PDPM Isolation, Quarantine, Skilling, COVID-19, and ICD-10

PDPM Isolation, Quarantine, Skilling, COVID-19, and ICD-10
Top 6 Things to Know

HHI is receiving ongoing inquiries on the MDS Coding qualifiers for Isolation and Quarantine. Although it may seem simple, there is a difference between Isolation and Quarantine.

  • Isolation is for patients with symptoms and or positive tests.
  • Quarantine is for patients exposed but exhibits no symptoms.

According to the CDC, isolation is for people who are ill, while quarantine applies to people who have been in the presence of a disease but have not necessarily become sick themselves. Per the CDC,


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5 Ways to Improve Your PDPM Reimbursement

It starts at the front door.

Smart choices upon admission will yield the best results. A strong admissions department will weigh various factors upon admitting a resident, working with the clinical team to select a strong primary diagnosis. This requires a comprehensive review of documentation and transfer paperwork provided upon arrival. By recognizing revenue triggers and selecting the best PDPM category composition; projected reimbursement is established at the highest appropriate level.

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Recalibrating PDPM after COVID-19

Confusion, new directives every hour, residents desperate for help, family, and hope. Your clinical awareness is sharp, on high alert, mindful of any shift in condition. Your all-consuming focus is the health of the patients in your care.

In March 2020, this was the scene in the Long-Term Care landscape. In the blink of an eye, staff intent on treating patients during the pandemic lost the time once dedicated to PDPM initiatives. Fast forward to October 2020, Long-Term Care heroes have helped define “essential”. Our SNF saviors have come out the other side, with techniques and processes to endure the COVID-19 pandemic; and ready to set their sights on the PDPM game once again.

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Round 3

Have you ever felt like your life was an eternal boxing match? Every day you wake up, put your gloves on, and head out just to fight another day. I have felt this feeling many times throughout my life, but nothing has compared to this year of uncertainty and change. As I sit at my desk writing this article, the date is October 1st. Exactly one year ago today the company put on its' boxing gloves and went out to face PDPM. Our company spent over a year planning and preparing for that day and just as we were getting our arms around this new payment system, in came Round 2, COVID-19.

We barely had time to sit in our corner and catch our breath before putting the gloves on to go fight again. With this opponent, we did not have much time for preparation. There was a lot of trial and error and learn as you go. All of our teams bravely stepped up to this new opponent, and I was personally able to see the unwavering commitment from all of you. Six months into this pandemic, we are starting to see the light at the end of the tunnel. But just as we have had a moment to sit in our corner and catch our breath, here comes Round 3!

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Grandparenthood and Aging

Grandparenthood has multiple meanings for the person, depending in part on age at the initial time of grandparenthood, and the number and accomplishments of the grandchildren are probably a source of status. The stage of grandparenthood may come to middle-aged persons depending on the age of their own childbearing and age of their children’s childbearing. The relatively young grandparent may either like and accept or resist the role and may not like the connection of age and being a grandparent.

Grandparents are often happy with their role in that they can enjoy the young person and enter into a playful, informal, companionable and confiding relationship. The grandchild is seen as a source of leisure activity, someone for whom to purchase items that are also enjoyable to the grandparent.
Grandchildren have a special tie to grandparents. The research indicates that even when there was a divorce in the family, adult children from divorced families continued their relationships with grandparents.

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Illinois in Conformity with Federal and State Medicaid Regulations on Unpaid Pre-Eligibility Medical Expenses

Illinois is the latest battleground state where Stotler Hayes Group (SHG) has brought the fight for post-Medicaid eligibility income deductions for recipients of long-term care Medicaid benefits. In an ideal world, residents would have all of their financial affairs in order prior to being admitted to a skilled nursing facility so that they secure Medicaid benefits as soon as they exhaust their insurance coverage or private resources. Anyone in the long-term care industry knows, however, that many residents are unable to secure the Medicaid start-date that they need, which leaves the resident – and their provider – with unpaid bills for services rendered prior to their Medicaid eligibility.

