Ghostbusters and QIO Program Turn 30: Who You Gonna Call for Medicare Concerns?

Primaris will no longer handle Missouri Medicare case reviews beginning August 1

Thirty years ago, Ghostbusters made the question “Who you gonna call” go viral long before the days of social media.

1984 was the same year Quality Improvement Organizations (QIOs), like Missouri-based Primaris, began answering the call of Medicare patients.  Primaris serves Missourians with Medicare by examining concerns about their care, or by reviewing cases where patients feel services ended too soon – for example, an early discharge from a hospital.

Beginning August 1, 2014, Missourian patients and providers will no longer call health care quality-improvement consulting company Primaris.  All current and future beneficiary quality review case work and appeals will be conducted by KEPRO, located in Seven Hills, Ohio.

For more information, please visit Primaris at http://primaris.org/quality-today/ghostbusters-and-qio-program-turn-30-who-you-gonna-call-for-medicare-concerns.

MDS System Requirements

Please note effective October 1, 2014 (FY 2015), CMS will no longer support Windows XP or Internet Explorer v8.0.  This means after October 1, 2014, you will not be able to transmit MDS and/or retrieve CASPER reports until you upgrade your internal system.  The recommended operating system is Windows 7 and the recommended browser is Internet Explorer v9.0.  Visit the QIES Technical Support Office at https://www.qtso.com/ to view Minimum System Requirements for Home Health Agencies, Hospice Providers, Long Term Care Facilities, Inpatient Rehabilitation Facilities and Long Term Care Hospitals.  NEW: FY2014 System Requirements [PDF 22KB].

This information is also available on the CMS MDS 3.0 System Welcome Page.

If you have any questions, please contact Joan Brundick, State RAI Coordinator at 573-751-6308 or joan.brundick@health.mo.gov, or contact Danette Beeson, State Automation Coordinator at 573-522-8421 or danette.beeson@health.mo.gov.

ICD-10 Coding Basics National Provider Call – Registration Now Open June 2014

June 4, 2014

12:30 p.m. – 2:00 p.m. Central Time

To Register:  Visit MLN Connects™ Upcoming Calls.  Space may be limited, register early.

HHS expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015.  Providers would have an extra year to prepare.  During this MLN Connects™ National Provider Call, join us for a keynote presentation on more ICD-10 coding basics by Sue Bowman from the American Health Information Management Association (AHIMA), along with updates from CMS.  A question and answer session will follow the presentation.

Agenda:

  • CMS updates, including the partial code freeze and 2015 code updates
  • Why ICD-9-CM is being replaced with ICD-10-CM
  • Benefits of ICD-10-CM
  • Similarities and differences from ICD-9-CM
  • Coding: Process of assigning a diagnosis code, 7th character, placeholder “x,” excludes notes, unspecified codes, external cause of injury codes, type of encounter
  • Documentation tips
  • How to obtain answers to coding questions
  • How to request modifications to ICD-10-CM

Target Audience:  Medical coders, physicians, physician office staff, nurses and other non-physician practitioners, provider billing staff, health records staff, vendors, educators, system maintainers, laboratories, and all Medicare providers.  Continuing education credit may be awarded for participation in certain MLN Connects Calls.  Visit the Continuing Education Credit Information web page to learn more.

Keep up with the latest news regarding ICD-10, visit http://cms.gov/Medicare/Coding/ICD10/Latest_News.html.

New PEPPER Release for Skilled Nursing Homes – May 2014

A new release of the Program for Evaluating Payment Patterns Electronic Report (PEPPER) is now available for skilled nursing homes.  PEPPERs will no longer be mailed to providers who previously received their PEPPERs by mail.  They will now be able to access them through a secure website portal, http://pepperresources.org/PEPPER/SecurePEPPERAccess.aspx.

Those providers who have been receiving their PEPPERs through QualityNet will continue to do so.  The Chief Executive Officer, President, or Administrator of the provider can obtain their PEPPER.  Information on accessing and downloading the PEPPER is available in the Secure PEPPER Access Guide.

Training and Resources are available on the website: www.pepperresources.org/TrainingResources/SkilledNursingFacilities.aspx.

PEPPER Training Update (May 2014):

PEPPERresources.org is the official site for information, training and support.  If you have questions about the PEPPER reports, you may submit questions on this website through the Help/Contact Us tab.  Please do not contact your state QIO or state survey agency for assistance with PEPPER.

