Reliant Reveal June

Headlines in This Issue…

PDPM Updates
SNF Provider Reports Available to Review
Clinical Services: The Client Connection Monthly Webinar Series
Clinical Appeals Corner:
Settlement Conference Facilitation (SCF)
HIPAA Happenings: Consent for Resident/Patient Photos
Care Matters Spotlight

The comment period for the SNF FY2018 Proposed Rule closed on June 26, 2018. Stakeholders and interested associations around the country submitted comments for CMS to consider prior to finalizing the annual rule. This year’s comments can be expected to be detailed and many due to the inclusion of CMS’s payment model proposal, the Patient Driven Payment Model (PDPM).
Over the next year, Reliant will continue planning and preparing for PDPM to ensure a smooth transition while maintaining quality care and successful outcomes. Stay up to date on the latest PDPM news with the Reliant Reveal and Real Time Memos.

Office of Medicare Hearings and Appeals (OMHA) Settlement Conference Facilitation (SCF) Expansion is Open

Right on the heels of the LVA settlement expression of interest period ending, there is now a new claim settlement option on the horizon.
Settlement Conference Facilitation (SCF) is an alternative dispute resolution process designed to bring the appellant and the Centers for Medicare & Medicaid Services (CMS) together to discuss the potential of a mutually agreeable resolution for claims appealed to the Office of Medicare Hearings and Appeals (OMHA) level or the Medicare Appeals Council (Council) level of the Medicare claims appeals process. If a resolution is reached, a settlement document is drafted to reflect the agreement. As part of the agreement, the requests for hearing or review for the appeals covered by the settlement will be dismissed.
A facilitator uses mediation principles to assist the appellant and CMS in working toward a mutually agreeable resolution. The facilitator does not make official determinations on the merits of the claims at issue and does not serve as a fact finder, but may help the appellant and CMS see the relative strengths and weaknesses of their positions. The facilitator is an employee of OMHA, which is a component of the Department of Health and Human Services (HHS) Office of the Secretary, and is organizationally and functionally separate from CMS. Mediation within this program is centered on facilitating payment negotiations.
here for the criteria that will be needed for appellant and claims eligibility.
Please refer to Reliant’s
Clinical Appeals Team for any questions you may have.


Every month on the third Thursday, Reliant’s Clinical Services offers a webinar to our partners on relevant topics within our industry.
In June, The Client Connection discussed Fall Prevention and Recovery. If you missed this presentation and are interested in knowing how therapy partners with your facilities for falls awareness, let us know!
Stay tuned for July’s presentation on Section GG. MDS Section GG will have new items added beginning October 1, 2018 including:
  • New measure: GG0100 Prior Functioning: Everyday Activities, with new scoring set
  • Addition of new not attempted code: “10. Not attempted due to environmental limitations (e.g. lack of equipment, weather constraints”
  • 12 new functional items items
  • Removal of GG0170H1: Does the resident walk?
Be prepared for these updates and learn how effective processes for Section GG can help you prepare for the Patient Driven Payment Model (PDPM) expected in October 2019.

We hope you’ll join us!

CMS Updates PDPM Group Tools and Resources

As stakeholders navigate the tools and resources CMS has prepared and made available for PDPM, dialogue between the two parties has included clarification requests and concerns regarding potential miscalculations in the provided grouper tool.

SNF Provider Preview Reports: Review by June 30th!

Skilled Nursing Facility (SNF) Provider Preview Reports have been updated and are now available. Providers have until June 30, 2018 to review their performance data prior to public display on the Nursing Home Compare (NHC) site.

Consent for Resident / Patient Photos and/or Videos

Sharing our resident’s successes and stories is a wonderful way to empower others to achieve their goals and honor the individual for their accomplishments. In the world of healthcare, it’s important to ask:
When is a consent form required for taking a resident/patient photo?
What is needed for consent?


Evan Schulman, the Centers for Medicare & Medicaid Services’ deputy director for Division of Nursing Homes presented at the American Association of Directors of Nursing Services’ annual meeting. He shared the top 5 deficiencies identified since the launch of the new survey process in November, 2017 and emphasized “we have to do better” on infection control.
Read the full article from McKnights

Destination: Success
Via Waikiki Beach and New Orleans!

Reliant Rehab therapists provide skilled care that produces quality outcomes in 40 states across the country. They consistently share stories of their patients’ success and motivation, and we love to be able to share those with you.
This month, we are sharing one of the many ways Reliant therapists help residents achieve that success: Group Therapy. Pictured above are two therapy teams from Missouri who, using Reliant’s clinical tool “Group Possible Solutions: GPS”, planned a day of adventure for their patients. One team spirited their patients off to Waikiki Beach. The atmosphere of hula skirts, ocean, and sand was enjoyed by all! The other team paraded to New Orleans to experience the World’s Fair, where the therapists and patients were able to
“let the good times roll!”
We are proud of our therapists across the country! Thank you for sharing your fun and creativity with us!


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