Richter ShareSource Blog

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.

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.

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?”

Revenue cycle management (RCM) is so much more than just a financial process. It is about the procedures that enable your long-term post-acute care (LTPAC) organization to maintain a positive financial picture and, in turn, allow you to focus on day-to-day operations and optimal outcomes. It sounds cliché, but that is why communication is key throughout the RCM process. Poor communication at any point can cause a complete breakdown.

With a new year underway, it’s important for accounting and finance professionals in all long-term post-acute care (LTPAC) settings to be aware of reporting updates that may have slipped your mind while getting through year end. In 2016, The Financial Accounting Standards Board (FASB) issued a previously proposed update (ASU 2016-14) that will affect nonprofit entities. The time has now come to get familiar with the details of this update, as it is effective for fiscal years beginning after December 2017.

If your long-term post-acute care (LTPAC) organization’s strategic approach to revenue cycle management doesn’t marry business performance with customer service and outcomes, you could be headed for divorce court.