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Richter ShareSource Blog

Understanding PDPM from a Therapist's Perspective

Posted by Nick Hicks PTA, RAC-CT, Vice President of Operations on Oct 10, 2019 5:02:53 PM

Extra…extra…read all about it: Therapists are being laid off across the nation!

Despite the alarming nature of this fictitious headline, the truth is, not all therapy companies have elected to cut staff in light of PDPM.

Yes, it is true—incentives for reimbursement have realigned under PDPM. The new payment model no longer gears reimbursement toward optimizing therapy minutes. But keep in mind: The therapy profession has never been about providing optimal minutes; rather, it has been about providing optimal outcomes. Trinity Rehab has been set up for success under PDPM since its creation in 2013, focusing on its employees, partners and the patients we are privileged to serve every day. Therapy companies now must allow that unproductive time for communication and collaboration will ultimately lead to more success for the provider and themselves.

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Topics: Clinical Consulting, pdpm

What Your LTPAC Should Do About Medicare Advantage Plans Under PDPM

Posted by Jennifer Leatherbarrow, RN, BSN, RAC-CT, IPCO, QCP, CIC on Oct 4, 2019 9:04:50 AM

In the months leading up to October 1, 2019, providers across the long-term post-acute care (LTPAC) spectrum have been very busy preparing for PDPM for Medicare A residents. We at Richter have as well, as we’ve been training, updating software, adjusting processes and planning our strategy for the biggest change in reimbursement in over 20 years. The good news: It’s finally here! The bad news: There is no real direction on what to do about Medicare Advantage plans.

As we all know, no matter how hard we try, payer information can be wrong. If you think that a resident is on a Medicare Advantage Plan upon admission and a month down the road, you find out they are classified under Traditional Medicare A, you will be in a world of hurt if you did not complete the Medicare A assessments. This is why we recommend that you complete the PDPM 5-day assessment on all Medicare and Medicare Advantage skilled residents. Although this will be a PDPM 5-day assessment, you will still be able to see the RUG-IV at the top of each assessment if needed by the Medicare Advantage Plan. If you are not using PointClickCare®, call your software vendor to see if you have this option available.

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Topics: Financial Consulting, pdpm

RAI Updates for October 1, 2019 Finally Released: Things You Need to Know

Posted by Jennifer Leatherbarrow, RN, BSN, RAC-CT, IPCO, QCP, CIC on Sep 20, 2019 3:47:09 PM

The final RAI Manual for October 1, 2019 was released on September 18. The good news is that there are no surprises! I have to say I was really happy with the examples that have been added throughout the various sections. This was definitely a much needed update. I have highlighted below the items I found to be the most noteworthy.

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RICHTER APPOINTS KENNETH VOLL, RHIT, AS DIRECTOR OF REVENUE CYCLE MANAGEMENT

Posted by Richter on Aug 6, 2019 1:36:18 PM

Richter is pleased to announce the appointment of Kenneth Voll, RHIT, as Director of Revenue Cycle Management.

In this position, Ken is responsible for overseeing Richter’s global revenue cycle management process and evaluating its impact on clients and staff through process improvement, relationship management and revenue cycle metrics. Richter’s customized revenue cycle management solutions are designed to help clients maintain a positive financial position by managing the entire accounts receivable process, from intake through collection of revenue.

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Topics: Press Releases

How the New Medicare-Medicaid Crossover Change Will Affect Your LTPAC’s Financial Statements

Posted by Liz Lane, CPA, Manager of Accounting Services on Jul 12, 2019 2:22:27 PM

This past April, the Centers for Medicaid and Medicare Services (CMS) issued guidance on how crossover bad debts are to be recorded within the income statement. Typically, these amounts are written off to a contractual allowance revenue account. With this new guidance, these unpaid amounts for Medicare-Medicaid crossover claims must correctly be classified to a bad debt expense account.

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Topics: Medicaid Consulting

6 Steps to Reduce Harm in Nursing Homes


In December 2018, the Centers for Medicare & Medicaid Services (CMS) and the Medicare Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) released the All Cause Harm Prevention in Nursing Homes Change Package, which was developed as a means to help prevent harm (i.e., adverse events, abuse, and neglect) for nursing home residents. The intended audience of this piece includes nursing homes participating in the National Nursing Home Quality Care Collaborative and anyone interested in improving the quality of life and quality of care for those living in nursing homes.

The following includes answers to some frequently asked questions about the Change Package.

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Topics: Clinical Consulting, Financial Consulting

Understanding How Functional Score Works Under PDPM

Posted by Jacklyn Brown, RN on May 21, 2019 4:34:42 PM

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!” 

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Topics: Clinical Consulting, Financial Consulting

Understanding Diagnosis Coding Under the New Payment Driven Patient Care (PDPM) Model

Posted by Jacklyn Brown, RN on Apr 5, 2019 12:11:52 PM

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. 

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Topics: Clinical Consulting, Financial Consulting