Welcome to the HealthPRO® Heritage Blog

SNF Leaders: Here's Your PDPM "To-Do" Checklist

Posted on: January 31, 2019

 With ~8 months to go, ask yourself: Are you on track for the transition to PDPM? Do you have the right therapy partner? This PDPM "To-Do" Checklist offers direction:

TODAY: PDPM “To-Do” Checklist

Read More

Under PDPM, CMS Holds the Line on the Definition of Skilled Requirements

Posted on: January 16, 2019

The more things change the more things stay the same.

CMS has been very clear that in order to receive Medicare Part A reimbursement under PDPM, the following will still hold true:  

Read More

Tags: PDPM, Patient-Driven Payment Model

Waiting on the World to Change: Are EMRs Ready for PDPM?

Posted on: January 7, 2019

Are you concerned about whether your EMR is equipped to handle the transition?  You’re not alone!

Read More

Tags: PDPM

G vs GG: Yes, One Letter Makes All the Difference!

Posted on: January 2, 2019

MDS coding experts must remain vigilant! Beware coding pitfalls when it comes to Section G versus Section GG.

Read More

Tags: Section GG

The New PDPM Paradigm: Nursing in the Limelight

Posted on: December 3, 2018

The tide is turning! Imagine a world where revenue is not based on managing therapy treatment minutes, but will be aligned to care delivery. PDPM will set reimbursement based on patients’ clinical profiles, as captured within various coding and assessment scoring factors from the interdisciplinary team (IDT).

This fundamental change will rely on input from all clinical team members, however, nursing and MDS will be under exponential pressure to understand the nuances of PDPM, document and code accurately, and communicate effectively. In the “Brave New World of PDPM”, there are huge financial implications for anything less than thorough and flawless documentation and coding.

Read More

Tags: Patient-Driven Payment Model, PDPM, Payment Reform

CMS’ Newly Released Fact Sheets for PDPM: What Do You Need to Know?

Posted on: November 21, 2018

While we here at HealthPRO® Heritage are thankful for many things this holiday season, this week we were able to add one more item to our list of “thanks”! We are always so grateful when we come upon new information to share with each of you, but even more thankful when that new information is PDPM clarification that we have anxiously been awaiting. So, while you are enjoying some well-deserved quality time with your loved ones this holiday, here is some light reading for you to digest alongside the turkey and pie!

On November 19, 2018, CMS released nine updated “Fact Sheets” to clarify additional areas and help providers strengthen their understanding of the changes to come on 10/1/19. We have reviewed these thoughtfully-crafted Fact Sheets and here is what you need to know:

Read More

Tags: PDPM, Patient-Driven Payment Model, CMS Update 2018

Importance of ICD-10 Coding: Today and Tomorrow

Posted on: November 16, 2018

Globally, the ICD-10 Classification System improves documentation of the increasing complexity of healthcare, specifically demonstrating the clinical presentation of each patient.

Read More

Tags: ICD 10

HealthPRO® Heritage Continues Expansion with Acquisition in Michigan

Posted on: November 14, 2018

November 14, 2018. HealthPRO® Heritage (“HealthPRO®”) completed the acquisition of the long-term care division of Agility Health (“Agility Health”) from Alliance Physical Therapy Management (“Alliance”), on August 31, 2018.

Read More

Denial Uncertainty in the Wake of PDPM: What Will Risk Look Like?

Posted on: November 8, 2018

When thinking about the future of skilled nursing and therapy services one quote comes to mind: “The biggest risk a person can take is to do nothing.” (Robert T. Kiyosaki) This has never been more true.

Under RUGS-IV, therapy utilization, by and large, has been the main driver for Medicare Part A reimbursement. When the skilled stay is supported by therapy, justification for nursing services can be overlooked. Under PDPM, however, each discipline, nursing and/or therapy, must justify the level of services provided and the patient’s condition as coded within the medical record. Without proper coding, claims could be denied or reimbursement will not be aligned with treatments. 

Read More

Tags: PDPM

Home Health PDGM Finale Rule Released

Posted on: November 2, 2018

CMS released the much anticipated Home Health Final Rule October 31. Much of the content from the Proposed Rule and the Final Rule will remain the same, with significant changes highlighted below.

Read More