Michigan Number One In Cybercrime Complaints

Cyberattack prevention is more important than ever. The overwhelming majority of ransomware attacks are targeted towards small businesses that can’t afford to spend on defense. Companies have been found to pay up to four times as much to resolve an attack than they would have to prevent one.

As PHI is incredibly valuable, it will be more important than ever for SNFs to think defensively. This article details the major impact of cybercrime on businesses, Michigan in particular, being ranked number one in cybercrime complaints, and the nation’s top ten for victim losses in internet crimes.

See below for more on this. 

UnitedHealthcare’s 2020 Medicare Advantage Plans To Expand

With their 2020 nationwide expansion, 90% of Medicare beneficiaries will have access to a UnitedHealthcare Medicare Advantage plan.

Through our close relationship with UnitedHealthcare, we’ve brought contracts to multiple facilities recently. If working with UHC is of interest to you, connect with us to see how our strategy may be mutually beneficial.

CMS Memo- PDPM HIPPS Coding for MA Plans

On September 26th CMS released a Medicare Advantage (MA) Plan Memo updating specifics surrounding HIPPS code sets related to PDPM implementation, launching today, October 1, 2019. (Memo 1) These details are inclusive of iSNP and MyCare.

The Memo relates to two previous CMS MA Plan Memos in 2014. (Memo 2) (Memo 3)

More specifically, the memo clarifies the required submission of HIPPS coding on each MA enrollee SNF claim:

  • The continued usage of previously approved HIPPS coding,
  • New HIPPS coding, derived from the PDPM,
  • Encourages payer communication distribution to providers and
  • Provides a CMS source for additional information if needed.

Access Advantage has been in communication with each contracted Managed Care Plan since August. Last week we provided to our Member’s an updated roster confirming the October 1st adoption of PDPM by all Plans with the exception of Premier and Medigold. (See below chart)

We anticipate additional communications by Payers over the next several days and weeks and will update all Member’s as it becomes available. We will also update our chart accordingly, such that it will be useful as a staff reference.

Please let us know if you have any questions. Our Service Box at service@accesselite.com is routinely monitored throughout the day or you may contact Rachel Pfahler, Director of Network Development and Engagement at rachelp@accesselite.com for assistance.

SNFs Prepare For Rising Acuity Of Patients

Skilled facilities and hospitals are observing patients with higher complexities being discharged to SNFs much sooner.
Because of this, SNFs are trying their best to prepare for the rising acuity of patients coming in.

This article from @skilled_nursing details the variances seen by geographic location, challenges expected and suggestions on how SNFs can partner with their hospital to help one another succeed.

What Is PDPM?

The Centers for Medicare and Medicaid Services (CMS) will soon be replacing the Resource Utilization Group (RUG) Version IV payment model with the new Patient Driven Payment Model (PDPM).

The current RUG-IV system focused on payments based on how much therapy services were received. However, PDPM places patients into case-mix groups based on certain clinical characteristics.

This article from @SIAResearch does a fantastic job detailing out what this new model will look like and what Skilled Nursing Facilities (SNF’s) should expect.

CMS Requested To Simplify Three-Day Stay Rule

Currently, Medicare beneficiaries must have a three-day hospital stay to receive subsequent fully covered skilled nursing services. Hospitals admitting on an observation basis rather than inpatient has lead to very costly Medicare denials.

The American Health Care Association (AHCA) CEO has asked Centers for Medicare & Medicaid Services (CMS) to eliminate uncertainty on the Medicare three-day stay rule stating, “three days is three days”.

For more on this, see this article from @skilled_nursing.