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Richter ShareSource Blog

Lessons Learned in the Aftermath of PDPM's Implementation


 

The Patient-Driven Payment Model (PDPM) was launched on Oct. 1, 2019, so as of this writing, observers have had ample time to see how it is taking shape. Thus far, the Centers for Medicare and Medicaid Services (CMS) has determined that PDPM has not been budget-neutral compared to the last model, as it was intended to be. PDPM is part of the larger, industry-wide shift toward value-based payment systems that reward providers for delivering high-quality care for people in need. While PDPM now requires more tracking and reporting for long-term care (LTC) providers and skilled nursing facilities (SNFs), particularly in terms of ICD-10 coding, the ultimate goal is providing better patient care.

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Topics: Clinical Consulting, pdpm, clinical consulting services

Understanding How to Skill Residents Under Medicare A in a Post-PDPM World


 

Here at Richter, our Clinical Consulting team has fielded an array of questions lately from skilled nursing facility (SNF) clients regarding what to skill residents for under Medicare A, and what the criteria is.

Based on our decades of experience in the industry, we’ve found that such questions aren’t out of the ordinary in “normal circumstances.” Indeed, under previous PPS payer rules, when a Medicare resident was discharged from an acute-care hospital, the general assumption was that they were eligible for skilled services through their need of therapy services. Accordingly, during this time, much of the documentation burden also lay with the therapist.

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Topics: Clinical Consulting, pdpm, clinical consulting services

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

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