KEY ENCORE NEWS
Data-Driven Analytics to Identify Risks
Encore is always looking at how we can identify risks based on data-driven analytics. Members of Clinical, Compliance, and Operations each bring their unique perspective to a monthly collaborative review of outcomes data and trends.
This exclusive review is made possible by customized reporting and interpretation by compliance specialists.
LOCKING IN ClAIMS
In preparation for the 2021 release of the SNF PEPPER, the Centers for Medicare & Medicaid Services (CMS) has decided to retire several target areas, retain several target areas, and add a new target area.
Retired Target Areas
With the implementation of the Patient-Driven Payment Model (PDPM), several target areas reported on Resource Utilization Groups (RUGs) are no longer meaningful. The following target areas will be retired:
- Therapy RUGs with High ADL
- Nontherapy RUGs with High ADL
- Ultrahigh Therapy RUGs
- Change of Therapy Assessment
Retained Target Areas
The following target areas will be retained, as they continue to be relevant:
- 20 Day Episodes of Care
- 90+ Day Episodes of Care
- Three to Five Day Readmissions
New Target Areas
CMS evaluated and approved a new target area to be added to the 2021 release of the SNF PEPPER. This new target area, PDPM High Utilization Codes, will monitor high utilization payments to SNFs. Analysis of claims data indicates that approximately 89% of SNFs have sufficient data to generate statistics for this target area. The PEPPER team will apply the following criteria to generate the numerator and denominator counts for the new PDPM High Utilization Codes target area:
- Numerator: Count of SNF claims where the first digit of the Health Insurance Prospective Payment System (HIPPS) code is one of the following: C, D, G, H, K, L, O, P
- Denominator: Count of all SNF claims
Adding PEPPER to Your Plate
March 25, 2021 @ 12:30 PM Eastern Time
KEY REGULATORY NEWS
Impacts on SNF's Quality Measures
Quality Measures are not new or different because of COVID, but there are some substantial impacts to a SNF's Quality Measures – whether or not they've seen active COVID cases in the facility.
QM Indicators to watch during quarantine:
- New use of antipsychotics, restraints, behavior affecting others, decline in locomotion, weight loss, pressure ulcers, depressive symptoms
- Long Stay - decline in locomotion - explain numerator and denominator
National benchmarks for change in mobility and self-care quality measures have progressively declined over the last year. The current national benchmark for mobility is 16, and self-care is 7.
March is National Nurtition Month
Maintaining a healthy weight is important for overall health and well-being. As you grow older, if you continue to eat the same types and amounts of food but don’t become more active, you’ll probably gain weight. That’s because metabolism (how you burn the calories you eat) can slow down with age.
The secret to maintaining a healthy weight is to balance “energy in” and “energy out.” Energy in means the calories you get from the food and beverages you consume. Energy out means the calories you burn for basic body functions and during physical activity.
How active should you be to keep a healthy weight?
The answer is different for each person, but generally:
- To keep your weight the same, you need to burn the same number of calories as you eat and drink
- To lose weight, burn more calories than you eat and drink
- To gain weight, burn fewer calories than you eat and drink
Other ways to maintain a healthy weight?
- Limit portion size to control calorie intake.
- Add healthy snacks during the day if you want to gain weight
- Be as physically active as you can be
- Talk to your doctor about your weight if you think that you weigh too much or too little.
- Read What’s On Your Plate?, the National Institute on Aging guide to healthy eating
Aim for 150 minutes of physical activity per week in sessions of 10 minutes or more.
- Read more tips for adding physical activity to your day
- Print useful tools
- Share your exercise story
Representing the clinical presentation is key to care planning.
A body mass index (BMI) above 40 can be captured for an NTA point for morbid obesity.
KEYS TO CODING
To capture the NTA point, an active diagnosis of morbid obesity must be listed in MDS Section I8000.
Please email Ryan Jones for additional information: [email protected]