CMS issued its final rule, Fiscal Year 2020 Payment and Policy changes for Medicare Skilled Nursing Facilities (CMS-1718-F), in July. The new payment rule aims to “strengthen the Medicare program by better aligning payment rates for these facilities with the costs of providing care and increasing transparency so that patients are able to make informed choices.” Within the rule are three major updated provisions that will affect the operation of SNFs: the Prospective Payment System (PPS) payment policy, the Value-Based Purchasing Program (VBP), and the Quality Reporting Program (QRP).
With the implementation of the Patient-Driven Payment Model (PDPM), SNF’s bottom lines are more at risk than ever before.
In these early days of PDPM, SNFs may find it difficult to project revenue and profitability for their Medicare Part A covered patients because so many factors, (e.g., patient acuity, clinical documentation, accurate ICD-10 coding) impact payment, says Kim Cusson, CCS, CPC, a consultant with Crowe Healthcare Risk Consulting, LLC.
As the financial effects of the Patient-Driven Payment Model (PDPM) become clearer in the coming months, SNF providers will likely make operational changes to address revenue loss and optimize reimbursement opportunities.
When it comes to knowing the difference between inclusions and exclusions in Consolidated Billing (CB), it can be extremely confusing for SNFs. Let’s first break it down by the basics. Included refers to items or services that are included in CB and for which the SNF must pay the outside vendor for specific services they provide. Excluded refers to items or services that are excluded from CB and may be billed by the outside vendor directly to Medicare Part B. Sometimes these items or services are also referred to as carve-outs.