Jul 01, 2019
AMBR Journal

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.

Jul 01, 2019
AMBR Journal

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.

Jun 27, 2019
Billing Alert for Long-Term Care

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.


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Tuesday, October 15, 2019 - 07:00

2019 Revenue Integrity Symposium

The 2019 Revenue Integrity Symposium covers topics essential to revenue integrity, Medicare compliance, and the revenue cycle in acute care and long-term care settings.

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Karen A. Thomas
Victorine Courtois