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.
With the October 1, 2019 go-live date for the Patient Driven Payment Model (PDPM) just months away, providers are anxious to learn of any updates or clarifications CMS will make prior to the new model taking effect. As such, many providers were relieved when CMS released the mid-year draft of the MDS 3.0 Resident Assessment Instrument (RAI) Manual v1.17 on May 20.