Specific Operational and Clinical Tasks to Support Quality Services and Accurate Payment

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Published On: September 16th, 2021Categories: NewsTags: , ,

It takes a high-functioning team and adequate training to provide accurate data reporting and improve claims payments with fewer denials. While meeting federal and state requirements for proper coding can be an overwhelming task, it doesn’t need to be—communication and training are pillars for success.  

Everyone plays a significant role in understanding and tracking accurate data. Minimum Data Set (MDS) coordinators and interdisciplinary teams (IDT) are responsible for staying up to date on Medicare Benefits Policy Manual (MBPM) requirements and communicating changes to all staff members. Nursing staff should record thorough notes detailing an issue or observation. Access to current manuals and updates improves accurate entry into electronic medical record (EMR) systems. 

Forum Extended Care’s September webinar, Specific Operational and Clinical Tasks to Support Quality Services and Accurate Payments, offers insights into achieving trouble-free claims through accurate data. This can be achieved through informed and educated staff and cohesive teamwork. Webinar speaker and industry leader Leah Klusch, RN, BSN, FACHCA, and Executive Director of the Alliance Training Center, share information approaching audit activity, additional documentation requests, and coordinated survey and data review.  

Successful operational and clinical leadership requires a coordinated focus on compliance, outcome reporting, and payment accuracy. Each area of focus involves scrutiny because of the analytics and review procedures the Centers for Medicare and Medicaid Services (CMS) have in place. For example, data quality and data formulation policy may require internal audit results on documentation of care in the facility.  

When reviewing care documentation in your facility, it is important to consider if new and current employees are aware of correct procedures and informed about documentation guidelines. Through in-service training or memos, communicating modifications and updates are essential so that medical record information is accurate at all times.  

Suppose a skilled nursing facility (SNF) partners with outside providers to perform physical, occupational, and speech therapy services. In that case, they need to be informed of any new requirements, including submitting complete and timely resident records, documentation for permanent medical records, and the responsibility to communicate each client’s status with the SNF staff and resident physician. 

There are also survey-related issues that impact data formulation and accuracy. Klusch recommends using the multi-colored MDS.3.0 as a quick and easy reference guide to ensure compliance. In addition, be sure that MDS coordinators are re-trained to use Patient Driven Payment Model (PDPM), which differs from the Prospective Payment System (PPS).  

The September webinar is filled with information, insight, and resources to put your organization on the path to excellence. Let CMS be your road map, and Leah Klusch be your guide as your organization aims for quality and accuracy. 

Check out the webinar here