CMS announced that Medicare will now cover any medically necessary ambulance ride for individuals with COVID-19 from any origin to any destination equipped to treat the patient’s condition. Acceptable destinations include, but are not limited to:
In order to address provider’s concerns regarding COVID-19, we have created a coronavirus forum where providers can connect with one another. The forum can include topics such as supplies, visitation, concerns, regulations, mandates, infection control, payment, staffing, etc. You’re not alone in this, we have you covered. Visit the forum to post questions, concerns, and tips and receive input from other providers across the nation. Join here.
As COVID-19 spreads throughout the U.S., LTC providers face unique challenges to keep their high-risk residents safe. In an effort to fully understand the challenges SNFs are currently facing as a result of the virus, we’d like readers to complete a survey to tell us about their challenges.
One quarter down, and PDPM appears to be mostly positive for SNFs. CMS is reporting a higher average per diem payment level than under RUGs. Despite some added coding complexity, paperwork burdens are down for providers (for example, we have two MDSs during most stays now vs. many more under RUGs).
Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) initial claims that are processed out of sequence are not paying the correct Variable Per Diem (VPD)-adjusted rate. Also, all adjustment claims are not processing correctly. Claims need to process in date of service order for each stay for the VPD to calculate correctly. CMS states it will correct this issue in October.
A truly successful SNF optimizes quality outcomes and reimbursement for their Medicare Part A patients. The Patient-Driven Payment Model (PDPM) supports this concept by shifting the focus from quantity of services to drive payments to basing payments on resident characteristics and quality outcomes. Outcomes are person centered, and SNFs can utilize several programs to provide that person-centered care.
Ideally the admission is coded as soon as possible upon admission, prior to entry of orders in the electronic medical record (EMR). This may not be a complete listing but should include diagnosis to support medications and treatments being provided to the resident.