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The RAC is back, increasing scrutiny in a complex nursing home audit environment

by Transitional Care Management

02 19, 2024 | Posted in Press | 0 comments

Sabrena McCarley Transitional Care Management Director of Clinical Reimbursement Sabrina McCarley, MBA-SL, OTR/L, CLIPP, RAC-CT, QCP, FAOTA, offers her expertise in the following article from McKnight's Long-Term Care News. Audits of skilled nursing providers are likely to increase this year, with a growing number of federal and state recovery audits adding to specialized compliance reviews announced last year. In 2023, regulators instituted audits of facilities using potentially inappropriate diagnoses of schizophrenia, as well as a new, five-claim audit of every US nursing home that was specifically meant to root out improper payments. Now, routine audits run by the federal Medicare Fee for Service Recovery Audit Program and states looking to ensure payment accuracy through the Medicaid program are roaring back to life. “While RAC audits practically halted during the COVID-19 pandemic, activity has picked up substantially following the end of the public health emergency,” attorney Amy Fouts wrote in BakerHostetler’s Healthcare Industry 2023 Year in Review published Thursday. While some of the Recovery Audit Contractor activity is moving toward outpatient services, she warned inpatient providers such as skilled nursing operators to stay vigilant for more scrutiny. So, too, does Sabrena McCarley, director of clinical Reimbursement for Transitional Care Management. While she won’t go so far as to call any 2023 increases in RAC activity an “explosion,” she said her company and others who provide billing and compliance support to nursing homes are seeing “an increase in audits of everything.” “The floodgates, essentially, have opened,” said McCarley, secretary of the National Association of Rehabilitation Providers and Agencies. “When you just talk about the RAC audit, people think, ‘Oh I’m totally excepted. I don’t take Medicare. I’m never going to see an audit.’ … They kind of get in this trap. They’re in a bubble, and then they don’t know what to do when their bubble bursts.”

READ THE FULL STORY HERE.

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2023/2024 Administrator in Training Program Kicks Off

by Transitional Care Management

11 14, 2023 | Posted in Press | 0 comments

Transitional Care Management’s new Administrator in Training program (AIT) provides hands-on, specialized learning and mentoring opportunities.

The nine 2023/2024 participants were invited to expand their horizons (and their career options) with Transitional Care University’s inaugural four-module, 460-hour administrative learning opportunity. They will gain practical career-advancing knowledge and experience in Long-Term Care, Skilled Nursing, Memory Care, and Behavioral Health. Transitional Care University AIT grads earn:
  • Supplemental, fast-track specialized training that is an ideal “next step” for professionals on an administrative career path
  • A certificate of course completion
  • Skills to further enhance career progression
  • Administrator in Training title
  • Opportunity for growth within the organization.
In addition, this program meets supplemental criteria for LNHA exam (dependent on individual licensure criteria) and helps prepare candidates to take licensure exams. The program will run annually with next class starting Fall of 2024. Talk to your administrator or contact Contact Terri Galloway, Director of Talent Acquisition, at TGalloway@tc-mgmt.com for more information.

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Terrace Care Communities Lead the Way with NEW, Award-Winning Program

by Transitional Care Management

11 14, 2023 | Posted in Press | 0 comments

Transitional Care-managed communities are setting new industry standards!

Terrace Care communities’ new Life Sills program, which features 10 key modules for teaching key skill sets for building competencies in daily routines that are needed to live more independently, earned the 2023 National Association of Rehab Providers and Agencies (NARA) Impact Award. Linda Ricco“The purpose of the NARA Impact Award is to recognize excellence in the creation of a program that demonstrates a positive clinical impact, exemplifies a new dimension of performance, and can be easily replicated or adapted,” says Linda Riccio, OT/L, Vice President of Therapy Services (pictured left). “Our new Life Skills program does exactly that!” Linda collaborated with a team of Terrace Care and Transitional Care experts, including Michelle Stuercke, Chief Clinical Officer and Najat Williams and Yomi Adebogun, Behavioral Program Specialists, to develop and launch the program. “The Terrace Care Life Skills program is a market differentiator for our communities,” says Charles Ross, Chief Strategy Officer. “It helps us improve census, impress referral sources, reduce re-hospitalization, and improve length of stay.” Denise Norman, President of Transitional Care Management (pictured lower left) adds,“Most importantly, our award-winning Life Skills program offers staff, residents, and guests a new toolbox of resources to help them better meet mental health and discharge preparation needs. It is a WIN/WIN for all!”  