Medicaid is a cooperative Federal and State program intended to assist needy and indigent individuals with the costs of care. In order to receive federal funding, State plans for Medicaid must comply with Federal requirements. The Centers for Medicare and Medicaid Services (“CMS”) has long interpreted unpaid expenses incurred prior to Medicaid approval as “not covered” under the State plan for Medicaid. As a result, Federal law requires State Medicaid programs to deduct unpaid medical expenses incurred prior to Medicaid eligibility when determining the amount of income that a resident is required to contribute toward the cost of his or her care; this amount is known as a resident’s “Cost Share” or “Patient Pay Liability.” In other words, Federal law provides Medicaid recipients the ability to apply their Cost Share/Patient Pay Liability towards uncovered pre-eligibility medical expenses. States are permitted to impose reasonable restrictions and many states have done so – allowing deductions, for example, only for uncovered medical expenses incurred three months (or, in some states, six months) prior to the month of the Medicaid application. Some states have elected to impose no time restrictions and allow for deductions in Cost Share/Patient Pay Liability for uncovered medical expenses regardless of when the expenses were incurred prior to the month of the Medicaid application.

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Romance And Aging

Travel agencies try to persuade us that romance flourishes in the right setting. Advertisements barrage us with products that promise to make us sexy, glittering, powerful, desirable.

Although these messages are biased and superficial, they do touch upon the truth. There are circumstances that quicken our heartbeat and sharpen our appreciation for sensual possibilities. We feel good and want to share the feeling. We look good to each other and something very pleasant might well happen.

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The Caregiver’s Role and Aging

The role of the middle-aged offspring in caring for the elderly parent has been often described in social science research and popular magazines. Even as elders are being cared for, they are a source of support – emotionally, socially and financially – by providing living arrangements for the adult child who may be the caregiver.

The caregiver in an elderly couple is most frequently the wife, as women live longer than men and are usually younger than their spouses. If the woman is impaired, the husband will often become caregiver.

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Assessing the Situation and Aging

John is an independent, proud-eighty-year-old man who had nursed his late wife through her long bout with advanced Alzheimer’s disease and kept her at home until the very end. When friends and family wondered how he did it, given his limited mobility due to crippling arthritis, he would say, “I would have it no other way.”

Not only did he insist on doing his own shopping and cooking, he also shopped for neighbors in his apartment building, whom he characterized as the “old folks.” But when John had a stroke which paralyzed his left side, there was no way he could return home from the hospital. John and his three children were told by a hospital representative that they had a week to find a skilled nursing facility for him.

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The Well Elderly and Aging

The emergence of a population group identified as the well elderly is the result of social and demographic progress in the industrial world. More elderly people are living longer and poverty, frailty, and dependence are not necessarily the com­mon characteristics attributed to most old people.

The future portends a healthier well elderly population who are better educated and physically as well as emotionally prepared. Society has, at present, begun utilizing their capabilities for the foreseeable future, thus guaranteeing a potentially rich human resource.

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Tactile Stimulation and the AD Patient | (AD = Alzheimer Disease)

The need for tactile stimulation or touch, continues throughout our lives. Older adults may experience less touch because they have fewer contacts in their immediate environment, compared to the younger person.

As the senses of sight and sound decrease, touch becomes an increasingly important means of communicating. Touch then becomes a vital vehicle for expressing emotions and a way to make meaningful contact with others.

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States Temporarily Prohibit Involuntary Discharge of Residents from Long-Term Care Facility’s for Non-Payment

In response to the COVID-19 pandemic, the governors of Illinois and Michigan have issue Executive Orders prohibiting long-term care providers from involuntarily discharging resident’s for non-payment. Other states, such as New York, are under pressure to pass similar prohibitions.

Pursuant to Illinois Executive Order 2020-35, Section 14, the provisions of the Nursing Home Care Act, 210 ILCS 45/3-401(d), MC/DD Act, 210 ILCS 46/3-401, and ID/DD Community Care Act, 210 ILCS 47/3-401, permitting a long-term care facility to initiate an involuntary transfer or discharge of a resident for late payment or nonpayment, is suspended. Full text available here.

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Learning New Things and Aging

Virtually everyone remains capable of learning throughout their lives. There is no known age at which the elderly lose their ability to learn new things although due to illness and other medical issues, many can and do experience increased difficulties in learning.

It may appear as if the elderly have failed to grasp any new ideas. This is not because they have been unable to learn, but because they may choose not to risk making mistakes and looking foolish – a caution which the old share with younger people.

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DEPRESSION: The Signs and Aging

We often mistake an old person’s quiet withdrawal and lack of complaint as philosophic acceptance when, in fact, she is putting her best possible face on a bitterly disappointing, humiliating or frightening situation.

