It’s official: According to CMS’ Skilled Nursing Facility (SNF) Prospective Payment System (PPS) final rule published in the Federal Register dated August 8, 2018, the Patient-Driven Payment Model (PDPM)--the new case-mix methodology to replace RUG-IV--is effective October 1, 2018. Facilities will have a year to transition to PDPM from RUG-IV by the October 1, 2019 implementation date. The final rule also establishes a 2.4% market basket update, meaning an $820 million raise for SNFs beginning October 1, 2018.
What it is: Biller's Talk is a moderated listserv that provides members of the Billers’ Association for Long-Term Care exclusive access to a forum for networking, sharing ideas, and solving problems. Discussions center on best practices, suggestions, and other issues related to billing and revenue cycle management professionals. Ask a question, bounce ideas off of peers, or find out how others are improving their billing processes.
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Postacute care has become an essential component of value-based care. By preparing new nurses through a long-term care residency program, facilities can improve nurse retention, confidence, and competency. Accountable care organizations, value-based care, and new reimbursement models are changing the healthcare landscape, and with that the role of the postacute care nurse is evolving as well. "It's important that [patients] don't go back to the hospital. So these nurses have to have a different skill level than, maybe, what people perceived long-term care as previously," says Edna Cadmus, PhD, RN, NEA-BC, FAAN, clinical professor at Rutgers University School of Nursing.
Oftentimes, claim rejections and negative outcomes from billing compliance audits are results of ineffective or nonexhaustive processes within the skilled nursing facility (SNF). This article will help providers lay the foundation for a comprehensive billing system that safeguards against these pitfalls by highlighting special consolidated billing (CB) cases whose navigation could otherwise throw a wrench in workflows.
Beneficiary enrollment in Medicare Advantage plans is on the rise, increasing from 5.3 million in 2013 to 19 million in 2017, according to information published by PLOS Medicine. A study released by the nonprofit advocacy organization in June compared postacute rehabilitation use, length of stay, and outcomes experienced by Medicare fee-for-service (FFS) and Medicare Advantage (MA) beneficiaries with hip fractures in the United States. The results? Although MA beneficiaries experienced shorter lengths of stay and less rehab, their return to the community was more successful and their readmission rates were significantly lower compared to the FFS beneficiaries.