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NARA Fall 2023 Conference

by Transitional Care Management

09 08, 2023 | Posted in Event | 0 comments

National Association of Rehab Providers & Agencies CONFERENCE

Tues, October 17, 2023 — Fri, October 20, 2023
An Interdisciplinary Approach to Managing the Behavioral Health Resident Presented by Transitional Care Management's Vice President of Therapy Services Linda Riccio, OT/L, and Chief Clinical Officer, Michelle Stuercke, RN, MSN DNP, MPH, LNHA
LindaMichelle
CMS's Behavioral Health Strategy incorporates four goal areas, one of which is to "improve access and quality of mental health care and services." With the new changes in the ROP (Requirements of Participation), managing the behavioral health client has become more specialized. Providers across the nation are developing their behavioral care service strategy to meet resident needs as well as create niche clinical programs that can grow census. This session will explore how the impact of mental health conditions is a consideration in all interdisciplinary team interventions and ensures that all persons are afforded opportunities to participate in life through engagement in meaningful occupations.
The presenters will review:
  • Key components of a behavioral health program
  • How each component serves to remediate common behavioral issues often experienced by adults with dementia and/or mental health disorders
  • The role of each member of the interdisciplinary team in managing the behavioral health client with specific emphasis on the role of occupational, speech and physical therapy
  • New program which can be implemented by therapy disciplines as a new niche clinical program
  • Strategies for assessment, treatment, and documentation of client factors and learn specific mental health tools and resources that they will be able to utilize in post-acute care settings
  • Strategies for reimbursement
Don’t miss this session and so many more that focus on providing rehab providers with strategic insight for your organization! For more information or to register for the conference visit:  https://www.eventsquid.com/event.cfm?id=20452

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Developing Personal Resilience and Work-Life Balance

by Transitional Care Management

08 16, 2023 | Posted in Event, General, Press | 0 comments

Linda

Join Linda Riccio, Vice President of Therapy Services with TransitionalCare Management, for a Zoom presentation identifying the key differences between compassion fatigue, burnout, secondary trauma, and PTSD. You will learn evidence-based tools used to assess compassion fatigue and well-being. Linda will encourage you to voice three self-care strategies you will use to minimize burnout and promote your resilience.

September 14th, 2023, 12:00 pm- 1 pm. $35

Illinois Pioneer Coalition members are eligible for one free CEU.

REGISTER HERE

 

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Supporting Nurse Leaders in Turbulent Times Webinar

by Transitional Care Management

06 13, 2023 | Posted in Event, General, Press | 0 comments

Join Michelle Stuercke, Chief Clinical Officer of Transitional Care
Management, for a timely Zoom presentation addressing the
challenges nurse leaders face and the factors needed for their
success. Michelle will review the causes of nurse leader burnout,
four pillars of of leadership, and the six values of leaders.

$35 per Community Free CEU's to IPC members

REGISTER HERE

 

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Nurse Recruitment Thought Leadership

by Transitional Care Management

04 12, 2023 | Posted in General, Press | 0 comments

Nurse Recruitment Thought Leadership Hiring immigrant workers for the nursing home industry from start to finish is grueling for operators. Still, leaders in the industry say it’s the closest to a "silver bullet" we have to meet the staffing crisis. Such a long-term investment is marred by glacial immigration processes and skyrocketing costs to bring people over as staffing agencies get in the game. There’s competition from other countries with far shorter wait times for prospective nurses, and Covid caused a backup in applications. Read more about the options for managing this staffing crisis, including insights from Mike Filippo, Transitional Care Management's Chief Financial Officer.

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American Occupational Therapy Association Annual Conference and Expo

by Transitional Care Management

02 23, 2023 | Posted in Event, General | 0 comments

APRIL 20 - 23, 2023, in Kansas City, Missouri

Transitional Care Management’s Sabrena McCarley, Director of Clinical Reimbursement MBA-SL, OTR/L, CLIPP, RAC-CT, QCP, FAOTA, and Linda Riccio, OTR/L, Vice President of Therapy Services, will present at the American Occupational Therapy Association conference in Kansas City, Missouri from April 20 - 23.
Location: Kansas City Convention Center, KCC Room 2103C
Date: Thursday, Apr 20 2:45 PM
The session will focus on strategies for OT practitioners in post-acute care settings to elevate their roles through meaningful occupations and highlight their role on the interdisciplinary team to achieve optimal patient outcomes.
Location: Kansas City Convention Center, KCC Room 2503AB
Date: Sunday, Apr 23 10:00 AM
Social determinants of health have a significant impact on individuals living in different socio-economic classes. This course will discuss the role of OT in addressing inequities and improving access to technologies for living in place.
Learn More Now  