Either assumption, that it is normal to be unhappy or that old people are somehow happy about being unhappy, obstructs our view of the person’s true state of mind. Signs of distress deserve attention in old age as much as at any point in the lifespan.

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Coronavirus placing great strain on U.S. healthcare system

Facilities face supply chain disruptions and staffing shortages

Faced with a global pandemic now affecting everyday life across the country, the U.S. healthcare system is struggling to cope with potential staffing shortages and supply chain disruptions.

“Everybody is stressed,” said Bill McGinley, President and CEO of the American College of Healthcare Administrators, or ACHCA. “Most of the stress is coming from the conflicting information put out by the CDC, CMS and various state agencies. Often it is conflicting and changes from day to day. It is very hard to keep up.”

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Geriatric Nursing and Aging

“Professional education is acquired through the learning experience offered with courses preparing the student for the role of leader and teacher, and that can be implemented at a level of competency.” Eleanor C. Lambertsen, RN, Ed.D

Nurses play a critical role in caring for the sick and frail older adult, and in promoting healthy aging. Yet not only is there a general shortage of nurses in the United States, there are even fewer nurses who have specialized in geriatric skills. Of the 2.5 million registered nurses in the U.S., less than 15,000 are certified in geriatrics. And of the 111,000 advanced practice nurses, only 3,500 are geriatric nurse practitioners and/or clinical specialists.

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Successful Litigation Impacting Future Medicaid Payments

Stotler Hayes Group Attorney, Nathan Peters, presented at the Texas Healthcare Association’s Board of Directors meeting on August 21st, 2019. Nathan shared two updates on how Stotler Hayes Group’s (SHG) Texas-based attorneys are successfully fighting to recover every Medicaid dollar available for our clients, and all Texas providers. SHG attorneys have litigated two major issues with the Texas Health and Human Services Commission (THHSC) and both could significantly impact future Medicaid payments in Texas. The issues the cases have dealt with include (1) the THHSC’s denial of an application for failing to exclude inaccessible resources for incapacitated Medicaid Applicants and (2) THHSC’s improper restrictions on Incurred Medical Expenses (IME). By some estimates, the IME payments could alone boost Medicaid provider payments over $40 million annually.

Unlike some state Medicaid agencies, THHSC previously refusing to exclude certain resources when reviewing Medicaid applications for incapacitated individuals. This policy is leading to a significant loss in payments for providers, because affected providers are left without a payor source until the incapacitated resident can secure a guardian with the authority to spend down their resources. Unfortunately for these providers, securing a guardian and spending down resources for incapacitated individuals is often a lengthy and complicated process. However, SHG’s recent victory in the case of Tex. HHS Comm’n v. Marroney, 2019 Tex. App. LEXIS 4298, 2019 WL 2237885 (Tex. App. – Austin May 24, 2019, Pet. Denied) should lead the THHSC to change its policy and start excluding inaccessible resources for incapacitated residents.

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Overcoming Difficulties and Aging

We must realize that the comfort and well-being of an afflicted person can be improved even when a progressive disease process does exist. Environments can be adapted to allow for a measure of independence together with safety.

Instead of isolation, the person with a brain disease can be given the opportunity of continued social contact in a warm and friendly setting. I have personally seen women diagnosed with dementia, work confidently and competently in a kitchen provided for their use.

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Legionnaires’ Disease presents grave threat to U.S. healthcare facilities

CDC said 25 percent of cases in hospitals and long-term care settings resulted in deaths during 2015

Legionnaires’ Disease (LD) cases and outbreaks anywhere are alarming enough, but when they occur in healthcare settings, they can be downright deadly.

According to 2015 data from the Centers for Disease Control and Prevention (CDC), 25 percent of cases of LD, a serious lung infection caused by Legionella bacteria, acquired in hospitals or long-term care facilities were fatal. The fatality rate in the general population was 10 percent.



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Age-Grading and Aging

Society has an alternative method of classifying people by age. The distinctions are based on a person’s life situation, especially the place held in society, rather than on number of years since birth. Sociologists and anthropologists sometimes refer to this as an age-grading approach. It has been the most important basis of age distinction in many societies, and continues as a supplementary approach in industrialized nations today.

A simple age-grading approach divides the population into the young, the grown up, and the aged.

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