October 1 will be here before we know it. And with that comes Medicare’s new Patient-Driven Payment Model (PDPM) for beneficiaries accessing their skilled nursing facility (SNF) Part A benefit. It seems like every day there is a new webinar being advertised to help you understand the ins and outs of PDPM, but if there’s one thing you can know without any training, it’s that the new payment model is a much more complex system than the resource utilization group, version IV (RUG-IV) system that we operate under currently. As we analyze data collected in our facilities trying to understand our place in a PDPM world, though, don’t forget this important consideration: your therapy contract.
When trying to understand something complex, it sometimes helps to use food as a metaphor. Under the Patient-Driven Payment Model (PDPM), therapy becomes a piece of the pie, rather than the whole thing. For providers considering ways to minimize therapy services or reduce therapy staffing, a few additional considerations should be looked at before making any cuts.
Providing excellent care and delivering successful resident outcomes are goals for which all facilities should strive. In order to achieve these goals, it is important to focus on what can be done to improve collaboration and teamwork. A true collaboration can result in the following:
This year, AMBR for Long-Term Care is partnering with the National Association for Healthcare Revenue Integrity (NAHRI) to offer a track at the Revenue Integrity Symposium dedicated to the unique billing and reimbursement challenges in that setting.
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Three changes happened recently for therapists that billers should know about: Medicare’s outpatient therapy cap was repealed and the therapy threshold was lowered; new modifiers for therapy assistants were added; and the requirement for functional limitations reporting was removed.
In the final 2018 outpatient prospective payment system (OPPS) rule released by CMS, total knee arthroplasty, also known as total knee replacement (TKA/TKR), was removed from the Medicare inpatient-only (IPO) list. The IPO list includes procedures that are only paid under the hospital inpatient prospective payment system.
As a member of the Billers’ Association for Long-Term Care, you have access to our talk forum, where billing professionals can ask and answer questions to help each other solve billing and reimbursement challenges. A recent biller brought up a good question: Do you therapists bill the time they participate in the SNF care plan meeting?