Reliant Reveal July :: Reliant Rehab

Reliant Reveal July

Headlines in This Issue…

CMS: Nursing Home Compare Updates Five-Star Rating
Clinical Services: The Client Connection Monthly Webinar Series
Clinical Appeals Corner: Top Denial Trends
HIPAA Happenings: HIPAA Administrative Simplification
Care Matters Spotlight

The Centers for Medicare and Medicaid Services (CMS) has updated the Nursing Home Compare (NHC) website with staffing data from the first quarter of 2018. The following measures have been updated based on Payroll-Based Journal (PBJ) data from January 1-March 31, 2018:
  • Physical therapist hours per resident day
  • RN hours per resident day
  • Total Nursing hours per resident day (RN + LPN + nurse aide hours)
  • RN staffing star rating
  • Staffing star rating
  • Overall Five-Star rating.
Points to keep in mind:
  • Nursing homes reporting 7 or more days in a quarter with no RN hours will receive a one-star rating in staffing domain.
  • Failure to submit any staffing data by deadline or audit identified discrepancies between hours reported and verified will receive a one-star rating in staffing domain.
Deadline for second quarter submission of PBJ staffing is August 14, 2018. Enter now and run validation checks to ensure data accuracy prior to deadline!

Palmetto Part A Skilled Nursing Facility Medical Review Top Denial Reason Codes for April-June 2018

Palmetto, a Medicare Administrative Contractor (MAC), has released the top denial reasons in their region for Part A providers. Palmetto covers Alabama, Georgia, and Tennessee, but trends in one region can provide valuable information on potential trends with other MACs.
Reviewing these top denial codes enables providers to review current practices to reduce the risk of future denials. The top denial reasons for Palmetto are identified as:
  1. Denial Code 5D504/5H504: Not Medically and Reasonable Necessary
  2. Denial Code 5DOWN: Medical Review Downcode
  3. Denial Code 56900: Auto Denial-Requested Records Not Submitted
  4. Denial Code 5D002/5X002: Agree With Provider (Bene Liable)
  5. Denial Code 5D510: There was no evidence of at least three consecutive days of inpatient hospital stay
Read full article

PAC QRP Non-Compliance Letters

CMS is providing notifications to facilities that were determined to be out of compliance with Skilled Nursing Facility (SNF) Quality Reporting Program (QRP). Non-compliance will affect FY 2019 Annual Payment Update (APU). 
Non-compliance notifications have been placed into facilities’ CASPER folders in QIES on July 9, 2018. Facilities that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than 11:59 pm PST, August 7, 2018.

CMS SNF QRP Provider Training

Materials are available for download and providers can still register to participate! Training begins on July 31st and ends on August 1st. Register for webcast and download materials


HIPAA Administrative Simplification

The Division of National Standards is announcing a new line of communications tools that we will be using to provide you with information about HIPAA Administrative Simplification. These include HIPAA Administrative Simplification Guidance Letters and HIPAA Administrative Simplification Information Bulletins. These tools have been branded as “Go-to-Info.”
Read full article



Reliant Rehabilitation has a program to help your facility and therapists work together to improve patient care through targeted quality indicators, quality measures, and effective communication within the facility.

No Patient Left Behind (NPLB)
trains our therapists in interpretation of quality indicator reports and the impact of quality measure reporting.
NPLB emphasizes the critical elements of
  • Notification,
  • Patient Identification,
  • Linking quality and care, and
  • Being an advocate.
Review our resource


Every month on the third Thursday, Reliant’s Clinical Services offers a webinar to our partners on relevant topics within our industry.
In July, The Client Connection reviewed the October 2018 MDS updates including extensive review of Section GG. If you missed this presentation and are interested in knowing more,
let us know

Stay tuned for August’s presentation on partnering with therapy to Reduce Re-Hospitalizations by utilizing Reliant’s clinical tool
Subtle Observed Symptoms (SOS). According to CMS, “hospital readmissions among the Medicare population are common, costly, and often preventable.” We look forward to working with you to reduce re-hospitalizations in your building.

We hope you’ll join us!

Empowering Success Across the Country

Reliant Rehabilitation is excited to partner with facilities across 40 states! Our therapists and directors of rehab (DOR) work together to provide successful outcomes for your residents. We equip our teams with training and resources to guide these partnerships.
Any given week, DORs around the country are gathered by their Regional Directors for a day of motivation, engagement, and training. Keeping our teams abreast of regulatory updates while ensuring quality care is a priority each time.

Motivating to lead in Iowa

Engaging for patient success in Missouri and Oklahoma

Training for the future in Texas

Know someone who may benefit from the Reliant Reveal and the Client Connection webinar series?
Share this sign up link today!


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