AHCA/NCAL Fraud and Abuse Prevention Toolkit

AHCA/NCAL is pleased to release the Fraud and Abuse Prevention Toolkit (posted on AHCA/NCAL website), which was prepared by Reed Smith attorneys, Susan Edwards and Carol Loepere; reviewed by AHCA’s Legal Committee; and edited by AHCA Public Affairs staff, Tom Burke.  This Toolkit will help AHCA/NCAL membership untangle the complex web of federal and state agencies, regulations and laws related to fraud and abuse.  Although the Toolkit focuses on nursing care centers (NCCs); much of the information within also applies to other settings, such as assisted living communities (ALCs) and centers for individuals with intellectual and developmental disabilities (ID/DD).  In all of those settings, for example, the federal anti-kickback and Stark laws will apply (e.g., those laws are relevant to all health care programs including both the Medicare and Medicaid).  Please note, the Toolkit will help AHCA/NCAL membership better understand the legal environment they operate within; however, it is not a Compliance Program or Compliance Plan.  Instead, this Toolkit was specifically developed to help members improve their compliance with federal fraud and abuse laws and regulations.  To obtain a copy of the Toolkit go to  Please contact Dianne De La Mare at if you have any questions.

November 21st, 2014|Newsfront, Quality Corner|

Accurate ICD-10 Implementation Critical for Claims Payments

As the October 1, 2015 implementation date gets closer, GHCA, along with AHCA/NCAL, encourages long term and post-acute care providers to start now to educate and train staff; make the required software changes to submit accurate assessments or claims with ICD-10 CM code sets; and monitor any state Medicaid policy changes that may be required by ICD-10-CM code sets.  Although CMS has provided numerous tools and resources for certain health care providers – – it has not very successfully provided tools for long term and post-acute care providers.  GHCA has training planned; and AHCA/NCAL is currently planning its own series of webinars especially for our sector (mark your calendars for Dec. 5th and 11th), which will be advertised shortly. In the meantime, to obtain more general information regarding ICD-10 implementation information go to:

Video: ICD-10: Getting From Here to There — Navigating the Road Ahead
Video: ICD-10 and Clinical Documentation
Expert Column: Preparing for ICD-10: Now Is the Time
View the ICD-10 Introduction fact sheet and FAQsfor an overview of ICD-10.
Find official resources designed to help providers, payers, vendors, and non-covered entities with the transition to ICD-10.

November 13th, 2014|Newsfront, Reimbursement Corner|

ACA Litigation Heads to the US Supreme Court – Again

The US Supreme Court has agreed to review the legal challenge in King v Burwell (most likely hearing the case in March 2015) and to decide whether or not the Obama Administration is improperly providing tax subsidies to consumers who purchase insurance through the Federal Exchanges (in more  than 30 states).  This will mark the third time that the US Supreme Court will hear litigation focusing on the Affordable Care Act (ACA), and casts a cloud on the tax subsidies issues as the second round of open enrollment for insurance through the Exchanges is set to begin.  In 2012, the US Supreme Court upheld the constitutionality of the ACA; but also found the Medicaid expansion provision unconstitutionally coercive to the states, leaving Medicaid expansion optional for the states.  Then earlier this year, the Court carved out an exception for providing contraceptive coverage for employers who object for religious reasons.  Now, in agreeing to hear King v Burwell, the US Supreme Court will review the lower court (US Court of Appeals for the Fourth Circuit) decision that upheld the subsidies for the Federal Exchanges.  Recall that on the same day that the Fourth Circuit released its decision,  a panel of the US Court of Appeals for the District of Columbia (DC) Circuit struck down the […]

November 13th, 2014|Newsfront, Reimbursement Corner|

GHCA Education November- December

In November and December 2014, GHCA is offering the following education:

November 3 in Stockbridge-MDS 3.0 Training: Special Focus on Assessment, Goal Setting and Restraints Click to Register >>

November 5-6 in Stockbridge- SOURCE Basic Case Manager Training Click to Register >>

November 9-14 in Stockbridge-Activity Directors State Approved 36 Hour Course Click to Register>>

November 20-21 in Stockbridge- MDS 3.0 Basic Training Click to Register>>

December 2 in Tifton and December 4 in Stockbridge-Integrating Process Tools into your QAPI Plan Tifton Click to Register>>  Integrating Process Tools into your QAPI Plan-Stockbridge Click to Register>>

December 3 in Stockbridge-Medicare 101 Click to Register>>

December 10 in Stockbridge-AHCA Bronze Quality Award Workshop Click to Register>>

December 11 in Stockbridge-AHCA Silver Quality Award Workshop Click to Register>>

Two additional programs are being considered for December. One is Thought Leadership, and the other will center on the Professional Development/Integrity and Residents Rights required category for licensed nursing home administrators. Watch for more information as it becomes available on the Events page of the GHCA website.

