UPDATE Weekly

Register today for Dementia Care for America’s Heroes: Understanding Dementia and Developing Skills for Positive Outcomes! This program will be held on March 24th, 2016 in Greensboro, NC and presented by Heather McKay, MS, OT/L, Dementia Care Specialist. Heather presented at our 2015 Annual Convention and Expo and is back by popular demand!

Heather will present a full day seminar that goes beyond the basics to address brain changes with dementia, communication challenges, the timeline of this disease and why people do what they do in every stage. Along with practical, ready-to-use communication techniques and hands-on skills that are safe for caregivers and those they support, participants will learn about the progression in 5 stages and strategies that work to support people at every stage. Participants will learn specific ways of grading their help to match a person’s changing needs and foster more positive interactions throughout the progression of dementia. Leaders will learn ways to engage and coach team members and support the whole team with objective competency measures that are helpful throughout the progression of dementia.

This program offers 5.5 contact hours for nursing home administrators. NCHCFA will issue a certificate of completion for 5.5 education contact hours for other attendees!

Click here to register now! Don’t miss out!

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Nursing facilities have long been aware of the problems associated with NCFAST and NCTracks that are preventing certain claims from being processed. NCHCFA has been working with the Division of Medical Assistance (DMA) to develop a permanent fix for these problems moving forward, as well as addressing the backlog of cases. The proposed solution will include changes at both the state and county levels.

At NCHCFA’s urging, DMA has agreed to issue hardship payment advances (HPAs). These payments are not the solution, but an interim step to bolster facility cash flow until the NCFAST/NCTracks system issues can be permanently addressed. The amounts of these payments are based on a percentage of the amount of claims that currently cannot be processed by NCFAST/NCTracks due to system issues. The details of receiving these payments are included in a letter from the Division of Medical Assistance which can be accessed by clicking here. A separate request will need to be submitted for each NPI. Once approved for payment, paper checks will be sent by overnight mail to the specified address.

Remember, when submitting claims information with any resident information, that it should be sent securely and in compliance with all HIPAA requirements.

If you submit an HPA request, please let us know the name of the facility, the date that it was submitted and the amount of claims submitted for consideration. Send this information to Sam Clark at samc@nchcfa.org. In addition, let us know once you have received the HPA and the amount of the payment. This information will help us track the performance and effectiveness of this new process.

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Election of officers and members of the Board of Directors were conducted on Monday, February 22nd, during NCHCFA’s Annual Business Meeting:

Chair Phillip Hill
Vice Chair Jim Martin
Secretary/Treasurer Jeff Wilson
District I Vice-Chair Steve Jones
District II Vice-Chair Paul Babinski
District III Vice-Chair Denise Clapp-Campbell
District IV Vice-Chair Ted Goins
District V Vice-Chair Vickie Beaver
Multi-Facility Vice-Chair John Barber
National Multi-Facility Vice-Chair Neil Pruitt
Independent Owner Vice-Chair Carron Suddreth
Not for Profit Vice-Chair Michelle Grandy
Member at Large Karen McDaniel
Member at Large Todd Nunn
Immediate Past Chairman Kevin Cox

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Last year, the Division of Medical Assistance (DMA) made changes to its processing of Medicare crossover claims for services rendered to Qualified Medicare Beneficiaries (QMBs). In July 2015, DMA determined that these changes did not align with CMS policy and retroactively changed policy, resulting in overpayments of some claims. Earlier this week, NCTracks sent providers an update on the reprocessing of these claims. The following is the content of that update.

As explained in a previous announcement, as of November 1, 2015, the “lesser of” logic is being applied to services covered by both Medicare and Medicaid that are rendered to Qualified Medicare Beneficiaries (QMBs.) Specifically, claims for Medicare-covered services that are also covered in the Medicaid state plan are paid at the lesser of the Medicare cost-share (which is the sum of co-insurance, deductible and co-pay) or the difference between the amount paid by Medicare and the Medicaid state plan rate (if any). For services not covered under the North Carolina Medicaid plan, the claims are paid the Medicare cost share amount. This applies to crossovers as well as secondary filed claims for Q class recipients. This methodology results in the provider receiving the Medicare or Medicaid allowable and the QMB recipient not being responsible for any additional monies for services covered by Medicaid and/or Medicare.

