Fifteen KHCA Members Achieve Bronze Quality Award

The AHCA/NCAL National Quality Award Program provides a pathway for providers of long term care services to journey towards performance excellence. The program is based on the core values and criteria of the Malcolm Baldrige National Quality Award (MBNQA) Program. The Kansas homes acheiving Bronze are:

The Kansas homes acheiving Bronze are:

Hickory Pointe Care and Rehabilitation Center, Oskaloosa KS
Life Care Center of Seneca, Seneca KS
Medicalodge of Wichita, Wichita KS
Pioneer Ridge Health Care, Lawrence KS
Rossville Healthcare and Rehabilitation Center, Rossville KS
Sandpiper Healthcare and Rehabilitation Center, Wichita KS
Sharon Lane Health Services, Shawnee KS
Tonganoxie Nursing Center, Tonganoxie KS
Vintage Park at Eureka, Eureka KS
Vintage Park at Fredonia, Fredonia KS
Vintage Park at Hiawatha, Hiawatha KS
Vintage Park at Holton, Holton KS
Vintage Park at Neodesha, Neodesha KS
Vintage Park at Wamego, Wamego KS
Vintage Park at Waterfront, Wichita KS

As previously announced, Kansas also has one Silver level winner which is Vintage Park at Paola, Paola KS.

Winners will be recognized at the AHCA Convention October 10-13, 2010 in Long Beach, CA. Click here for AHCA Convention Details.

The Quality Award program has three progressive step levels. Applications are judged by trained examiners who provide feedback on opportunities for improvement to support continuous learning. Facilities must achieve an award at each level to progress to the next level.

•Bronze – Commitment to Quality (formerly Step I) applicants begin their quality journey by developing an organizational profile including vision and mission statements, an awareness of their environment and customers’ expectations, and a demonstration of their ability to improve a process.

•Silver – Achievement in Quality (formerly Step II) applicants demonstrate a level of achievement in their quality journey through good performance outcomes that have evolved from how they embrace the core values and concepts of visionary leadership, focus on the future, resident-focused excellence, management by innovation, and focus on results and creating value.

•Gold – Excellence in Quality (formerly Step III) applicants must show superior performance over time that is based on their systematic approaches to leadership; strategic planning, focus on customers, measurement, analysis and knowledge management, workforce focus, process management and results. Gold applicants address the complete Baldrige Criteria for Performance Excellence in Health Care.

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  KHCA 60th Annual Convention - Groovy

Come on Ozzie, grab Harriet and Get your Groove on.
Make plans now to attend the “Really Big Shew” at the
Kansas Health Care Association and Kansas Center for Assisted Living
60th Annual Convention and Tradeshow October 21 & 22, 2010 in Wichita. Click  here for hotel and convention registration infomation. You will also find your KHCA/KCAL award nomination forms there. Go ahead and register today - you'll save 10% if you register by August 1, 2010.

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  The Heat is On!

With record-setting temperatures in many parts of the state, it seems like a good time to remind all our members of required temperature levels within your homes. The Federal requirements are below.

  Section 483.15 (h) Environment. The facility must provide—

(1) A safe, clean, comfortable, and homelike environment, allowing the resident to use his

or her personal belongings to the extent possible;

(2) Housekeeping and maintenance services necessary to maintain a sanitary, orderly, and  comfortable interior;

(3) Clean bed and bath linens that are in good condition;

(4) Private closet space in each resident room, as specified in §483.70(d)(2)(iv) of this part;

(5) Adequate and comfortable lighting levels in all areas;

(6) Comfortable and safe temperature levels. Facilities initially certified after October

1, 1990 must maintain a temperature range of 71–81°F; and

(7) For the maintenance of comfortable sound levels.

Additional, as stated in Kansas Regulations 28-39-162c, Physical Environment, Mechanical and Electrical Requirements Page 90:

(g) Heating, air-conditioning, and ventilation systems.

