In 1775, the chant of the day was “The Redcoats are coming! The Redcoats are coming!” Fast-forward to 2019 and in the realm of skilled nursing providers, the popular refrain is “PDPM is coming! PDPM is coming!”
The new Medicare fee-for-service reimbursement model known as Patient Driven Payment Model (PDPM) will drastically change how reimbursement will be determined. In the past, the Resource Utilization Groups (RUG-IV) have determined reimbursement, in which the amount of therapy a resident received played a significant part in the amount of reimbursement the facility received for that resident. Reimbursement will transition away from the volume-based payments of RUG-IV toward the new PDPM model. With PDPM, ICD-10 codes will be a crucial driver for reimbursement.
Trepidation, fear and confusion have all been experienced by minimum data set (MDS) coordinators and staff alike at various long-term post-acute care (LTPAC) facilities regarding selecting and/or having to code diagnosis for residents—especially upon admission. Some common questions include: “What do I choose?” “How do I know if it is the correct primary or admitting diagnosis?” “I’m not a coder—how do I know what diagnosis to choose?”
Note: This is the first blog in our multi-part blog series on the CMS Requirements of Participation.
Did you know that one in three long-term post-acute care (LTPAC) residents is harmed by an adverse event within 35 days of their stay? Indeed, it is true, and the statistics from the Office of Inspector General don’t stop there:
- 59% of events are preventable
- 37% of such events medication related (medication induced change in mental status, excessive bleeding)
- 37% are resident related (fall, electrolyte imbalance, pressure injury)
- 26% are infection related
- 50% of those residents affected returned to the hospital
Note: This is the third blog in our multi-part blog series on the CMS Requirements of Participation.
Nov. 28, 2019 is quickly approaching, and with that will come Phase 3 of the Centers for Medicare and Medicaid Services’ (CMS’) Requirements of Participation. As part of this, a fully integrated QAPI program will be required on this date. This should come as no surprise since some of the QAPI components should have already been implemented by your long-term post-acute care (LTPAC) facility, as stated below. This requirement is not going away and should be implemented soon rather than later.
Note: This is the second blog in our multi-part blog series on the CMS Requirements of Participation.
Individual trauma is an experience (or series of circumstances, events or occurrences) that an individual considers emotionally, physically or socially threatening or harmful and that has a long-term negative impact on the individual’s emotional, physical and/or social well-being. An event becomes traumatic when the ability to cope is overwhelmed.
Note: This is the fourth blog in our multi-part blog series on the CMS Requirements of Participation.
The Compliance and Ethics section of the Centers for Medicare and Medicaid Services’ (CMS’) Requirements of Participation is a new section developed in response to a mandate under the Affordable Care Act that requires the operating organizations of skilled nursing facilities to have a compliance and ethics program that is effective in preventing and detecting criminal, civil and administrative violations and in promoting quality of care consistent with current regulations.
Topics: QAPI Consulting
The life cycle of the business office in long-term post-acute care (LTPAC) settings is a science if you get it right—and a science experiment gone horribly awry if you don’t.
Process is the key word to success when it comes to managing your accounts receivable; but the wheel going round and round has to make sense and includes many moving parts outside of your control—hence the reason it is so important to have a work flow!