The QMB claims paid between July 1, 2013, and October 31, 2015, will be reprocessed over the course of multiple checkwrites between March 29, 2016, and June 21, 2016. The claim reprocessing will address two situations:

• Previously paid QMB crossover and secondary claims for services not covered under the North Carolina Medicaid plan, where the provider should have received the Medicare cost share amount
• Claims that paid 100% of the Medicare cost share for services covered under the North Carolina Medicaid plan between March 1, 2015, and July 19, 2015, which resulted in an overpayment that will be recouped as a result of this reprocessing

The reprocessed claims will appear in a separate section of the paper Remittance Advice (RA) with a unique Explanation of Benefits (EOB) code. Depending on the date when the claim was originally processed, one of two EOB codes will be associated with the reprocessed claim:

• EOB 06000 – MEDICARE QMB REPROCESSING OF CLAIMS PROCESSED BETWEEN JULY 1, 2013 AND FEBRUARY 28, 2015
• EOB 06021 – MEDICARE QMB REPROCESSING OF CLAIMS PROCESSED BETWEEN MARCH 1, 2015 and OCTOBER 31, 2015

The 835 electronic transactions will include the reprocessed claims along with other claims submitted for the checkwrite. (There is no separate 835.)

Note that reprocessing does not guarantee payment for the claim. While some edits may be bypassed as part of the claim reprocessing, changes made to the system since the claims were originally adjudicated may apply to reprocessed claims. Therefore, the reprocessed claim could deny.

If the claim reprocessing results in a recoupment and there are not sufficient funds to satisfy the full recoupment amount from claims paid in the current checkwrite, the recoupment process will continue on each checkwrite until the full amount due is recouped.

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On Friday, March 4, AHCA hosted a Webinar summarizing the new CMS quality measures that will be added to Nursing Home Compare and the Five-Star Quality Rating System. For those who were unable to participate, the recorded presentation is now available and can be accessed here.

Members can also find other resources including answers to questions about the new changes, and measurement specifics on the ahcancalED Website. Note: Members MUST login using their AHCA username and password to access resources on ahcancalED.

As we receive more information over the coming weeks, we will share those developments with you.

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Earlier this week, Tom Coble, American Health Care Association (AHCA) Board of Governors Chair, released an update for AHCA members. Click here to access this update.

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Alliant Quality wants to encourage SNFs to keep signing up for the National Collaborative – or SPACE. Alliant recommends having as much time as possible to get started on Quality Assurance Performance Improvement (QAPI) improvement work and improving facility quality measures in a systems approach to improve their five star and composite scores.

Alliant Quality is the Medicare Quality Innovation Network (QIN)-Quality Improvement Organization (QIO) for North Carolina. Under contract with the Centers for Medicare & Medicaid Services (CMS), Alliant Quality invites your nursing home to participate in a collaborative designed to ensure that every nursing home resident receives the highest quality of care.

The Collaborative offers an exciting opportunity to learn from high performing nursing homes regarding their processes as they pertain to consistent/permanent staff assignment, teamwork and communications, leadership, regulatory compliance, clinical models, and quality of life indicators. The Collaborative aligns national nursing home quality initiatives and partnerships such as the Advancing Excellence in America’s Nursing Homes Campaign, The Partnership to Improve Dementia Care, and QAPI. Targeted focus areas will include increasing mobility, decreasing unnecessary use of antipsychotics in residents with dementia, decreasing potentially avoidable hospitalizations and decreasing healthcare acquired infections and conditions.

When ready to register, click here for the Participation Agreement and fax or e-mail it back to Lisa Klemis. For more details, e-mail Jennifer Brock at Jennifer.Brock@area-F.hcqis.org or call (678) 527-3417.

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New Publication Available: Hospitality For Boomers – AHCA is excited to announce this highly informative resource is now part of their inventory. Start improving your community reputation, marketability, and profitability today with Hospitality for Boomers: How to attract residents, retain staff, and maximize profitability. Written by former restaurateur, health-care food service director, and current national Kind Dining® service trainer, Cindy Heilman, this quick read shares a unique service perspective and is full of hospitality tips.

Learn how to:

• Respect your diner’s experience
• Train your staff to excel
• Apply empathy daily
• Exceed your residents’ expectations
• Build your hospitality team
• Grow your employees personally and professionally
• Focus your leadership team
• And more!

To order, visit http://www.AHCApublications.org or call (800) 321-0343. Fax orders may also be placed at (800) 869-5605.

Product #: 8274
Price: $19.95

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Important information for residents and families… This brochure outlines what physical restraints are, when they should be used, rules and regulations concerning restraints, and making decisions about using them. To order, e-mail your request to Donna Snyder at donnas@nchcfa.org.

• NCHCFA Member: $30.00 per 100 brochures plus tax and shipping
• Non-Members: $60.00 per 100 brochures plus tax and shipping

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20 Things the Most Respected Bosses Do Every Day

http://www.inc.com/bill-murphy-jr/want-to-be-a-highly-respected-boss-20-things-to-do-every-day.html

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Niagara Falls actually consists of three sets of waterfalls. Canada’s Horseshoe Falls are the longest with a 2,600 foot brink, while the connected American and Bridal Veil falls have a 1,060 foot brink. In total, 750,000 gallons of water run over the falls every second.

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