October 31st, 2014|Education Updates|

2015 GHCA Winter Convention and Trade Show

The  GHCA Winter Convention and Trade Show is January 20 -23, 2015. The theme is the Pursuit of Happiness. There will be some preliminary meetings and education sessions on the afternoon of January 20, with the opening session on January 21, 2015. Convention registration will open soon.  The trade show is January 21-22, 2015.  Trade Show registration is open, and you can download the trade show registration.

To reserve a hotel room click on the link below.
Renaissance Atlanta Waverly Hotel & Convention Center for 160.00 USD per night
Book your group rate: GHCA’s 2015 Convention >>

Or call 1 (888) 391 8724, and ask for the Georgia Health Care Association group rate

Or if you do not use the one step link above,  just go to and find the Renaissance Atlanta Waverly Hotel & Convention Center online, they will need to click on special rates and awards on the right side, select group code and then enter ghcghca in the box that will appear.

October 31st, 2014|Convention, Trade Show|

Look What’s New at the 2015 AHCA/NCAL Quality Symposium

Registration is now open!
7th Annual AHCA/NCAL Quality Symposium 
Austin, Texas
February 23-25, 2015.  
The deadline for registration is January 23, 2015.
The AHCA/NCAL 7th Annual Quality Symposium: It’s Time to Roar builds on a tradition of providing high level, extremely targeted quality improvement programming. The quality call to action has grown from a persistent chorus of voices to an industry-wide roar. Be sure your voice is among those contributing to the roar that drives change, progress, and outcomes.
Register now for the premier quality education and networking event in long term and post-acute care. You can earn up to 15.5 CEUs for administrators. Nurse hours are also available.
What’s in store for this year’s  attendees?

NEW! A series of talks called AHCA/NCAL LED Talks modeled after the popular TED Talk concept and curated by Provider magazine. These talks will inspire you to LEAD, ENGAGE, and DISCOVER.
NEW! Sponsor-supported education sessions with CEUs featuring content presented by our sponsor partners.
20 concurrent education sessions over three days
Moderated […]

October 30th, 2014|Assisted Living, News, Newsfront|

GMCF “Next Steps” Webinar – November 5

On November 5th, GMCF will host a kickoff call for providers in North Carolina and Georgia that will introduce (or update!) providers on their work for the 2014-2019 contract period. During this time GMCF will also let nursing homes know how they can join in their efforts and partner with GMCF on these projects. They hope and look forward to having as many as possible attend and for the facilities convenience, are hosting two calls, one at 11 am (EST) and one at 2pm (EST). Click on the links below for more information on how to join the calls. Please share with your members and join GMCF!
Information to join the 11am webinar, click HERE.
Information to join the 2pm webinar, click HERE.

October 30th, 2014|Newsfront, Quality Corner|

GHCA Concludes Fall Council Tour

After eight stops all over the state Georgia, the fall council tour comes to a conclusion.  Close to four hundred attendees participated in the town hall style meetings.  To view a complete version of the presentation slides, please click HERE

October 30th, 2014|News, Newsfront|

New LTC Trend Tracker Unveiled at the AHCA Convention

On Monday, October 6, 2014, at the AHCA/NCAL Annual Convention & Expo, AHCA launched a new and improved version of LTC Trend Tracker.

For those who were unable to attend Convention, or if you’d like additional assistance, AHCA has set up webinars for users to learn how to navigate the new system. Please register for one that suits your schedule:

Monday, November 3, 2:00pm ET
Monday, November 17, 2:00pm ET
Monday, December 8, 2:00pm ET

In addition, all users should have received a new username and password to the system on October 6. This personal username and password will allow you to access all of AHCA web-based services. 
LTC Trend Tracker is a web-based tool that enables long term and post-acute care providers to access key information that can help their organization succeed. This exclusive, AHCA member benefit allows skilled nursing organizations to benchmark personal metrics to those of their peers and examine ongoing quality improvement efforts. LTC Trend Tracker is AHCA members’ one-stop-shop to gain timely information and valuable insight about their own performance as well as the entire profession’s.  
If you need more information please contact us at

October 30th, 2014|Newsfront, Reimbursement Corner|

Part A Rates Effective 10/1/14

For many of you Part A Rates changed on October 1, 2014.  Since a resource for these rates because available through AHCA, GHCA will not be publishing its version of the rates.  In order to access the rates, here is the link:  This spreadsheet will also enable you to estimate how much your Medicare revenue will change based on your  RUG history. 
You will need the AHCA username and password.  If you do not have them, please send an email to Hope Hickman at 

October 30th, 2014|Newsfront, Reimbursement Corner|