In long-term care, especially within the nursing home sector, per patient days (PPD), a financial cost measurement tool, is looked at as the gold standard of financial measuring devices in the industry. Administrators should be thoroughly conversant in the concept of PPD, which is often measured in hours or dollars per patient day and is the cornerstone for monitoring your facility’s daily financial status.
SNFs must provide quality care to residents in a field that is being suffocated by regulation and paperwork, and that is placing ever-increasing importance on data. The key is to ensure the data does not eclipse the care. SNFs must adhere to the principle that putting residents first will improve quality measures, increase reimbursement rates, and ensure a successful survey. Enhancing resident care will then give a facility the reputational excellence it needs to fill its beds.
The Centers for Medicare & Medicaid Services’ (CMS) new proposed payment system, the Patient-Driven Payment Model (PDPM), follows multiple recommendations from the Medicare Payment Advisory Commission to revise the current prospective payment system (PPS). The revisions include transitioning reimbursement from a volume-based to a value-based system, which accounts for individual patient characteristics, captures more clinical complexity, and reduces the focus on therapy minutes by correlating reimbursement with a broader spectrum of care services.
While Medicare is most often the primary payer for Medicare beneficiaries, some beneficiaries are also covered by an insurance plan that is primary to Medicare (i.e., must be billed before Medicare). This is different from the secondary insurances that many beneficiaries have, which will pay for additional costs not covered by Medicare. In cases when the insurance is the primary payer, the insurance must be billed before any claims can be submitted to Medicare.