(1) Heating, air-conditioning, and ventilation system design specifications for facilities
constructed after February 15, 1977 shall be as follows:
(A) The system shall be designed to maintain a year-round indoor temperature range in
resident care areas of 70° F to 85° F. The winter outside design temperature of the facility shall
be -10°  F dry bulb, and the summer outside design temperature of the facility shall be 100° F dry
bulb.
 
Also remember, hydrate, hydrate, hydrate!
 

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  Electronic Health Record (EHR) Incentive Program “Meaningful Use” Final Rule (CMS-0033-F)

CMS and ONC jointly announced their final rules for both electronic health record standards for certification and the Medicare and Medicaid EHR incentive programs, including the definition of meaningful use. 
 
Under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specified objectives.  One of the two regulations announced today defines the “meaningful use” objectives that providers must meet to qualify for the bonus payments, and the other regulation identifies the technical capabilities required for certified EHR technology. 
 
Announcement of today’s regulations marks the completion of multiple steps laying the groundwork for the incentive payments program.  With “meaningful use” definitions in place, EHR system vendors can ensure that their systems deliver the required capabilities, providers can be assured that the system they acquire will support achievement of “meaningful use” objectives, and a concentrated five-year national initiative to adopt and use electronic records in health care can begin.
 
To read the Press Release issued today (7/13) click here: 

 
Also CMS Issued Fact Sheets (7/13) with additional details at: http://www.cms.gov/apps/media/fact_sheets.asp

 
To learn more about the Medicare and Medicaid EHR incentive programs, visit the CMS-dedicated website to this program, http://www.cms.gov/EHRIncentivePrograms/ .  Here you’ll find information about eligibility, requirements, upcoming events and more.

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  CMS Develops Newsletter for RACs Information

CMS is developing a  series of articles (MLN Matters)  that will disseminate information on RAC high dollar improper payment vulnerabilities.  The first issue has been released, and can be accessed by clicking here.  The article is short and straightforward.  The MLN is a good compact refresher course on the nature of a RAC review and how to prepare.  This article also provides the four websites to follow the specific issues that are being addressed by the RACs in the various Regions. 

CMS indicates that the purpose of  this first article is to provide education regarding RAC demonstration-identified vulnerabilities in an effort to prevent these same problems from occurring in the future.  CMS states that with the expansion of the RAC Program and the initiation of complex medical review (coding and medical necessity) in all four RAC regions, it is essential that providers understand the lessons learned from the demonstration and implement appropriate corrective actions.  They mention two of the high risk vulnerabilities:

·         Provider non-compliance with timely submission of requested medical documentation; and

·         Insufficient documentation that did not justify that the services billed were covered, medically necessary, or correctly coded.

Again, while the MLN Matter does not list all the specific issues that RACS are looking at it does provide the means to find this out.  It list:

·         The states in each of the four RAC Regions

·         The website and email address for each RAC

The four websites are very important and members are encouraged to go the RAC website periodically  where they will find issues specific to their Region and provider type.
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  2010 Medicare Part B Fee Schedules (January 1, 2010 through November 30, 2010)

The Medicare Part B fee schedule information is now available for the period of June 1, 2010 through November 30, 2010.  This information has been posted to the AHCA website at http://www.ahcancal.org/facility_operations/medicare/Pages/2010MedicarePartBFeeSchedule.aspx.  The Medicare Part B rates for the period of January 1, 2010 through May 31, 2010 are also provided at this link.  Please note that instructions for claims reprocessing for the period of January 1, 2010 through May 31, 2010 are forthcoming from CMS.  A new Medicare Physician Fee Schedule will be required for dates of service beginning December 1, 2010. 
 
The information provided in this memo covers the periods of January 1, 2010 through May 31, 2010, and June 1, 2010 through November 30, 2010.

