Therapy Management & Consulting Services Blog

Make The Choice To Prepare

Our ongoing efforts to prepare for payment reform has led HealthPRO/Heritage to develop the industry’s most informative RUGS to RCS-1 reimbursement crosswalk, allowing providers to see both patient and enterprise level reimbursement impacts and identify specific areas of risk and opportunity. This will help establish strategic processes for operational changes that minimize risks and help providers successfully navigate this fundamental payment shift.

We encourage providers to:

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Tags: CMS, RCS-1, CMS Update 2018, Payment Reform

Therapy Cap REPEALED!

GREAT NEWS! The cap on therapy services for Medicare beneficiaries has been repealed. We thank everyone who petitioned their respective legislators to help achieve this important legislative victory.

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Tags: CMS, Therapy Cap, CMS Update 2018

January Advisor Newsletter

Attention: CMS has released updated quality measure star ratings for all LTC providers. The Nursing Home Compare site was updated January 24, 2018.

RCS-1: Get Ready, While We Watch & Wait

HealthPRO®/Heritage continues to lead the industry in preparation for RCS-1 as we prepare for a likely reimbursement system overhaul.

Based on the fact that CMS received a high volume of comments from industry stakeholders during the extended public comment period through August 2017, we expect there will be some changes to the Advance Notice Proposed Rulemaking (ANPRM) regarding the complete overhaul of PPS. We do know that payment reform is coming, and we must be prepared for a big change in our industry. We will stay close to the proposed changes to be released in April 2018. 

HealthPRO®/Heritage strategy is to watch, to wait and to BE PREPARED! The providers who come out on top will be the ones most well prepared to weather the transition, should the system change occur as scheduled on October 1, 2018.

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Tags: CMS, HealthPRO/Heritage, senior living, Home Health, RCS-1, Nursing Home Compare Website, Bundled Payments, BCPI, Bundled Payment for Care Improvement Advanced

December Advisor Newsletter

What’s New with CMS?
Four Big CMS Changes and “Bottom-Line” Solutions from HealthPRO®/Heritage 

CHANGE #1: Comprehensive Care for Joint Replacement Model Policy Changes and Cancellation of Episode Payment Models and Cardiac Rehabilitation Incentive Payment Model

Details related to this change include:

  • Thirty-three of the 67 MSAs in CJR have an option to voluntarily participate in CJR for years 3, 4 and 5. These rural-area hospitals with low volume will be given a one-time opportunity to continue their participation.
  • From January 1 through January 31, 2018, CMS will hold a one-time participation election period for hospitals with a CCN primary address located in the voluntary-participation-MSAs, and for specified low-volume hospitals and rural hospitals in the mandatory participation MSAs. CMS must receive the hospital’s voluntary participation election letter no later than January 31, 2018 in order for a hospital to voluntarily continue to participate in the CJR Model.
  • For reference, the CJR webpage lists:
    • all CJR participating hospitals and respective MSAs
    • mandatory or voluntary MSA status
    • whether the hospital is rural or low volume
  • In the future, CMS anticipates:
    • more opportunities for providers to participate in voluntary initiatives
    • possible changes to current CJR pricing methodology

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November Advisor Newsletter

IMPORTANT REMINDER: November 16 is the deadline for submitting staffing data for the period of July 1 to September 30. Providers that miss this deadline are subject to suppression of your “Overall Staffing Rating” and “Registered Nurse Staffing Rating” for the December 2017 Nursing Home Compare update.

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Tags: skilled nursing facility, CMS, Long Term Care, Advisor Newsletter, Advisor, Home Health, QAPI Plan

Important Payroll Based Journal (PBJ) Update

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Tags: CMS, Long Term Care, CMS Update 2017, Advisor Newsletter, Advisor, Payroll Based Journal, Update, Long Term Care Facilities, CMS-671 Form, Five Star Quality Rating System, Payroll Based Public Use File, 5 Star Quality Rating System, Nursing Home Compare Website

Advisor Newsletter - September 2017

RCS-1 Reimbursement Crosswalk ModelLooking for Guidance on Jimmo v. Sebeilus?Countdown to Major Home Health Changes

RCS-1 Reimbursement Crosswalk Model
HealthPRO®/Heritage has developed a proprietary, sophisticated RCS-1 Reimbursement Crosswalk Model that will help us work strategically with partners to assess aggregate reimbursement risk and understand the interplay between nursing and therapy reimbursement components. The model is dynamic, allowing behavior changes to be modeled so providers can see the impact of specific elements that significantly drive reimbursement under RCS-1 (e.g.: such as diagnostic coding, cognitive assessment, and ADL scoring).

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Tags: Jimmo V Sebelius, PAC provider, HealthPRO/Heritage, Advisor Newsletter, Advisor, Home Health, RCS-1, Jimmo v. Sebeilus, CMS policy, Crosswalk Model, CMS Calculator, Skilled Therapy

August 2017 Advisor Newsletter

CMS Update: Bundled Payments Cancelled?Quality Measures Revealed: Where Do "QMs" Come From? RCS-1 Myth Busters!  Are You Up On Your BR?

CMS Update: CMS Proposes Cancellation of Bundled Payments

Recent news that CMS may be planning to walk back plans for bundled payment models for cardiac and orthopedic care came on August 17, 2017, amidst mixed responses from the healthcare community.

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Special Edition Advisor - August 2017

CMS has released two separate communications related to the Pre-Rule 2019, or ANPRM.

ONE: A “financial analysis” demonstrating the impact of RCS-1 as compared to the RUGs-IV system
While the intention of this recently released file was to support CMS claims for a “budget neutral” impact, significant differences (both positive & negative) can be appreciated. (Note: Analyses are available for those included on or before 2014 Medicare Program and assumes no behavior change on the part of providers.)

HealthPRO®/Heritage is strongly encouraging clients to review this CMS “financial analysis” with your RVP or the Clinical Strategies Division as soon as possible! It is critical to assess the potential impact that RCS-1 may have on your community’s bottom line, and – if necessary – begin thinking about and implementing strategic processes to ensure your future success (should RCS-1 be implemented next year).

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Tags: HealthPRO/Heritage, Advisor Newsletter, Advisor

July 2017 Advisor Newsletter

Introduction to RCS-1 • SNFs & HHAs Scorecards: Let’s Get on the Same Page 
SNFs & HHAs: What About the PEPPER?
 • Letters of Non-Compliance with SNF QRP: Threatening Up to 2% FY 2018 Annual Payment Update (APU)

NOTICE: CMS announced on June 25th that Quality Reporting Program (QRP) data for Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs), and Skilled Nursing Facilities (SNFs) is due August 15, 2017 for the first quarter of 2017.

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Tags: skilled nursing facility, snf, HealthPRO/Heritage, Advisor Newsletter, SNF Operators, Advisor, Home Health, RCS-1, QRP non-compliance letters