Ambulance transfers are extremely expensive for SNFs and their Medicare Part A–covered patients. “The high costs associated with transfers create a significant financial risk for SNFs,” says Barbara Reimer, consultant with the Fox Group.
The phrase, “Cash is king” rings true for providers. With-out positive margins and healthy cashflow, your ability to operate and provide excellent care to patients suffers. That’s why many billers monitor the accounts receivable report (A/R) with an eye toward optimizing cashflow.
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.