Changing Antipsychotic Thinking (CAT) Tip #7

Cat Without a Tail

Do you see a TIGER in your percentages when you expect a KITTEN?  Are unexpected names on your Quality Measure (QM) Report for antipsychotic drug usage? Even the “appropriate” diagnosis of Schizophrenia will trigger the measure if not correctly reported. Schizophrenia, Tourette’s, and Huntington’s are the three accepted diagnoses for the use of an antipsychotic. Report these on the pre-printed section of the Minimum Data Set (MDS) Resident Assessment by checking I6000 for Schizophrenia, I5350 for Tourette’s Syndrome, and/or I5250 for Huntington’s Disease. In I8000 Additional active diagnoses, you may manually input “Schizophrenia with a tail.” One example is “Schizophrenia with Psychosis.” Please view CAT Tip #7 here: CAT_Tip_7.  View more tips at http://primaris.org/tool.  The Missouri Local Area Network for Excellence (MOLANE) is the state coalition for Advancing Excellence.

MDS Section Q: Reminder for Social Workers and MDS Coordinators

Section Q:  Participation in Assessment and Goal Setting

The Section for Long-Term Care Regulation is posting this reminder to assist providers that may not understand all the requirements and procedures to follow regarding discharge planning within Section Q of the Minimum Data Set (MDS).

On May 1, 2014, the Missouri Department of Social Services issued Nursing Home Bulletin Vol. 26, No. 27 to assist providers with this requirement.  The bulletin contains specific instructions for completing the online referral.  Please view the bulletin here:  DSS Provider Bulletin 36-27 05-01-2014, or visit http://dss.mo.gov/mhd/providers/pages/bulletins.htm.

Accurate completion of Section Q of the MDS is a requirement of the Centers for Medicare and Medicaid Services.  This section is designed to provide residents who do not have current active plans for discharge, with an opportunity to speak with an outside resource (Local Contact Agency or LCA).  The LCAs are contracted by the Division of Senior and Disability Services within the Missouri Department of Health and Senior Services.

Section Q is an interview process for all comprehensive MDS assessments and asks the following question in Q0500 of all residents who do not have current active discharge plans:  “Do you want to talk to someone about the possibility of leaving this facility and returning to live and receive services in the community?”  If the resident wishes to speak to an options counselor about a potential discharge, no matter how feasible the care plan team thinks discharge may or may not be, the facility is expected to make a referral to the LCA, at https://dssapp3.dss.mo.gov/mfpnursinghome/Login.aspx.  (If the resident answers “yes” to Q0500, also indicate “yes” on question Q0600 and make the referral).

Please remember that this is a Resident’s Rights issue and the facility cannot skip asking the question in Q0500 unless there is current active discharge planning already occurring.  The intent of Section Q is not to address residents who are already planning on discharge.  The intent is to capture all of the long-term care residents who do not have active discharge plans.  These are the residents who would be referred and benefit from speaking with an options counselor from the LCA.  The only time Q0500 would not be asked of the resident is if they have a guardian or invoked durable power of attorney.  In these cases, question Q0500 would be asked of the guardian/invoked durable power of attorney, rather than the resident.

If you have questions about Section Q of the MDS, you may contact Joan Brundick, State RAI Coordinator at 573-751-6308 or Joan.Brundick@health.mo.gov.

Antipsychotic Drug use in Nursing Homes: Trend Update

CMS is tracking the progress of the Partnership to Improve Dementia Care in Nursing Homes by reviewing publicly reported MDS quality measures. The official measure of the Partnership is the percentage of long-stay nursing home residents who are receiving an antipsychotic medication, excluding those residents diagnosed with schizophrenia, Huntington’s Disease or Tourette’s Syndrome.

Since the Partnership began in 2012, this data indicates Missouri’s percentage rates have dropped every quarter, with an overall decrease of 9.17 percent. This is encouraging and shows that Missouri is making improvements towards decreasing the use of antipsychotic medications for residents with dementia when their use is not indicated or appropriate. Please view the trend update here: CMS Trend Update – Antipsychotic Drug Use in Nursing Homes.

MDS and Flu Season

CMS posts the public Quality Measures on Nursing Home Compare, and consumers are able to view the percentage data that your nursing home offered and administered the flu vaccine during the current or most recent influenza season.

The 3.0 Resident Assessment Instrument (RAI) manual does not provide specific dates for influenza season.  This has prompted Missouri facilities to ask what dates are considered the influenza season in Missouri, in order to correctly code the MDS, which will be reflected in their Quality Measures.  Seasonal flu monitoring and reporting to the CDC in Missouri begins in early October and extends well in to the month of May.

