Volume XXX, Number 12
December 2015

United Healthcare Checklist for Claims

United Healthcare has shared a checklist for nursing facilities to use when troubleshooting claim payments. The list is based on claim errors that they see most. Before you escalate, have you checked:

• Tax ID
• Bill Type is correct
• Cash Postings – payments are posted to correct patients/month
• Posted Zero Pay Remits
• Check Mesav for
  • Eligibility
  • Service Auth
  • Level of Care
  • Applied Income
• Revenue code is correct
• Verify dates and LOC billed match Mesav
• Bill RUG splits on separate claims
• Make sure claim is not a duplicate
• Make sure Diagnosis code is valid to 4th or 5th digit as necessary

President’s Report

• President’s Report

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 Legislative Update

• House Speaker Announces Interim Charges

• THCA Honors Estes for Leadership on Long Term Care Issues

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 Commitment to Care

• One a Month Campaign

• Register Today – THCA Members Only Webinar Your 5-STAR Rating Really IS in Your Control – December 8

• DADS is Accepting Applications for Civil Money Penalty Project Funding

• Updated Texas Minimum Data Set Resources

• Taking the Pulse of Person-Centered Care

• DADS Asking for Nurses Feedback on CE Needs and Preferences

• DADS Joint Training Opportunities in December and January

If you have any questions about the THCA C to C Initiative or would like to share your facilities successes please contact Gloria Bean-Williams at gbwilliams@txhca.org or call (512) 458-1257.

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State / THCA News

• Analysis of Survey Trends, List of Top Ten Deficiencies Enclosed

• TMHP to Require Providers to use Internet Explorer 11 Beginning December 12

• Skilled Nursing Facility MMP Quick Reference Document

• United Healthcare Checklist for Claims

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National / AHCA News

• 2016 OIG Work Plan: Long Term Care Facilities Areas of Focus

• CMS Issues Final CJR Rule

• CMS issues S&C memo on focused Dementia Care Survey Tools

• Medicare SNF Coinsurance Amounts for 2016 Posted

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Announcements & Recognitions

• Visit, Like and Follow THCA

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THCAPAC

• THCAPAC 500 Club Recognitions & Information

• THCA Hosts Annual Summer “Golf Fore PAC” Tournament

?’s About THCAPAC…Contact Us

Ron Payne, THCAPAC Co-Chair
rpayne@swltc.com

Mark McKenzie, THCAPAC Co-Chair
mmckenzie
@seniorcarecentersltc.com

Gina Muniz, THCAPAC Liaison
gmuniz@txhca.org

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Region News

• Key Focus Areas Identified for Education at 2016 Region Meetings!

• Don’t forget to share your facility’s Holiday Spirit!

• THCA Members in Regions 1 & 2…THCA Region Chairs Want You!

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Education

• REMINDER – THCA Members Only Webinar
  Your 5-STAR Rating Really IS in Your Control – December 8

• Free Conference Coming to a Town Near You – Infection Control and Prevention Strategies for Texas Nursing Facilities – Multi-Drug Resistant Organisms and Clostridium difficile

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Calendar

• December 2015

• January 2016

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  Follow the THCA Twitter page