Jul 01, 2019
 | 
AMBR Journal

The Patient-Driven Payment Model (PDPM) will bring countless changes to how the MDS coordinators support the facility’s revenue cycle. In PDPM, the patient’s acuity, rather than therapy utilization, drives reimbursement. For the first time, reimbursement is directly tied to the patient’s medical conditions. As such, the role of the MDS coordinator will evolve to facilitate the capture of all of the patient’s clinical conditions on the MDS that will be critical to attaining accurate and optimal reimbursement.

Jul 01, 2019
 | 
AMBR Journal

In nearly all provider segments of health care, revenue maximization and integrity are directly tied to compliance and quality ratings. Beginning October 1, 2019, skilled nursing facilities (SNF) that failed to meet the 80% threshold reporting requirement on quality measures (QM) will experience a 2% payment reduction. The cut-off date to meet the compliance level for the quality reporting period October 1, 2018 to December 31, 2018 was May 15, 2019.

Apr 01, 2019
 | 
AMBR Journal

As of November 28, 2019, CMS will require SNFs to have a compliance and ethics program in place that meets one of CMS’ regulations in the Conditions of Participation (CoP).

Many SNFs have compliance and ethics programs in place, but November marks the first time that facilities can be subject to a survey tag or cited for not meeting the specific elements outlined in the CoPs, says Stefanie Corbett, DHA, postacute regulatory specialist for HCPro.

Apr 01, 2019
 | 
AMBR Journal

Everything SNF providers knew under the RUG-IV casemix system is set to change when CMS’ new Patient-Driven Payment Model (PDPM) goes into effect on October 1, 2019. PDPM ushers in a new reimbursement paradigm that emphasizes treating the whole patient. The resident’s clinical complexity will drive payment. This is a massive shift away from the RUG-IV system, which reimbursed facilities based on the volume of resources provided (e.g., therapy minutes).

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jfitzgerald@hcpro.com
jfitzgerald@hcpro.com
tswartz@hcpro.com