For MDS coding purposes, if the resident is not in the facility between October 1 and May 31, you should code in Section O:  “Resident not in facility during this year’s flu season.”  For residents who are in the facility from October 1 through the last week of May, the facility is required to offer the flu vaccine as long as it is “reasonably available,” which means that it is still available to be ordered from your local pharmacy or supplier.

If you have any questions, you may contact Joan Brundick, State RAI Coordinator, at 573-751-6308 or email joan.brundick@health.mo.gov.

MC5 Regional Meetings – January 2014

Visit the Missouri Coalition Celebrating Care Continuum Change (MC5) website at www.momc5.com.

Person-Centered Care in Behavioral Health

Interventions to keep people in the home, and when it is time to intervene with inpatient care
Location:  East Hills Library, 502 North Woodbine Rd., St. Joseph.  RSVP to Karen Fletchall at karen.fletchall@yahoo.com or 660-564-3304; or Freda Miller at fmiller@nwmoaaa.org or 660-822-6209.

Webinar #1: The Big Picture

MC5 and Primaris Learning Collaborative

Please view the flyer here:  January 8, 2014 Southwest MC5 and Primaris

Creating Well-Being for Those Who Live with Dementia:  Alternatives to Medication Use

Would you like to provide your staff with high quality training from world-renowned experts, but just can’t afford it?  Now you can!  MC5 and Primaris have teamed up to bring you the six part webinar series developed by Dr. Al Power and The Eden Alternative.  Each meeting will include one of the hour-long webinars, followed by a learning session led by Primaris Program Manager Judy Halley, RN-BC, LNHA.  Location:  Council of Churches, 627 N.  Glenstone, Springfield.  RSVP to cindybutler@mchsi.com.

  • January 10, 2014:  East

All Aboard!

Caregiver Empowerment in Culture Change:  Mentoring, Assigning, and Engaging for a Better Life
Successfully delivering person-centered care greatly depends on caregiver commitment to the Culture Change effort.  This presentation will include the community-wide mentoring program at Parc Provence, the use of consistent assignment at West County Care Center; and caregiver huddles, memory care training, and QAPI responsibilities at Bethesda Dilworth.  Location:  Brentwood Community Center, Rm. 104, 2502 S. Brentwood Blvd., Brentwood.  RSVP to Ruthie at rrochman@alz.org or 314-801-0446.

Caring for Individuals with Alzheimer’s Disease in a Culture Change World

Location:   Community Center, 200 North Ash, Nevada.  RSVP to sghouser@medicalodges.com.

PLEASE NOTE – MEETING LOCATION CHANGE

Please view the flyer here:  January 21, 2014 new location East Central MC5 and Primaris Collaborative

Operationalizing Person-Centered Care and Building Capacity for QAPI – Part I: Aligning Daily Documentation and Communication

MC5 and Primaris Learning Collaborative

Pioneer Network Webinar Series on Using MDS 3.0 as an Engine for High Quality Individualized Care.  Monthly meetings will be facilitated by Primaris Program Manager Nursing Home Services, Alexis Roam, MSN, RN. 

Monthly meetings will include:

     Toolkit

     Webinars

     Facilitation with Alexis Roam

     Sharing with all group members

Please note location change:  Comfort Inn and Suites, 1650 Old Wire Outer Road, Rolla.
Registration in advance is appreciated – please RSVP to mary.ehrenreich@alz.org or 314-801-0462; or to tracy.rosenow@mvc.dps.mo.gov or 573-265-3271.

Exercise Makes a Difference: Why and How to Incorporate Daily Exercise in Person-Centered Care

Location:  Loch Haven Senior Living Community Apartments, New Activity Rm., 701 Sunset Hills Dr., Macon.

RSVP to Wendy or Katie at 660-385-3113.

  • January 22, 2014:  West

Culture Change 101

Presented by Missouri Department of Health and Senior Services State Culture Change Coordinator Sam Plaster.
Location:  Centerpoint Medical Center, East Auditorium, 19600 East 39th St., Independence.  RSVP to Kathy Vogt or Leslie Carter at 816-228-5655. 

For more information about these regional meetings, including available CEUs, please visit the Missouri Coalition Celebrating Care Continuum Change (MC5) website at www.momc5.com/regional-meetings.html.

