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March 2018 Advisor

New Medicare Card Update

To address the current risk of medical identity theft, CMS is required to remove Social Security Numbers (SSN) from Medicare cards by April 2019. A new unique number, MBI or Medicare Beneficiary Identifier, will replace the SSN based Health Insurance Claim Number (HICN) on each new card. This number will be unique to each beneficiary.

Starting in April 2018, CMS will begin mailing new Medicare cards to all persons with Medicare on a flow basis, based on geographic location and other factors. Medicare beneficiaries will be able to check the status of card mailings in their area on Medicare.gov at that time.

The mailings will follow the sequence listed below:

  • Wave 1: April – June 2018: Delaware, DC, Maryland, Pennsylvania, Virginia, West Virginia
  • Wave 2: April – June 2018: Alaska, Am. Samoa, California, Guam, Hawaii, N. Mariana Is., Oregon
  • Wave 3: After June 2018:Arkansas, Illinois, Indiana, Iowa, Kansas, Minnesota, Nebraska, North Dakota, Oklahoma, South Dakota, Wisconsin
  • Wave 4: After June 2018:Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, Vermont
  • Wave 5: After June 2018: Alabama, Florida, Georgia, North Carolina, South Carolina
  • Wave 6: After June 2018: Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Texas, Utah Washington, Wyoming
  • Wave 7: After June 2018: Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Puerto Rico, Tennessee, Virgin Islands


The transition period is from April 2018 through April 2019. All systems must be modified to transmit the correct MBI by April 2018. CMS will accept either the new MBI or the old HICN from April 2018 through December 31, 2019.

Providers will be able to determine if a beneficiary has received the new card by checking the CMS HIPAA Eligibility Transaction System (HETS). It is imperative that all current and new residents receive their cards to enable appropriate claim submission.

It is recommended that providers educate families and beneficiaries to be sure new cards are received which will ensure a smooth transition.

Overwhelmed by Rules of Participation?
In light of the recent implementation of CMS’ LTC Phase 2 Rules of Participation, are you changing the way you prep for survey?

Five ways your therapy partner should be supporting you:

  • With plenty of outcomes data to support QAPI Programming and safe transition planning
  • With a robust “Safe Transitions Plan”
  • With an abundance of health literacy materials
  • With expertise in support of Clinical Competencies (pathways, training, grid)
  • With dementia programming & sophisticated training modules to successfully guide PAC provider in RoPs

Since November 2017, providers were required to make significant changes in 13 different areas related to care delivery. In the new dawn of 2018, survey readiness takes on a whole new light. As leaders in therapy management and healthcare reform consulting, HealthPRO® Heritage lights the way with 12 recommendations to get ready for survey.

  1. All staff need to understand the why – the principles and concepts in all policies. Start with education on the why and what so you can achieve positive outcomes. This will lead to a better and more robust understanding of the process. Next, ensure that you monitor performance in accordance to these policies and processes, and implement ways to correct any non-compliant areas. Open your eyes to what the surveyors may see and don’t be afraid to say something and make it right. 
  1. Work directly with your EMR company to ensure documentation requirements are updated to support accurate, on-time completion of assessments
  2. Ensure that all staff undergo formal training to understand documentation requirement changes. Document these training sessions.
  3. Conducting frequent and ongoing audits to QA training efforts. Document these audits.
  4. Consider consolidating efforts related to the 48-hour baseline care plan and the discharge planning meeting
  5. Audit whether staff is documenting goals and plans of care in lay terms. By including residents and their caregivers as active participants in their own care delivery, it is critical that all written communication be easy-to-understand and accessible for all members of this extended care team. Provide training as necessary. Audits and training sessions should be documented.
  6. Train all staff in necessary areas of specialization.
  7. Clinical competency checks must be well-documented.
  8. Medication reconciliation and management must continue to be an important part of therapeutic intervention for residents and their caregivers to ensure safe and timely discharges and transfers, and mitigate risk for hospital readmissions. Therapy staff must utilize all appropriate evaluations and treatment interventions to assess and educate residents and/or caregivers on their ability to manage medications. Documentation related to tests and education is a must.
  9. Speech Therapists must partner closely with dieticians and ancillary staff to carry out functions of Food Services, taking into consideration Plan of Care, necessary dietary modifications, etc. Document these efforts to work collaboratively. Also, all staff (including speech therapists) must receive appropriate competencies and skills to address specific diagnoses and acuity levels.
  10. Access and interpret outcome measures. While the Quality Assurance and Performance Improvement (QAPI) requirements will be implemented in Phase 3, the initial QAPI Plan must be provided to State Agency Surveyor at the annual survey. The QAPI Program requires all SNFs to develop, implement and maintain a plan that focuses on systems of care, outcomes of care and quality of life.

    A SNF’s ability to design and refine an effectual QAPI Program will depend largely upon their ability to access and interpret outcome measures. Preparing a QAPI Program requires a data-driven process that supports decisions for policy, education, feedback, data systems, monitoring, systematic analysis and systemic action.
  11. Don’t throw the kitchen sink at care planning. The ability to create and update an individualized care plan, starting with the baseline care plan, is a large focus of today’s survey environment. Provide specifically what the resident needs and continue to update that as the resident makes progress or needs change. A best practice is to review and update during the clinical meeting for short term and long term. Then update again during your discharge planning meetings for short term and at risk or clinical grand rounds for long term. It turns your baseline care plan into a document that focuses on the resident and their ever changing needs. Ensure the care plan is centered on the resident’s goals, preferences, and plans for discharge. 

How HealthPRO® Heritage Can Help

At HealthPRO® Heritage, we developed a “Training & Competency Module” based on the needs outlined per the facility-wide resource assessment to ensure all therapists are trained and demonstrate competencies in specialty areas. Our proprietary Safe Transitions post-acute transfer-discharge communication form has been updated to meet the requirements for all information needed when transferring your residents.

By maintaining our comprehensive library of health literacy resources for providers, therapists utilize standardized assessment tools to ensure safe medication reconciliation to fortify processes for medication administration and ensure positive survey results.

Based on HealthPRO® Heritage’s depth of experience and a foundation built on a robust Business Intelligence platform, our clients use our outcome measures to help define and redefine elements of their QAPI requirements. Likewise, guidance for interpreting these metrics and translating outcome measures into tangible policy is offered by our clinical strategy consultants as well.

As SNF leadership teams prepare for survey, HealthPRO® Heritage takes on a supportive role by proactively developing and offering details related to Policy and Procedure in support of what is outlined in the Facility Assessment. Also, HealthPRO® Heritage clients make good use of a customizable “Clinical Capabilities Grid” that serves to mirror that which is captured on the facility assessment. A sophisticated, comprehensive “Clinical Capabilities Grid” can be used to support a variety of initiatives from marketing efforts to ER diversion planning.

Prepping for the first survey following the major changes of Phase 2 may be a challenge for many SNF providers. HealthPRO® Heritage is available to light the way. Our healthcare reform experts understand the nuances of CMS’ most recent changes. Rely on our Clinical Strategies and Operations Teams to support your efforts. We provide the necessary documentation training, auditing activities, competency training and development of policies, procedures and QAPI programming. Rest assured there is light at the end of the tunnel!

For more information, please contact Kristy Yoskey, Senior VP of Clinical Strategies, at clinicalstrategies@healthpro-heritage.com

Tags: CMS, Long Term Care, Safe Transitions, CMS Update 2018, Care Delivery, Medicare Card Update, Rules of Participation