NY‒RAH Offers Free Nursing Documentation Training to Group B Facilities

NY‒RAH recently announced the availability of facility-based needs assessments and trainings on nursing documentation for Group B facilities. The assessments and trainings will be provided by CMS Compliance Group, Inc., a New York-based regulatory compliance and quality improvement consulting firm with extensive experience servicing post-acute and long-term care facilities and agencies. The assessments and trainings build upon the in-service programs each facility was required to conduct earlier this year on nursing documentation around the six conditions. CMS Compliance Group will help facilities with their unique challenges, identify process breakdowns, and address documentation issues both within and beyond the six conditions. The trainings will also help prepare staff for the October 1 transition to the Patient Driven Payment Model (PDPM), which emphasizes nursing services over therapy services. The full-day, on-site assessments will include a review of medical records and a discussion with nursing administration about challenges and issues. Custom trainings will then be developed and provided for all shifts (in the form of two one-hour sessions per shift).

NY‒RAH will cover the consulting fees, so there is no cost for Group B facilities for the assessments and trainings. Trainings are available on a first-come, first-served basis. To sign up, please contact Megan Burns.

NY‒RAH Releases New Web-Based Potential Missed Opportunities Dashboard

In July, NY‒RAH released the Potential Missed Opportunities Dashboard, a new report that all Group A and B administrators can access through the NY‒RAH data portal. The report uses Medicare hospitalization and nursing home claims data to identify potential missed opportunities for billing the CMS Nursing Facility Initiative (NFI) facility payment incentive codes (G9679-G9684). This is the first report created by NY‒RAH that allows for dynamic filtering and drilldowns into resident-level Medicare claims data.

The NY‒RAH data team reviewed the new report during the July 9 Clinical Intervention Learning Community webinar. Facilities viewed different ways to use the dashboard to further improve internal processes. The dashboard allows viewers to see specific resident-level hospitalizations associated with the six qualifying conditions, providing an opportunity for chart reviews that can help identify areas of improvement for the facility’s early identification of changes of condition, documentation standards, and billing processes. While these processes could impact billing for NY−RAH’s six qualifying conditions, they could also have a broader impact on quality improvement efforts and reducing hospitalizations.  

The NY‒RAH Project Management Team (PMT) strongly encourages all facilities to routinely access and use the dashboard to address opportunities for improvement. For more information on the Potential Missed Opportunities Dashboard, including how to access the NY‒RAH data portal, please contact Courtney Zyla.

NY‒RAH Continues to Promote Use of Practitioner Payment Incentive

As part of its current year project workplan, NY‒RAH brought on two Clinical Project Specialists (CPSs) to work directly with NY‒RAH medical directors, medical groups, and eligible practitioners. The CPSs work with physicians and other practitioners who provide care to NY‒RAH-eligible residents to encourage use of the special Medicare Part B practitioner payment code developed for the NFI. CMS developed the practitioner payment code in response to concerns raised during Phase One of the NFI that the otherwise applicable payment codes available for practitioners incentivized a transfer to the hospital. The new practitioner code -- G9685 -- was specifically developed to equalize payment levels between an initial visit to a resident in a nursing facility and in the hospital. CMS hopes that the new payment code will reduce the likelihood that practitioners will be incentivized to transfer a resident to the hospital and will instead seek to treat them at the nursing facility, if possible. 

Since joining the NY‒RAH project, the two CPSs -- Lisa Gonzalez and Mariam Vaezi -- have been contacting eligible practitioners at Group B facilities to promote the use of G9685. The CPSs have sought to address concerns that have been raised about lists of eligible residents, documentation requirements, and the clinical criteria associated with the six qualifying conditions. As for practitioner concerns about the comprehensive documentation level required for G9685, CMS modified the documentation requirements as of January 1, 2019 to reduce the documentation burden and further incentivize the use of G9685. The NY‒RAH project hopes that by working with eligible practitioners to use the higher-paying code, the project and the entire NFI can make a compelling case to CMS for why physicians and other practitioners caring for long-stay residents in nursing facilities should be paid at a higher level for the important care that they provide. NY−RAH encourages practitioners to avail themselves of this new code -- which only eligible practitioners under the NFI can use. 

The CPSs are available for presentations at medical staff meetings and to work directly with individual eligible practitioners to ensure the proper usage of the new practitioner payment code. If you, your staff, or your practitioners would like to speak with or meet with the CPSs, please contact Faiza Haq.

NY‒RAH Surpasses $9M in Phase Two Facility Reimbursement; Still Work to be Done

Since Phase Two began in November 2016, the NY‒RAH project’s 54 participating skilled nursing facilities have surpassed $9 million in total reimbursement for facility episodes, representing approximately $300,000 in additional monthly revenue. Many facilities have now exceeded $250,000 in total reimbursement since the new payment codes became available. Despite these successes, NY‒RAH still sees room for improvement within the billing process that can ensure more established and consistent monthly billing practices. 

NY−RAH receives monthly data from CMS on each facility’s billed episodes since November 2016. The NY‒RAH data team reviews this information to monitor each facility’s billing practices and identify any inconsistencies or irregularities. In the most recent data, NY−RAH noted that 35% of all participating facilities did not bill for an episode during the first two quarters of 2019 (from January to June). This percentage increases to 61% when considering just the second quarter of 2019 (from April to June). The NY‒RAH PMT has found that consistent, timely billing more often reflects an established and sustainable process that ensures facilities accurately and completely capture billing opportunities as they occur. Consistently relying on retrospective reviews to bill episodes leads to delays in process improvement, which further impacts a facility’s ability to create a sustainable and effective billing workflow. The NY‒RAH PMT is available to provide additional support to your facility to aid in implementing a more consistent process for billing the new payment incentives in real time as episodes occur.

For questions about your facility’s billing data, please contact Courtney Zyla. If you have questions or would like to discuss improving your facility’s billing workflow, please contact Faiza Haq.

In Case You Missed It

Clinical Intervention Learning Community Webinars

  • July 9: New Potential Missed Opportunities Dashboard 
    • During the July 9 webinar, the NY‒RAH Data Analytics Team discussed the new Potential Missed Opportunities Dashboard, an interactive Tableau report that enables facilities to review hospitalizations that could potentially have been avoided.   
    • Webinar Recording
  • August 13: Importance of Nursing Documentation and Newly Available Trainings
    • During the August 13 webinar, CMS Compliance Group, Inc., a New York-based regulatory compliance and quality improvement consulting firm, discussed the importance of nurse documentation. The NY‒RAH PMT also introduced a new opportunity for facilities to have CMS Compliance Group conduct a facility-based needs assessment and provide training on nurse documentation. 
    • Webinar Recording

Beneficiary Notification Forms in Chinese
NY‒RAH recently created Chinese-translated versions of the beneficiary notification form and opt-out form. Both are available on the NY‒RAH website

For questions, please contact Faiza Haq.

      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.