MatrixCare Town Hall Recording Available On-Demand
As you may have heard, MatrixCare joined the ResMed family in mid-November. ResMed (NYSE: RMD, ASX: RMD) is a leader in cloud-connected medical devices and out-of-hospital software-as-a-service (SaaS) business solutions. MatrixCare President John Damgaard led a couple of Town Hall meetings to explain why this is a great strategic fit for MatrixCare and to answer questions from customers. If you missed one of these sessions, you can access a recorded version here. We’re excited about the opportunities this new relationship will bring to MatrixCare and our clients!
Registration Now Open for MatrixCare Directions 2019!
It’s time to start planning for your attendance at Directions 2019 in Nashville, April 24-26, at the Gaylord Opryland Resort. MatrixCare Directions will provide you with comprehensive learning experiences including CE credits, hands-on sessions, and panel discussions. Our General Sessions will include PDPM, Antibiotic Stewardship Requirements of Participation, ICD-10 and more. There will also be plenty of opportunities to network with peers, visit the Partner Pavilion to view the newest technologies, and spend one-on-one time with industry experts to help you maximize your use of MatrixCare software and do your job more efficiently.
Interested in learning more? Visit the Conference Summary page for more details. Agenda is coming soon!
Ready to reserve your spot? Register today and receive early-bird savings!
Preparing for the Patient-Driven Payment Model
A Webinar by CliftonLarsonAllen (CLA)
Written by Jessica Stagg, Product Manager
In November, CliftonLarsonAllen LLP (CLA) held a webinar to provide guidance to U.S health care providers on the changes surrounding the Patient-Driven Payment Model (PDPM). CLA is a professional service firm that provides wealth advisory, outsourcing, as well as audit and tax consulting. They have more than 5,400 employees with offices across the country. CLA serves more than 8,300 health care organizations.
The webinar’s two speakers brought their considerable experience to the call. Deb Freeland is a Principal in CLA’s health care practice and specializes in reimbursement services for senior living facilities and hospitals. She was joined by Jillian Martin, a senior consultant in long-term health care who specializes in operational assessments, reimbursement best practices, and education for individual and multi-site organizations, just to name a few.
The webinar provided detailed information around PDPM including a detailed breakdown of the calculation. CLA also identified potential operational changes that may be necessary to sustain your organization during the transition to PDPM. In addition to providing some background, this article primarily will focus on those recommendations.
PDPM – What is it?
Consistent with the IMPACT Act, CMS has created a payment model that focuses on quality and outcomes. Reimbursement will be reflective of the outcomes achieved rather than the services provided. PDPM:
- Removes therapy minutes to assess reimbursement level. Reimbursement rates are instead primarily based on clinical and diagnosis info rather than the amount of service needed.
- Includes a separate payment component for Non-Therapy Ancillary (NTA) services, using resident characteristics to predict utilization
- Has five case mix components:
- Establishes a base rate for each of these components
PDPM – Motivating Factors
Primarily based on therapy minutes, the existing RUG payment model does not fully consider the wide range of clinical characteristics that influence the relative resources used in a Skilled Nursing Facility. In moving to PDPM, the goal is to reduce overtreatment and focus instead on the characteristics and condition of the resident. In doing this, there is increased reimbursement accuracy for therapy, nursing, and non-therapy ancillary services.
CLA reviewed four recommended practices for skilled nursing facilities to achieve success:
Understanding financial impacts
- Use your current data to assess the financial implications under PDPM
- Characteristics of populations will determine overall profitability under this model
- Clinically complex residents and residents with comorbidities tend to be more profitable while high rehab residents tend to be less profitable.
Recognizing the financial drivers
- Exploration of top five RUG levels
- Assess, for your facility, what are your top 5 rug scores and what do they translate into (approximately) under PDPM, factoring in length of stay?
- Using the RUG scores of RUB, RUA, RUC, RVB and RVC, CLA demonstrated that while the PDPM rate for days 1 through 3 is significantly higher than the RUG rate for each of those scores, the PDPM rate drops below the RUG rate for all but one of those RUG scores (RVB) on day 4.
- Using national averages, CLA presented a predictive sensitivity analysis to demonstrate how the following factors will impact revenue under PDPM
- PDPM Therapy CMI à Higher CMI = High Revenue
- PDPM Comorbidity à Higher CMI = Higher Revenue
- Length of Stay (LOS) à Shorter stays = Higher Revenue
- This analysis assumes occupancy rates also stay the same which may be a challenge to facilities
Training and coordination
- Changes and implications of PDPM must be understood across all levels of your organization
- CMS offers a PDPM Calculation Worksheet1 and additional tools to walk users through determining the scores for each case mix component
- Accurate MDS and ICD-10 coding will become even more critical
- Who completes Section GG today?
- Do the individuals completing Section GG know all the coding guidelines?
