For a SNF biller, nothing feels better than hitting that submit button and sending a claim off to Medicare or a managed care plan. The claim is gone and off your desk—until it comes back for a post-payment review or outright denial. In that case, nothing feels worse.
The Patient-Driven Payment Model (PDPM) will bring countless changes to how the MDS coordinators support the facility’s revenue cycle. In PDPM, the patient’s acuity, rather than therapy utilization, drives reimbursement. For the first time, reimbursement is directly tied to the patient’s medical conditions. As such, the role of the MDS coordinator will evolve to facilitate the capture of all of the patient’s clinical conditions on the MDS that will be critical to attaining accurate and optimal reimbursement.
In nearly all provider segments of health care, revenue maximization and integrity are directly tied to compliance and quality ratings. Beginning October 1, 2019, skilled nursing facilities (SNF) that failed to meet the 80% threshold reporting requirement on quality measures (QM) will experience a 2% payment reduction. The cut-off date to meet the compliance level for the quality reporting period October 1, 2018 to December 31, 2018 was May 15, 2019.
With the implementation of the Patient-Driven Payment Model (PDPM) just three months away, SNFs need to take a close look at their triple-check process to ensure it validates the more specific clinical information required by PDPM.
The state of New York is proposing a change in the way it calculates the case mix that sets Medicaid reimbursements for skilled nursing facilities — with the goal of realizing $246 million in net savings.
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.