Welcome to the HealthPRO® Heritage Blog

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.

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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:

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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.

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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.

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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. 

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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.

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Nine (Really Important) Reasons Why Therapy Still Matters in PDPM

Posted on: November 1, 2018

Imagine a world where reimbursement isn’t based on managing treatment minutes. Instead, therapists are empowered with the freedom to care for residents and drive outcomes based exclusively on clinical need. Let’s face it: Therapy services and reimbursement under PPS has not always served our industry well.

HealthPRO® Heritage experts agree: CMS’ PDPM system will breathe new life into how, when, and why therapists deliver care. We are, in fact, excited for a new world where our success will be measured by the evidence-based therapy we provide and the outcomes we achieve on behalf of our clients and patients.

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

Which PDPM Therapy Pricing Method is Best?

Posted on: October 22, 2018

Since the RCS-1 Proposed Rule was released in Spring 2017, through the PDPM Final Rule and up to today, we’ve spent hundreds of hours thinking and pressure testing different ideas. We’ve had ongoing conversations with customers, colleagues, and consultants about PDPM therapy pricing. Our goal was simple: Develop a pricing approach which equally addresses and ensures the success of our patients, customers, and employees under PDPM. 

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

Do You Know How Much Rehab Your Facility Can Afford Under PDPM?

Posted on: October 11, 2018

Step one to ensuring your facility delivers positive patient outcomes, maintains regulatory compliance, and achieves financial viability in the New PDPM World is to perform a RUGs-to-PDPM Crosswalk on all your patients.

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

Home Health Providers: Leverage QAPI Plan to Prep for PDGM?

Posted on: October 1, 2018

In the recently updated Conditions of Participation, CMS spells out what they expect from a QAPI program. Additionally, the final draft of the interpretive guidelines (IG) for the Home Health Agency Conditions of Participation (CoP) was released last month.

How can agencies use this already mandatory requirement to help prepare them for the expected changes coming in 2020 with the proposed Patient Driven Groupings Model (PDGM)?

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Tags: PDGM, QAPI Plan, Home Health