- ICD-10 coding can “make or break” the resident’s primary clinical category and comorbidity score, which would significantly impact several of the case mix components
- Timely and accurate hospital discharge information is critical
- Discharge diagnoses
- Prior surgery information
- Timely and accurate hospital discharge information is critical
- Start thinking and having conversations about them now, do not put changes into place until PDPM goes into effect
- Consider, how will delivery of therapy change with the ability to utilize group/concurrent therapy?
- Focus now on how therapy practices may be modified with a focus on obtaining functional outcomes
- Current contracts may be based on minutes or portion of RUG score
- Contracts also may be based on resident achievements
- How does therapy fit as part of the whole care team?
We hope you found this summary helpful. Please check matrixcare.com/PDPM for more information and updates as they become available.
MatrixCare Release Coming Soon
The next MatrixCare release for SigmaCare by MatrixCare users is planned for early 2019, and we are busy preparing the following new features and enhancements.
- Application enhancements in support of SHIN-NY “Common Clinical Data Set”
- MealTracker Diet Order Interface usability enhancements
- Auditing reporting
- Matrix for Providers reporting request
- Enhanced Care Plan enhancements
- Additional Miscellaneous enhancements
Stay tuned for more information regarding these value-added enhancements!
Frequently Asked Questions and Helpful Tips
There is a quick and easy way to search for residents that are missing a Medicare Beneficiary Identifier (MBI) in SigmaCare. This option allows a user to pull up all the residents that are missing an MBI number on one log and it allows the user to easily access the Resident Summary page from the log.
From the navigation bar, perform the following tasks:
- If the Resident Menu is not open, click the > icon next to Resident.
- Next, click on Select Resident.
- Locate the Show search field (located to the bottom right of the Search Fields).
- Select Missing MBI from the drop-down menu.
- Click Search.
For instructions on how to add a Resident’s MBI, review the Job Aid available in help.
MatrixCare Enterprise Financials:
A Critical Tool for Organizations of All Sizes
MatrixCare Enterprise Financials is a comprehensive suite of robust, fully integrated modules for tracking and managing financial information, including Accounts Payable, General Ledger, Fixed Assets, Bank Reconciliation, Capital Projects, Purchase Orders, Inventory Management and F9 Reporting. Enterprise Financials, designed specifically for use in the LTPAC industry, is a hosted solution, offering all of the benefits of automated backups, redundant systems, world-class security, and the flexibility to access your data from anywhere.
Recent product enhancements provide robust reporting options with just a push of a button.
- New Financial Report Options
Several new financial reports are available for forecasting, budgeting, and census information. Additionally, you now have options for including GL Account Numbers in a separate column on Excel outputs and do not include Group Code Options if all the GL Accounts assigned to the Group Code have a balance of zero. The new reports include the following:
- Monthly Budget – 12 Month synopsis of Budget information
- Monthly Actual with PPD – 12 Month Actual Report and Census Statistics “PPD”
- Monthly Budget with PPD – 12 Month Budget Report and Census Statistics
- Census Days 1 – Monthly and YTD Comparative statement of Actual Census statistics.
- Census Days 2 – Monthly and YTD Comparative statement of Budget Census info
- Census Days 3 – 12 Month Actual Census only
- Census Days 4 – 12 Month Budget Census only
- Forecast Report – 12 Month Report showing GL Estimate information
- Blended Overtime by Week
To comply with regulatory requirements, you can now compute a Blended Overtime Rate by week within a bi-weekly payroll. The blended OT for each week is combined to print on the PR check and DD statements.
To learn more about MatrixCare Enterprise Financials, contact your Account Manager today or download a product brochure.
Product Webinars Available OnDemand
Miss our recent live product webinars? Now you can view them On-Demand!
Improve Intake Management: Reduce Data Entry, Increase Accuracy
Entering Referrals 2 or 3 times can lead to errors, frustration, and late reporting, not to mention the impact on your team entering the same thing in multiple systems. In this webinar, MatrixCare Product Manager, Bradley Lawton, discusses how you can minimize duplicate data entry through eDischarge and MatrixCare integrations, to improve accuracy and efficiency.
Improving Nutrition Through Interoperability in LTPAC
Successfully managing resident nutrition can be challenging. The key is to collect, maintain, and utilize resident dietary requirements and preferences to provide meals that meet each resident’s nutritional needs. The data collected in nutrition management and Electronic Health Record (EHR) systems can be used in conjunction to ensure the highest level of nutrition in all residents across the community/facility.
Are You Keeping Up with MatrixCare?
MatrixCare continually evolves based on client requests and inevitable industry changes. As the new year approaches, it’s a great time to ensure that you and your staff are up to date with all of the changes. MatrixCare Training Assurance Plus gives you options to secure training and consulting throughout the year, guaranteeing you will have the education necessary to stay on top of the changes.
MatrixCare Training Assurance Plus Options:
- Annual Product Optimization – Yearly MatrixCare audit done by our staff results in a customized agenda focused on recommended areas for improvement.
- New Hire Training – Let us know your staff turnover situation, and we’ll customize an agenda to ensure you have the same level of expertise always on board.