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CMS Requirements of Participation Phase 3 Webinar Series

by Transitional Care Management

12 27, 2022 | Posted in Event, General | 0 comments

Understanding the Updated Guidance

Transitional Care Management University Logo
  On June 29, 2022, the Centers for Medicare and Medicaid Services (CMS) released Updated Guidance for Nursing Home Resident Health and Safety as part of the Requirements for Participation (ROP) Phases 2 and 3 that went into effect on October 24, 2022. To assist facilities in understanding these updates, IHCA, in partnership with Transitional Care Management, is hosting a series of webinars in the coming months. This training series will review the updated guidance and best practices, as well as resources that participants can take back to their facilities to train staff and implement appropriate changes.  Flexible training to meet your needs! This webinar series offers more than 12 hours of training. Sessions are being held virtually and will be available on the IHCA Education Access Virtual Learning Platform (more information to come). Registrants can sign up for individual sessions ($100 per session), register for the entire series, and save $50!

Sessions

Sessions held Thursdays at 1:00 p.m.
  • Jan. 5, 2023 — Session 1: ROP Phase 3 Guidance Introduction / Residents Rights
  • Jan. 12, 2023 — Session 2: Abuse and Neglect / Nurse Staffing (Payroll-Based Journal)
  • Jan. 26, 2023 — Session 3: Admission, Transfer and Discharge / Mental Health/Substance Use Disorder (SUD)
  • Feb. 2, 2023 — Session 4: Potential Inaccurate Diagnosis and/or Assessment / Pharmacy
  • Feb. 9, 2023 — Session 5: Infection Control
  • Feb. 16, 2023 — Session 6: Arbitration / Psychosocial Outcome Severity Guide
  • Feb. 23, 2023 — Session 7: State Operations Manual Chapter 5 / ROP Phase 3 Guidance Overview/Wrap Up
**Please note: No session is scheduled on Thursday, January 19, 2023.

Presenters

Michelle StuerckeMichelle Stuercke, RN, MSN, DNP, LNHA, Chief Clinical Officer Michelle Stuercke has more than 30 years of experience in long-term care. She has served as a nurse, Director of Nursing, Education Officer, Chief Nursing Officer, and Chief Clinical Officer. As Chief Clinical Officer for Transitional Care Management, Stuercke is responsible for the clinical operations of 12 facilities in Illinois. She holds BSN, MSN, MPH, and DNP degrees and is also a licensed nursing home administrator. She is the President of the Long Term Care Nurses Association (LTCNA) and serves on the IHCA Board of Directors. She is also a frequent presenter for IHCA and other organizations.     Sabrena McCarleySabrena McCarley, OTR/L, CLIPP, RAC-CT, QCP, FAOTA, Director of Clinical Reimbursement Sabrena McCarley is a licensed occupational therapist with expertise in providing clinical and operational management within post-acute care settings. McCarley works for Transitional Care Management, where she is the Director of Clinical Reimbursement. McCarley is a regular guest faculty speaker at various colleges and universities and state, national, and international conferences. She is a California representative for the AOTA Representative Assembly and is a member of the Living in Place Medical Advisory Panel. McCarley is also actively involved in leadership with The National Association of Rehabilitation Providers and Agencies as Secretary and the Chair of the Government Affairs Committee. In 2022, McCarley was appointed to the Technical Expert Panel for the Measurement of Gaps and Measure Development Priorities for the Skilled Nursing Facility Value Based Purchasing Program.
  Download More Information Register Now  

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Elevating the Occupational Therapy Practitioner Role in Post-Acute Care Settings Following the COVID-19 Public Health Emergency

by Transitional Care Management

09 22, 2022 | Posted in General | 0 comments

Transitional Care Management’s Sabrena McCarley, Director of Clinical Reimbursement MBA-SL, OTR/L, CLIPP, RAC-CT, QCP, FAOTA, and Linda Riccio, OTR/L, Vice President of Therapy Services, will present at the Illinois Occupational Therapy Association on November 18, 2022.
For more information, please visit: https://www.ilota.org/2022-conference-main-page.

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