Winter 2019

IN THIS ISSUE

NY-RAH Adds Clinical Project Specialist to Optimize Practitioner Billing

NY-RAH Continues Meetings with External Stakeholders

2019 National Healthcare Decisions Day Promotion

NY-RAH Uses Monthly Claims Data to Track Facility Episode Billing

In Case You Missed It

NY-RAH Adds Clinical Project Specialist to Optimize Practitioner Billing

At the late-October start of Year 3 of Phase Two, NY-RAH made a program modification to Group B facilities that included replacing Registered Nurse Care Coordinators with Quality Improvement Specialists. NY-RAH also added a Clinical Project Specialist (CPS) position to help medical directors and eligible practitioners at Group B facilities that use the Centers for Medicare & Medicaid Services' (CMS) new billing code (G9685), which was available at the start of Phase Two. Practitioners treating eligible residents in place at the nursing facility can use G9685 in an effort to reduce avoidable transfers and hospitalizations for Phase Two's six qualifying conditions. A practitioner could be reimbursed via G9685 at a rate equal to what they'd be reimbursed if the resident were admitted to and treated at the hospital (99223) and at a rate higher than what would otherwise be available during nursing facility follow-up visit codes (99307-99310).

Dr. Lisa Gonzalez assumed the Senior CPS role in December. She has extensive experience working with practitioners and medical groups on quality improvement and workflow activities. Dr. Gonzalez has begun working with Group B nursing facility medical directors, individual practitioners, and medical groups to discuss challenges with G9685 and how to help practitioners meet the associated documentation and billing requirements. If you're interested in speaking with Dr. Gonzalez, please contact her at lgonzalez@gnyha.org.

NY-RAH Continues Meetings with External Stakeholders

Over the past year, the NY-RAH Project Management Team (PMT) has discussed the Nursing Facility Initiative (NFI) and the project with various external stakeholders. The PMT knows it is important to inform various local, state, and national entities -- including nursing facility associations, health plans, and regulatory agencies -- about the project's challenges and successes. During these meetings, stakeholders are updated on current interventions and their impact on the 57 skilled nursing facilities currently participating in the project. The PMT also highlights the commitment made by the participating nursing facilities to improve the quality of care for their long-stay residents. Stakeholders understand successes, best practices, and ongoing challenges such as facility and practitioner engagement, implementation of workflow processes, leadership turnover, and the importance of interdisciplinary efforts. Many stakeholders' goals align with the NFI's overall goals, creating opportunities for future collaboration. The PMT will continue to publicize the results of both the project and the NFI, and the unique opportunity for participating facilities to further reduce the potential for avoidable transfers for their long-stay nursing facility residents.

2019 National Healthcare Decisions Day Promotion

NY-RAH will again promote National Healthcare Decisions Day (NHDD) at Group B facilities. NHDD, a private national initiative, is held annually on April 16, the day after tax day, to reflect the adage that the only things in life that are certain are death and taxes. NY-RAH also will host a March 12 Group B Clinical Intervention Learning Community webinar during which NY-RAH Medical and Palliative Care Director Joseph Sacco, MD, will review types of advance directives and offer updates on the 2017 amendments to the Family Health Care Decisions Act (FHCDA) and the 2018 amendments to the Health Care Proxy Law. The amendments give nurse practitioners the same authority as physicians to determine patient incapacity and to write do-not-resuscitate (DNR) orders and other orders to withhold and/or withdraw life-sustaining treatment. NY-RAH strongly encourages Group B facilities to invite any staff that could benefit from additional training on advance directives to participate.

NY-RAH will update this year's NHDD promotional materials and introduce new materials that will be sent to Group B facilities in April. NY-RAH encourages all Group B facilities to hold NHDD events during April as an effective way to increase the facility's rate of advance directives and promote palliative care and respect for end-of-life wishes. NY-RAH continues to track the rate of advance directives, including the health care proxy, DNR, do not hospitalize, and MOLST in the NY-RAH data portal, and encourages facilities to continue using the data portal to track this information, which is effective for use in quality assessment and performance improvement (QAPI) projects.

If you would like your facility's NHDD event featured in the next NY-RAH News, please contact Megan Burns, Associate Project Director.

NY-RAH Uses Monthly Claims Data to Track Facility Episode Billing

CMS sends NY-RAH monthly claims data on the number of episodes for which each participating facility has billed since the start of Phase Two. On February 15, facilities received the second Monthly Billed Facility Episodes Overview report, which provides information on each facility's recent facility episode billing patterns and revenue earned via the NY-RAH facility codes. The report also compares each facility's results against the results of all other NY-RAH facilities. Reviewing these metrics could ensure that your facility's billing processes are occurring as expected. Over the past month, more than half of participating facilities (31) have billed new facility episodes, indicating continued progress with implementing processes to identify, manage, and bill for the six qualifying conditions, the NY-RAH team has observed.

NY-RAH also compares previous monthly files to identify overall facility billing trends. On average, 29 facilities bill for at least one new episode each month. For January, the number of facilities that had a change in their billing report was slightly higher than average, as 31 facilities billed new facility episodes. However, while a larger-than-average number of facilities billed at least one new episode, the overall number of new episodes billed by facilities was less than average, with 224 new episodes billed in January. This compares to an average monthly rate of 244 new episodes. Additionally, NY-RAH facilities have earned more than $7.5 million in new revenue through the facility billing codes to date, with more than $330,000 earned during January.

NY-RAH will continue to track billing patterns, episodes, and earned revenue across all participating facilities. The PMT hopes that the processes to track and treat these conditions in the nursing facilities will continue to improve, producing more opportunities to provide better care for the eligible population and to bill for additional episodes.

If you have any questions regarding the Monthly Billed Facility Episodes Overview report, please contact Courtney Zyla, Senior Research Analyst.

In Case You Missed It

February 12: Clinical Intervention Learning Community Webinar on Clinical Criteria Revisions and Changes to Documentation Guidelines
During the February 12 webinar, the NY-RAH PMT reviewed the clinical criteria revisions and changes to G9685 documentation guidelines, effective January 1.

Access a recording of the webinar here.

Additional items mentioned during the webinar:

For questions, please contact Faiza Haq at GNYHA.

      NY-RAH is supported by Funding Opportunity Number 1E1CMS331492-01-01 from the US
Department of Health and Human Services, Centers for Medicare & Medicaid Services. The
contents provided are solely the responsibility of the authors and do not necessarily represent
the official views of HHS or any of its agencies.