Care Plans: What Do We Need To Know? – Free Webinar

Free QIPMO Webinar with several dates to choose from!

  • October 29, 2013
  • October 30, 2013
  • November 4, 2013
  • November 5, 2013
  • November 6, 2013

View the flyer here:  Care Plans QIPMO Webinar 2013 or visit QIPMO’s MDS webpage at http://nursinghomehelp.org/supgr.html.

To register, visit https://attendee.gotowebinar.com/rt/3389283429345947393.  Upon registration, participants will receive a confirmation email containing additional webinar information.  Handouts will be available prior to the webinar.

MC5 Regional Meetings – November, 2013

  • November 8, 2013:   East

Music & Memory:  Bringing Joy to Persons with Dementia Through Personalized Music

Location:  Brentwood Community Center, Rm. 104, 2505 South Brentwood Blvd., Brentwood.  RSVP to Ruthie at 314-801-0446 or rrochman@alz.org.

 

  • November 19, 2013:   East Central

Using MDS 3.0 as an Engine for High Quality Individualized Care

In 2012, Missouri was selected by Pioneer Network to participate in the National Learning Collaborative: Using MDS 3.0 as an Engine for High Quality Individualized Care.  In Missouri, 19 homes completed the 16-month collaborative, putting in place four foundational practices – consistent assignment, huddles, involving CNAs in care planning, and Quality Improvement closest to the resident – and then using the practices to individualize care for improvements in high priority clinical areas, such as reducing falls, alarms, rehospitalizations, antipsychotic medications, and pressure ulcers.  View the video documenting some of the incredible results experienced by Missouri homes that participated:  www.youtube.com/watch?v=n8teFIKGLHg.

The national collaborative has concluded, but it is not too late for your team!  MC5 and Primaris are partnering to bring the learning collaborate tools to the East Central Region.  Monthly meetings will be facilitated by Primaris Program Manager Nursing Home Services, Alexis Roam, MSN, RN.  To learn more and join the collaborative, plan to attend the next East Central MC5 meeting.  Your home does not have to be in the East Central region to participate.  Location:  Presbyterian Manor, 1200 Homelife Plaza, Rolla.  RSVP to Mary Ehrenreich at 314-801-0462 or mary.ehrenreich@alz.org; or Tracy Rosenow at 573-265-3271 or tracy.rosenow@mvc.dps.mo.gov. View the flyer here: MC5 and Primaris – Using MDS as an Engine for High Quality Individualized Care

 

  • November 20, 2013:  Northwest

Durable Power of Attorneys and the Appointed Decision Maker – presented by Attorney Doug Tschauder.  Appointed Decision Makers in Long-Term Care – presented by the Missouri Department of Health and Senior Services, Section for Long-Term Care Regulation Supervisor Jamie Dixon.

Location:  East Hills Library, 502 North Woodbine Rd., St. Joseph.  RSVP to Karen Fletchall at wccc.karen@yahoo.com or 660-564-3304, or Freda Miller at fmiller@nwmoaaa.org or 660-822-6209. 

 

  • November 27, 2013:  Northeast

Music & Memory

Location:   Loch Haven Senior Living Community Apartments, New Activity Room, 701 Sunset Hills Dr., Macon.  RSVP to Wendy or Katie at 660-385-3113. 

Visit the NEW Missouri Coalition Celebrating Care Continuum Change (MC5) website at www.momc5.com/

 

Transition Guidelines for SNF PPS Policy and MDS 3.0 Effective October 1, 2013

The memo Transition for Implementation of FY 2014 SNF PPS MDS 3.0 Policy Changes describing the transition guidelines for SNF PPS policy and MDS 3.0 changes effective FY 2014 related to the final rule, is located on the SNF PPS Spotlight webpage, under the Downloads section: www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Spotlight.html.

Reminder: MDS 3.0 Discharge Assessments

This reminder is available on the CMS MDS 3.0 RAI Manual webpage:

www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html.

CMS is providing an opportunity to rectify the current situation related to missing and incomplete discharge assessments.  Homes must complete missing discharge assessments as soon as possible, but no later than September 30, 2013.  Homes can self-audit their MDS assessments by accessing the CASPER system and requesting a MDS 3.0 Resident Roster or a MDS 3.0 Missing Assessment Report.  If you need assistance accessing or interpreting these reports, please contact the State MDS Unit at 573-751-6308, joan.brundick@health.mo.gov or 573-522-8421, denise.mueller@health.mo.gov.