2010 Medicare Part B Fee Schedules – Effective June 1, 2010 through November 30, 2010

The June 1, 2010 therapy fees for each CPT/HCPCS in each geographic area are provided in Excel format.  This document has three worksheets containing the following information:

The 2010 Medicare Part B Fee Schedule (Part B Fees) for Outpatient Rehabilitation for each Carrier and Locality.
The 2010 Relative Value Units (RVUs) for each Outpatient Rehabilitation Therapy Code.
The 2010 Geographic Practice Cost Indices (GPCI) by Medicare Carrier and Locality.
The final Part B Fee Schedule amount is calculated as follows:

(( A1 x B1) + (A2 x B2) + (A3 x B3)) x Conversion Factor, where: 

A1 = Physician Work RVU
A2 = Non-Facility Practice Expense RVU
A3 = Malpractice RVU
B1 = Work GPCI
B2 = Practice Expense GPCI
B3 = Malpractice GPCI

Conversion Factor = $36.8729

These fees reflect a change in the conversion factor as a result of the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010, which President Obama signed into law on June 25, 2010.  This legislation provides for a 2.2 percent update to the 2010 Medicare Physician Fee Schedule (MPFS), effective for dates of service June 1, 2010, through November 30, 2010.  (Revised payment files were posted by CMS on July 1, 2010.)
 

2010 Medicare Part B Fee Schedules – Effective January 1, 2010 through May 31, 2010

The January 1, 2010 therapy fees for each CPT/HCPCS in each geographic area are provided in Excel format.  This document has three worksheets containing the following information:

The 2010 Medicare Part B Fee Schedule (Part B Fees) for Outpatient Rehabilitation for each Carrier and Locality.
The 2010 Relative Value Units (RVUs) for each Outpatient Rehabilitation Therapy Code.
The 2010 Geographic Practice Cost Indices (GPCI) by Medicare Carrier and Locality.
The final Part B Fee Schedule amount is calculated as follows:

(( A1 x B1) + (A2 x B2) + (A3 x B3)) x Conversion Factor, where: 

A1 = Physician Work RVU
A2 = Non-Facility Practice Expense RVU
A3 = Malpractice RVU
B1 = Work GPCI
B2 = Practice Expense GPCI
B3 = Malpractice GPCI

Conversion Factor = $36.0791

On May 10, 2010 CMS released revised physician payment files to Medicare Contractors necessary to reflect changes to payments as a result of the CY 2010 correction notice published in the Federal Register on May 11, 2010 and changes resulting from the Patient Protection and Affordable Health Care Act.  This fee schedule also reflects the Department of Defense Appropriations Act of 2010, the Temporary Extension Act of 2010, and the Continuing Extension Act of 2010 which have provided for a zero percent update to the 2010 Medicare Physician Fee Schedule and is effective for claims with dates of service from January 1, 2010 through May 31, 2010.  Instructions regarding the reprocessing of claims paid prior to the implementation of the revised files is forthcoming from CMS.

 
The 2010 Medicare Physician Fee Schedule Final Rule was published in the Federal Register on November 25, 2009 and initial corrections were published in the Federal Register on December 10, 2009.

 
An overview of the Physician Fee Schedule Payment Policies may be found at http://www.cms.hhs.gov/PhysicianFeeSched/ and an overview of skilled nursing facility consolidated billing and annual updates can be found at http://www.cms.hhs.gov/SNFConsolidatedBilling/.

 
Please note:  A new Medicare Physician Fee Schedule will be required for dates of service beginning December 1, 2010.

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  DMEPOS Competitive Bidding Payment Rates Announced on July 1, 2010

Medicare beneficiaries in nine areas of the country who use certain medical equipment and supplies will see average savings of about 32% percent off the current cost of those items.  The savings will be realized through the first round of a new Competitive Bidding Program that will be used to determine the price that Medicare pays for certain durable medical equipment, prosthetics, orthotics and supplies (DMEPOS).  The program replaces Medicare’s existing fee schedule amounts with market-based prices. 

