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Reimbursement

Catalog

  • PRF Reporting Requirements – Updated January 25th

    AHCA/NCAL now has available a pre-recorded webex on the January 15, 2021 PRF Reporting Registration instructions as well as the updated reporting guidance.

  • Person-Centered Care In A PDPM World

    This four-module course is designed to improve person-centered care for post-acute care (short stay) residents under the PDPM payment system. Since the PDPM model was a wholesale shift in payment and delivery, initial training mechanisms focused on the new system components. Now that those immediate change needs have been adopted, education and training on best practices for implementing person-centered care should be reviewed to fully adopt CMS’s vision for the PDPM model. This course will define person-centered care and show how it is a key feature in PDPM and when implemented can improve care practices that lead to better patient outcomes.

  • It's Called the Patient Driven Payment Model for a Reason CE Webinar

    In the Fiscal Year 2019 Skilled Nursing Facility Prospective Payment System Final Rule and subsequent guidance, the Centers for Medicare and Medicaid Services (CMS) has discussed the need for “holistic care planning” under the Patient Driven Payment Model (PDPM). Most research and policy on holistic care planning is associated with Medicaid-financed long-term care rather than Medicare-financed post-acute care (PAC). Of note, in the final Skilled Nursing Facility Requirements for Participation, CMS discusses a “comprehensive, person-centered care plan.” Such alignment continues CMS’ focus on aligning payment policy with quality.

  • COVID-19 - Overview of SNF 3-Day Stay and Benefit Period Waivers

    This webinar will provide a brief overview of the background of these important waivers and will also provide specific details about when and how it would be appropriate for SNFs to apply the waivers to assure that Medicare beneficiaries are able to access skilled SNF Part A benefits in a manner that also minimizes risks for unnecessary exposure or transmission of the COVID-19 virus. Examples of how the 3-Day Stay and Benefit Period waivers can or cannot apply in common situations will be discussed. Additionally, details related to documentation, MDS assessment scheduling, and claims coding and sequencing requirements specific to these waivers will be reviewed.

  • Contract Assessment and Return on Investment (CARI)

    Historically, being “in network” with an MA plan was thought to be the optimal position. As MA plans have adjusted payments and operational requirements, being part of their network may not always be worth the administrative burden that continues to increase. The more complex it is to work with an MA plan, the more time staff must divert from their daily responsibilities. There is an opportunity cost and quantifying the costs associated with every contract, is part of the current imperative. Further, because of the growing penetration of varying MA plans in geographical locations, being in network with all MA plans in your location may no longer be necessary. What may be more important is deciphering which particular MA plans are the best for your organization, rather than taking a “contract with all” approach. This tool walks providers through the process for evaluating and understanding the real Return on Investment (ROI) of their Medicare Advantage contracts, ultimately assisting providers in determining whether remaining a network provider is worthwhile, or if other strategies may be more advantageous for both the provider and the residents.

NCAL AHCA