporter of the National Association of State Veterans Homes (NASVH) and work with several veterans facilities as clients. What is the NASVH? The…

November 5, 2019

How does the new hospital discharge planning rule impact relationships between hospitals and skilled nursing facilities (SNFs)? By Maria Arellano, MS, RN Ignoring key regulatory changes in other health care provider settings is a dangerous practice. Although you may be tempted to focus only on your internal challenges with the rapid-fire changes from CMS, many…

October 31, 2019

If you were unable to attend this year’s AHCA/NCAL Convention & Expo, check out our observations and favorite moments from this year’s event. The show’s theme centered around healthcare ‘superheroes’ and many of the keynotes touched on the more personal side of healthcare. “Caring defines what we do every day.” Outgoing AHCA Board Chair Michael…

October 23, 2019

PointRight Helps Hospitals Comply By Janine Savage, RN, RAC-CT, CHC September 26, 2019, The Centers for Medicare & Medicaid Services (CMS) issued a Final Rule addressing acute care to post-acute care (PAC) discharge planning. There are many complex and detailed requirements and prohibitions in this Final Rule that aim to improve patient engagement and decrease…

October 14, 2019

Keep What Your Teams Are Working Hard to Achieve By Janine Savage, RN, RAC-CT, CHC In one of my past roles, I was a Corporate Compliance Officer for a long-term and post-acute care provider. I still maintain my CHC (Certified in Healthcare Compliance) credential through the Healthcare Compliance Board and stay connected to the LTPAC…

September 30, 2019

Have you cut the cord with your cable provider yet? If you are like most of us, the answer is no. If anything, your cable company is finding more ways to lock you into their service through price promotions and bundling that make it harder to switch later if they raise prices or change service….

September 24, 2019

By Maria Arellano, MS, RN Over the last 12 months, skilled nursing facility (SNF) providers spent considerable time and resources preparing interdisciplinary teams for the anxiously awaited Patient Driven Payment Model (PDPM). PDPM is the most dramatic change to hit skilled nursing facilities in two decades and shifts payment for caring for Medicare beneficiaries from…

September 4, 2019

By Paola DiNatale Healthcare providers understand too well that the patient’s clinical record documentation is based on the clinical situation, however too often we get trapped in the mindset of ‘when it’s too much or too little reporting’. Long passed are the good ole days when the clinical record documentation meant ensuring that the correct…

July 30, 2019

By Jennifer Gross, BSN, RN-BC, RAC-CT, CPHIMS As Skilled Nursing Facilities (SNFs) prepare for the implementation of the Patient-Driven Payment Model (PDPM) on October 1, 2019, much of the focus of training has been on diagnosis coding.  Rightly so, since ICD-10 coding can make or break a facility’s capture of the correct PDPM Clinical Categories…

July 14, 2019

by Pam Kaiser, MSN, RN In the past, changes to the payment system for Skilled Nursing Facilities (SNFs) impacted other health care sectors. When the Balanced Budget Act of 1997 (BBA) went into effect, many hospital dialysis patients had a hard time getting places in SNFs. Under Consolidated Billing at the time, the SNF was…

May 21, 2019

By Janine Savage, RN, RAC-CT, CHC Since the CMS Final Rule announcing the Patient-Driven Payment Model (PDPM) was released, there has been much speculation among SNF providers and industry experts about what compliance will look like under the new reimbursement system. Under RUG-IV, compliance primarily depends on one key metric: medical necessity for therapy services….

March 14, 2019

CMS is “thawing out” the freeze on Five-Star Ratings effective April 2019. We were all expecting the thaw this spring, and CMS doesn’t disappoint! Remember that spring showers bring May flowers, and for some of you, “flowers” will take the form of an improvement in your Five-Star Rating. CMS did more than just unfreeze the Five-Star…

January 15, 2019

by Steven Littlehale December 2018 marked Five Star’s ten-year “birthday.” When you read its birth certificate, you’ll see its given name is: “Five-Star Quality Rating System,” though interestingly enough, the only direct measures of quality (the CMS quality measures) carry the least weight. Over the last ten years Five-Star has certainly matured considerably and if…

January 9, 2019

by Pam Kaiser, MSN, RN If it seems that hospitals have been focused on readmission rates for years, they have. Starting in fiscal year 2013, hospitals have been penalized for readmission rates for Medicare beneficiaries with certain diagnoses. Those penalties have been increasing with each year until the penalty cap of 3% was reached. Progress…

December 18, 2018

Thank you PointRight clients, partners and friends for a great 2018. It’s been quite a year for our industry to say the least. Wild fires in California turned hero care-givers into hero rescuers, CMS’ continued its commitment to value-based reimbursement with the announcement of PDPM and Five Star turned 10. Looking to 2019, PointRight is preparing our clients to…

December 12, 2018

We are celebrating Five-Star’s 10th year birthday this December 2018. Over the last ten years, Five-Star has certainly matured considerably, and if you believe it measures quality, then you also must accept that nursing home quality has also improved.  [We at PointRight believe that quality has improved but choose other ways to validate the industry’s improvement.]…