“When this program begins in January, Medicare beneficiaries in these nine areas will see substantially lower prices than they are paying now,” said CMS Deputy Administrator and Director for the Center for Medicare Jonathan Blum.  “The program also ensures continued access for beneficiaries to high quality products from accredited suppliers that meet stringent quality and financial standards, which help to prevent fraud.  Once the program is in place across the country, it is expected to save Medicare and taxpayers about $17 billion over ten years.”
 
The first round of the program is scheduled to begin on January 1, 2011, for beneficiaries in Charlotte, Cincinnati, Cleveland, Dallas, Kansas City, Miami, Orlando, Pittsburgh and Riverside.  Suppliers that wished to participate in the program submitted bids last year.  CMS plans to announce the contract suppliers in September once all contracts have been finalized. 

As part of the first round of the Competitive Bidding Program, beneficiaries and Medicare will see significant savings on the cost of some medical equipment and supplies including:

• Oxygen, Oxygen Equipment, and Supplies

• Standard Power Wheelchairs, Scooters, and Related Accessories

• Complex Rehabilitative Power Wheelchairs and Related Accessories (Group 2 only)

• Mail-Order Diabetic Supplies

• Enteral Nutrients, Equipment and Supplies

• Continuous Positive Airway Pressure (CPAP) Devices, Respiratory Assist Devices (RADs), and Related Supplies and Accessories

• Hospital Beds and Related Accessories

• Walkers and Related Accessories

• Support Surfaces (Group 2 mattresses and overlays in Miami only)

In order to help you stay fully informed about Medicare’s DMEPOS Competitive Bidding Program, CMS has prepared information and training materials to help you understand the new program so you can accurately inform Medicare beneficiaries.  These materials can be found in our DMEPOS Toolkit at http://www.cms.hhs.gov/Partnerships/03_DMEPOS_Toolkit.asp#TopOfPage.  We encourage you to share this information with your local affiliates throughout the country, particularly in the nine initial competitive bidding areas. 

 
Click here for the entire CMS DMEPOS Fact Sheet.

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  CMS to host Free Meeting in KC

The CMS Kansas City Regional Office invites you to attend the FREE 2010 National Medicare Workshop.

When: Tuesday, August 31 – Thursday, September 2, 2010

Where: Kansas City Marriott Downtown
             200 West 12th Street, Kansas City, MO 64105

Meeting Information and Registration
For complete details on the workshop refer to the invitation attached to this email. Click on the following link to access the workshop web site: www.blsmeetings.net/2010NationalMedicareTrainingProgram.

Please contact Karen Mines via email at mailto:kmines@blseamon.com or via phone at 301.577.0244, ext 2300 if you have any questions.

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  SNF, IRF & home health market basket updates from CMS

On Friday, July 16, the Center for Medicare & Medicaid Services (CMS) issued several notices, including its FY 2011 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Notice. The notice provides for a Medicare Part A market basket update of 1.7 percent  -  an increase of approximately $542 million for FY 2011.
During a late afternoon call, CMS officials briefed AHCA regarding a new “hybrid” RUG-III PPS for FY 2011, as well as plans to make interim payments under the RUG-IV PPS beginning with service dates of October 1, 2010, until the new HR-III PPS is ready.

CMS also provided updates for home health and IRFs. Medicare payments to home health agencies (HHAs) for calendar year (CY) 2011 will decrease by 4.75 percent, which is approximately $900 million less than the payments HHAs now receive. The agency noted that factors contributing to the overall decrease include changes in case-mix and patient health status; market basket and wage-index updates; and specific provisions in the Patient Protection & Affordable Care Act (PPACA). CMS' IRF PPS notice provides increased Medicare payments to IRFs of $135 million for FY 2011, which reflects both a full market basket update of $140 million and the 0.25 percent ($5 million) reduction called for in the PPACA.

For details regarding the SNF PPS notice, please review the following PDF. 

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