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Overview of Medicare Regulations for Long-Term Care

presented by Jane Snecinski

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Disclosure Statement:

Financial Post Acute Advisors is a consulting firm that may be engaged to work with a SNF on a project involving compliance Nonfinancial Jane Snecinski/Post Acute Advisors has no nonfinancial conflicts to disclose

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

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Video Runtime: 47 Minutes; Learning Assessment Runtime: 32 Minutes

The regulations governing Long-Term Care (LTC)/Skilled Nursing Facilities (SNF) are unique and clarify the place that LTC/SNF play in the Medicare/Medicaid continuum of care. Despite these specific regulations, the role of and care delivered within the regulatory structure is not always well understood by administrative and clinical staff, especially if new to this level of care. This course will define the LTC/SNF setting and review the coverage guidelines for SNF, provide an overview of the Prospective Payment System and Minimum Data Set tool and schedule, and the assignment of reimbursement categories.

Meet Your Instructor

Jane Snecinski, FACHE, MBA

Ms. Snecinski has bachelor's and master's degrees in music and an MBA in health care administration from the University of Miami, Coral Gables, FL. She has had seventeen years of hospital administration and management experience and more than seventeen years of consulting experience in post-acute levels of care, including inpatient and outpatient therapy, sports medicine,…

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Chapters & Learning Objectives

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1. LTC/SNF in the Medicare Continuum of Care

In the current levels of care for Medicare beneficiaries there is a great deal of competition for patients to be admitted to various levels of care. This chapter will help participants understand the identified role of LTC/SNF in this continuum of care to be able to provide an appropriate scope of services for Medicare beneficiaries and other residents.

2. The Prospective Payment System (PPS) for SNF

As a result of the regulatory structure that defines SNF, a specific reimbursement system has been established for the Skilled Nursing level of care. It is often said that the SNF reimbursement system is a very complicated system for a less sophisticated level of care. Therefore, understanding the intent of the system and how the reimbursement categories were established to provide appropriate reimbursement for resources provided is critical. This chapter focuses on the process that results in the assignment of a specific reimbursement category for each patient/resident as well as the wide variance in reimbursement categories and examples of associated reimbursement.

3. The Minimum Data Set (MDS) Tool

The various reimbursement categories of the PPS for SNF are determined by an accurate, timely, and comprehensive completion of the MDS for each resident at clearly identified time frames of the stay. This chapter will help the team understand the process for completion and their role in ensuring accuracy of the data set.

More Courses in this Series

Compliance in LTC/SNF

Presented by Jane Snecinski, FACHE, MBA

Compliance in LTC/SNF

Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
Video Runtime: 59 Minutes; Learning Assessment Runtime: 33 Minutes

Having a “living” and customized compliance plan in the long-term care (LTC)/skilled nursing facility (SNF) setting is necessary to receive and maintain operations in line with regulation and accurate reimbursement. Understanding how the components of this plan are implemented to become a program is critical. Since all staff have a role in successful implementation, providing all staff with compliance education specific to LTC/SNF will have a significant impact on the success of the program.

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The Quality Measures for LTC/SNF

Presented by Jane Snecinski, FACHE, MBA

The Quality Measures for LTC/SNF

Subscribe now, and access clinical education and patient education—anytime, anywhere—with video instruction from recognized industry experts.
Video Runtime: 47 Minutes; Learning Assessment Runtime: 24 Minutes

The Centers for Medicare and Medicaid Services (CMS) have developed and required specific quality measures for each level of care, including long-term care/skilled nursing facilities. These quality measures provide a framework for care and prepare organizations for moving to a value-based payment system. Understanding the measures, how to quantify them, and the value of using the data from the measures is critical for all long-term care providers.

View full course details

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