- Advanced Training & Consulting – This option is designed to assist your experienced staff with implementing newly released features of MatrixCare on an ongoing basis.
- Personalized Plan – Consult with MatrixCare to determine a PLUS solution that works for you.
Contact your Account Manager today to sign up!
MatrixCare Partner Webinar Available On-Demand
The MatrixCare Partner Webinar held on December 18th was led by a panel of our certified partners who presented on products and solutions that integrate with MatrixCare technology to help our customers meet their unique technology needs, enable them to automate content management & workflow, enhance outcomes for patients & caregivers, and empower organizations to staff consistently.
Interested in learning more about a specific partner’s technology? View the webinar!
At CDW Healthcare, we understand your focus is on people, not just technology. That’s why we make it our business to bring you the guidance, responsive support and comprehensive services you need to take the best possible care of your residents with technology solutions tailored to your communities’ unique needs.
Paperless Environments is an Enterprise Content Management and workflow automation solutions provider. Our products integrate with your existing business applications and infrastructure.
Welch Allyn, now part of Hill-Rom, is committed to providing smarter tools to help clinicians assess, diagnose and treat every patient with confidence. From physical assessment tools to connected vital signs and cardiology devices to vision care solutions, we help enhance outcomes for patients and caregivers.
OnShift’s suite of products for hiring, scheduling and employee engagement drives quality care, lower costs and higher performance by empowering senior care providers to staff consistently and efficiently.
Amerigroup Comm Care ERA Routing Changes
Important information for MatrixCare Claims Management users: Amerigroup Comm Care has changed their ERA routing for some states.
- Payer Name: AMERIGROUP COMM CARE
- Professional CPID: 1741
- Institutional CPID: 1569
- Payer-assigned Payer ID: 27514
- States Impacted: DC, FL, GA, IA, MD, NM, NV, TN, TX, WA
Although a new enrollment is not required, if a facility has stopped receiving ERAs or is experiencing any issues, we recommend completing a new ERA enrollment at this time. ERA enrollment requests can be submitted on our MatrixCare Client Portal.
If you have any questions, please contact MatrixCare Financial Support 866-287-4987.
CMS Resources for PDPM
CMS has published a PDPM site that includes a variety of educational and training resources to assist stakeholders in preparing for PDPM implementation including PDPM Fact Sheets, FAQs, Training Presentations, and PDPM Resources.
- Fact Sheets > MDS Changes
- Page 3, New MDS Item Sets: IPA and OSA
- Page 3, New MDS Item: Section I: SNF Primary Diagnosis
- Page 3, New MDS Items: Section J: Patient Surgical History
- Page 5, New MDS Item: Section GG: Interim Performance
- PDPM Frequently Asked Questions > PDPM FAQs
- Page 34, Section 14: Transition Policy and Medicaid Issues
14.2: How will I get a PDPM payment code to bill starting October 1, 2019?
- Page 34, Section 14: Transition Policy and Medicaid Issues
- PDPM Resources > PDPM Classification Walkthrough
- New version of the document that defines each portion of the PDPM calculation
Quality Reporting Program (QRP) Spotlights and Announcements
CMS routinely publishes new updates for Skilled Nursing Facilities (SNFs). Stay up to date on the changes, access the CMS QRP page for complete details.
- Inaugural Release of SNF QRP Data on NH Compare
- QTSO page update from qtso.com to qtso.cms.gov
- Provider Preview Reports – Now Available
- Fact Sheet on Transitions for New Quality Measures and Data Elements Effective October 1, 2018 – Now Available
- Disaster Information Now Available on the Reconsiderations and Exceptions & Extensions Page
Medicare Deductibles for 2019
On October 12, 2018, the Centers for Medicare & Medicaid Services (CMS) released the 2019 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs.
For more information on the 2019 Medicare Parts A and B premiums and deductibles (CMS-8068-N, CMS-8069-N, CMS-8070-N), please visit the Federal Register website.
The End of Functional Reporting for Outpatient Therapy Services
Published in the Federal Register on November 23, 2018, CMS has eliminated the claims-based functional reporting requirements for Part B therapy services. Beginning January 2019, SNFs will no longer be required to append the following non-payable functional limitation G-codes (G8978 through G8999 and G9158 through G9186) or the following severity modifiers (CH through CN) to any outpatient therapy claim.
To no longer allow these ancillary charges to bill on or after 01/01/2019 in MatrixCare for your Medicare Part B type payers, we suggest you add a new payer row with a Begin Date of 01/01/2019 and select the No Longer Covered checkbox, for example:
2018 Trade Show Season Comes to an End
At MatrixCare we strive to deliver solutions that drive superior results across the community of care. Trade shows offer us the opportunity to meet with our clients, partners, and prospective customers to demonstrate our innovative solutions and share our expertise and advice on topics relevant to the industry. In 2018, we attended 120+ events throughout the country that allowed us to stay on top of both current and emerging trends and develop solutions that meet the needs of our customers today, and in the future.
We look forward to a successful 2019 conference season! Stay tuned for information on where we’ll be exhibiting next.