Q. Should therapy treatment practices change under the Patient-Driven Payment Model (PDPM)?
A. Even though therapy minutes are no longer relevant to the provision and payment for therapy, CMS has assumed that most therapy will continue to be provided one-on-one. SNFs with contract providers need to take great care to ensure that the contractor does not automatically ramp up inpatient therapy on a group and concurrent basis to the 25% threshold!
Unless the facility has experienced a significant change in overall case mix from when under resource utilization groups (RUG) to PDPM (fewer therapy-qualified residents), there would be no logical clinical reason to change treatment practices.
Three changes happened recently for therapists that billers should know about: Medicare’s outpatient therapy cap was repealed and the therapy threshold was lowered; new modifiers for therapy assistants were added; and the requirement for functional limitations reporting was removed.
SNFs see zero reimbursement value from no-pay bills and benefits exhaust claims, so no-pay bills often go overlooked. Billers are instead looking to deal with issues that will result in cash flow for the facility. So what exactly are no-pay bills, and where does a benefits exhaust situation come into play?
by Deborah Collum, national director of revenue cycle management at Covenant Retirement Communities and AMBR Advisory Board member
Implementing a revenue cycle management (RCM) model in your facility will help you streamline your billing process to prepare for the Patient-Driven Payment Model (PDPM) to be implemented October 1, 2019. If your billing office still follows an accounts receivable (AR) model that only focuses on outstanding accounts, you’re not alone—but it may be time for a change.