Issue #2027 - July 17, 2019
UPDATE FROM KEPRO ON BRCC-QIO TRANSITION
The following is a message from KEPRO regarding some of the issues that providers have been facing recently:

BFCC-QIO Transition Update

Since Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIOs) started transitioning into a new 5-year contract with the Centers for Medicare & Medicaid Services (CMS), KEPRO has been making necessary changes to help streamline processes. During the next few weeks, we will share periodic updates with you in a special bulletin. 
Availability of Case Status Check Online Tool

KEPRO is glad to announce that the Case Status Check tool is once again available on its website at www.keproqio.com/casestatus . Medicare providers and patients can check the case status online for appeals cases started on or after July 14, 2019. 
 
As we have stated previously, KEPRO was required to use a government system that did not allow case data to be accessed. Due to problems with this system, KEPRO has been allowed to return to its proprietary system, which will allow the Case Status Check tool to be available again. 
 
The government system's challenges resulted in the following:
•       Faxes were periodically not being sent or received
•       Medical record requests were not being generated
•       Appeals letters were not being generated
•    The Case Status Check tool did not function, which led to increased call volume telephone wait time, and response to voicemails

We appreciate your patience during this difficult transition. KEPRO continues to work with the Centers for Medicare & Medicaid Services (CMS) to improve processes that we are mandated to follow, creating a better system for everyone.

New Format for Appeals Case IDs
 
As KEPRO returns to its proprietary system, you will see a new format for appeals case IDs:

2019MMDD_appeal number_patient's first and last initial
 
Appeal Information Example: John Doe filed appeal #23 on 7/14/19
Appeal Case ID Example: 20190714_23_JD
 
Fax Information
 
We know that there has been confusion related to our fax number for appeals. The correct fax number for sending medical records is 844-878-7921. This number is for all states served by KEPRO.

NEWS
MEDICAL REVIEW TARGETED PROBE AND EDUCATE (TPE) TELECONFERENCE QUESTIONS AND ANSWERS
On June 3 rd , Palmetto GBA had a teleconference on the Medical Review Targeted Probe and Educate (TPE) audit process. The questions and answers from this teleconference are now available. To access these items, click here .

MEDICAID SPECIAL BULLETIN ON POTENTIAL MEDICAID FRAUD
The NC Medicaid Office of Compliance and Program Integrity has released information concerning potential Medicaid fraud involving provider enrollment. Some providers have received e-mails implying that managed care enrollment is closed, unless a fee is paid to an outside entity. This is not correct. To read this special bulletin, click here .

UPDATED LIST OF EXCLUDED INDIVIDUALS AND ENTITIES (LEIE)
The updated List of Excluded Individuals and Entities (LEIE) database file, which reflects all OIG exclusions and reinstatement actions up to, and including, those taken in June 2019 has been posted. The updated files are posted on OIG's website . To prevent significant fines, healthcare providers have an "affirmative duty" to check to ensure that excluded individuals are not working in their facilities.
SNF PPS PATIENT DRIVEN PAYMENT MODEL (PDPM):
GET READY FOR OCTOBER 1 IMPLEMENTATION
On October 1 st , the new Patient Driven Payment Model (PDPM) is replacing the Resource Utilization Group, Version IV for the Skilled Nursing Facility (SNF) Prospective Payment System (PPS). CMS has resources to help you prepare:


  • Materials from the Medicare Learning Network call in December



REGISTER TODAY FOR NCHCFA NEW SEMINAR ON PDPM
NCHCFA will present Strategies for Success Under the Patient Driven Payment Model on August 22, 2019 at the McKimmon Center in Raleigh, NC. The speaker will be Robin Hillier with RLH Consulting. This day-long program will help administrator, directors of nursing, MDS coordinators, therapists and other members of the interdisciplinary team (IDT) apply information learned about PDPM to develop strategies to capture the most accurate reimbursement rates possible for each Medicare Part A stay. Robin Hillier will discuss how to choose the patient’s primary reason for the SNF stay; how to code key MDS sections including GG, I, J, and K; the importance of resident interviews; how to rethink the selection of the Assessment Reference Date for the five-day assessment; and improving IDT communication and documentation to achieve a thorough and accurate five-day assessment.
 
This is NOT a replacement or duplicate of the PDPM training that was offered by NCHCFA in March 2019, but will focus more on strategies. This session will include PDPM related information from the draft RAI manual update. 

Don’t miss out!   Only 50 seats remaining! 
Click here to review the agenda and register online now.  

NCHCFA would like to thank our sponsor for this event! 

REGISTER FOR THE NEXT LUNCH AND LEARN WEBINAR

Title: Corporate Compliance Programs Under Phase III of the Revised CMS Requirements of Participation



The next Lunch and Learn Webinar is scheduled for Thursday, July 18th, 2019 at 12:00 PM Ken Burgess, Partner, Poyner & Spruill, LLP will be discussing what you need to know to be compliant by November 2019.

Click here to register today.

