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?”
Wouldn’t you hate to work hard all day, every day, only to have your employer tell you that you messed up and the paycheck you just received had to be turned back over to them? That is exactly what could happen to many long-term post-acute care (LTPAC) facilities in the case of an audit due to the status of the certification/recertification for skilled services.
Topics: Clinical Consulting
In April 2018, the Centers for Medicare and Medicaid Services (CMS) threw yet another curveball at (MDS) coordinators and skilled nursing facilities (SNFs) across the country. CMS’ original plan to introduce RCS-1 (resident classification system, the proposed new federal payment system) was overturned and replaced by the now proposed patient driven payment model (PDPM). This new payment model does have similarities to the previous RCS-1, but there were improvements made to increase payment accuracy.
Long-term care rules and regulations have been changing at a fast and furious pace over the past few years. Often, changes can happen so quickly that it can be nearly impossible to train staff and update processes in time to stay current. We have seen this burden play out across all senior living facilities (SNFs), from independent homes to small and large chains alike.
Richter Healthcare Consultants, a leading provider of clinical, accounting, implementation and revenue cycle consulting services for long-term post-acute care (LTPAC) organizations, is pleased to announce that Jennifer Leatherbarrow, RN, BSN, RAC-CT, QCP, CIC, has been selected by the American Health Care Association to serve as a 2018 Senior Examiner for the AHCA/NCAL National Quality Award Program.
WHAT are we seeing in ADRs right now?
The long-term post-acute care (LTPAC) industry as a whole is seeing an increase of ADRs as of late. These ADRs are not only coming from Medicare, but insurance companies as well. Both entities are being increasingly aggressive in their attempts for recoupment. If a facility is not responding to ADR requests and/or not sending in appropriate documents to support the claims, they are being denied. If the auditors see a trend of this happening in a facility, they are in return sending even more. This can very quickly become overwhelming at the facility level. The best way to avoid this vicious circle is to respond to the ADR in a timely and complete manner the first time around. This keeps your LTPAC facility off the proverbial ADR radar.
Topics: Clinical Consulting