AHCA’S VIRTUAL PDPM TRAINING IS NOW AVAILABLE!
If you missed NCHCFA’s in-person PDPM training earlier this year, you can now take  AHCA’s Virtual PDPM Training . This on-line training mirrors the in-person training and can also be taken by those who feel like they could benefit from taking the PDPM course again.  
 
The new Patient Driven Payment Model (PDPM) for skilled nursing facilities begins October 1, 2019. The PDPM system will rely on more than 180 MDS item fields and completely transforms the existing system Medicare Part A payment system for skilled nursing facilities. Staff roles and facility processes must be substantially modified to operate effectively under PDPM.
The virtual training allows AHCA SNF members to learn about the critical steps necessary on the pathway to success under PDPM. Included with the virtual training is access to all materials on AHCA’s PDPM Academy . The PDPM Academy is where updates, tools, webinars and other supporting materials are housed. AHCA SNF members who attend the Virtual PDPM Training will also be able to join in free monthly PDPM Academy webinars hosted by AHCA.
 
With a little more than three months left before PDPM implementation, AHCA’s Virtual PDPM Training can set your facility up for success. This training is available to AHCA SNF provider members only. The cost for the training – whether first time or repeated - is $350. The training has been approved for 8 NAB CE credits.

To register for this vital training, click here .

NCHCFA members will need to login with their AHCA/NCAL usernames and passwords. For assistance obtaining AHCA/NCAL usernames and passwords, please e-mail educate@ahca.org with your name and facility contact information.  

REGISTER FOR THE 70 TH ANNUAL ACHA/NCAL CONVENTION & EXPO
This year’s 70 th Annual AHCA/NCAL Convention & Expo boasts more than 70 education sessions on topics like PDPM, RoP phase 3, workforce and regulatory issues, and so much more. There is something for everyone, no matter what your role is in long term and post-acute care. Browse through the list of sessions and speakers, then register for this extra-ordinary event. 
 
The convention offers the opportunity to earn up to 15 CEs. You can also earn more by signing up for the Premium Package when you register. The Premium Package offers access to recorded sessions post-convention in a Webinar format with additional CEs. Education sessions begin with Sunday intensives, October 13 th , and run through Wednesday afternoon, October 16 th . You can save $200 when you register by July 26 th . Take advantage of the Early Bird discount and get the maximum savings. In addition to this discount, you can also save another $100 when you stay within the AHCA/NCAL hotel room block.
 
Join us in sunny Florida!  Click here to register now!

SAVE THE DATE FOR THE NCDONA CONFERENCE
The 24 th Annual Multistate North Carolina Directors of Nursing Administration (NCDONA) conference will be September 18 – 20, 2019 at the Hilton Myrtle Beach Resort in Myrtle Beach, SC.  Click here for more details and to register.  
EARLY REGISTRATION ENDS JULY 19TH - REGISTER TODAY FOR THE EIGHTH ANNUAL NCHCFA SUMMER SYMPOSIUM & SAVE
Make plans today to join your colleagues for the 8th Annual NCHCFA Summer Symposium. Click here to download a brochure! The three-day event will be August 7-9, 2019 at the Embassy Suites Resort at Kingston Plantation, Myrtle Beach, SC. 

Administrators and registered nurses will be able to earn up to 11.5 hours of continuing education.

Agenda items include the following:
  • Sam Clark - Medicaid Managed Care
  • Medical Malpractice Reform
  • Hurricane Emergency Preparedness
  • Internal Dispute Resolution (IDR)
  • NCHCFA Institute for LTC Leaders
  • Alliant Quality
  • AHCA/NCAL National Quality Awards
  • Cindy Deporter - Phase 3 Requirements of Participation
  • Luncheon and Program with Amy Dee
  • NCHCFA Day at the Beach
  • Robin Hillier - Patient Driven Payment Model (PDPM)
  • Daily Sunrise Yoga
  • NCHCFA Sponsor Showcase
  • And daily networking opportunities for best practice sharing!
PLEASE CALL THE ASSOCIATION OFFICE TODAY IF YOU NEED AN OVERNIGHT RESERVATION FOR THE EIGHTH ANNUAL SUMMER SYMPOSIUM
NCHCFA has exceeded its block of rooms at the Embassy Suites Resort for the Annual Summer Symposium. NCHCFA is working with the hotel to secure a few additional rooms for our event. Please call Allison Dew at the Association office at (919) 782-3827 or email allisond@nchcfa.org as soon as possible if you need an overnight reservation. NCHCFA will do our best to accommodate all attendees for the event within the hotel properties!
Thank You Gold Sponsors:
Thank You Silver Sponsors:
Thank You Bronze Sponsors:
American HealthTech | Carolina Therapy Services, Inc. | Fox Rothschild LLP
NEED TO GO
Youths! Go Listen to Your Elders!
DID YOU KNOW?
 The card game Blackjack originated in French casinos around the 1700s where it was called "vingt-et-un" (twenty-and-one).