Therapy Management & Consulting Services Blog

CMS Considers Cutting the Fluff

CMS has finally, FINALLY, proposed to remove those pesky functional limitations (aka G-Codes) for all Medicare Part B and some Managed Care Part B claims (outpatient therapy services). We have been doing these since January 1, 2013 and wondering why: What was the significance? How will CMS use these codes? They aren’t even standardized. I am sure you have thought these same things.

The time has come to hopefully say goodbye.

We will wait with bated breath to see if this makes it to the final rule. If it does, we could say adieu to G-codes by January 1, 2019.

Written By: Kristy Yoskey, MOT, OTR/L, RAC-CT, Senior Vice President of Clinical Strategies
Kristy's #HigherCalling: "My purpose in life is to help organizations be better, do better, and continue to evolve."

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Functional Status vs. Functional Approach and Goals

MDS 3.0 Section G vs. GG; the future of PDPM.

Let’s take a look at the differences in these sections and examine why both will be of upmost importance for direct care staff to have a hold on definitions.

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PDPM & PDGM: Let's Break Down the Confusion...Pt 1

On Monday, July 2, 2018, Centers for Medicare and Medicaid Services (CMS) released the 2019 Proposed Rule. Our industry has been anxiously awaiting this announcement since the introduction of “Home Health Groupings Model,” or HHGM in July 2017.

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Case Mix Medicaid Excellence

Maintaining accuracy with Medicaid reimbursement within the nursing home setting is dependent on communication throughout the clinical team and verifying all MDS coding items are reviewed.
Check out our recent webinar on case mix here: 

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Data is the Future of Senior Living

In today’s healthcare climate, change and resiliency are a requirement. When we think about healthcare reform: accountable care, bundled payment, triple aim: we think post-acute care, specifically skilled nursing and home health due to the costs associated with those services for our Medicare (and even Medicare Advantage) residents. If you are a senior living: assisted living or independent living providers, you may be thinking these changes have nothing to do with you and you would be wrong.

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Tags: Senior Living Community

A Surefire Way to Increase Audits Under PDPM

The number one question we receive regarding the new payment model, the Patient-Driven Payment Model or PDPM is, “Will we be paid for the therapy component even if therapy is not actively treating the resident?” The answer is YES!

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

Senior Living: Staying the Course?

As we continue to grow in the senior living marketplace as quality care providers of outpatient therapy and home health, we continue to see assisted living providers staying the course. They are not adapting or changing based on everything going on around them. Today is a very unique time for senior living providers. They have a huge opportunity to adapt to changing hospital and skilled nursing facility (SNF) partnership needs. Many assisted living providers respond, “But we are assisted living. That doesn’t impact us.”

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Tags: Senior Living Community

Non-Therapy Ancillaries: Paving the Way for Patient Care Under PDPM

What exactly are Non-Therapy Ancillaries, otherwise known as NTA’s?

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

SNF Public Reporting is Ramping Up

More data is almost ready to go public on the quality of care you provide – have you reviewed it?

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Tags: CMS Update 2018

Targeted Probe and Educate Audits Are Here: Are you at Risk?

MAC’s, otherwise known as Medicare Administrator Contractors or fiscal intermediaries, are beginning to reach out to providers to inform them that they are being reviewed as a part of their new auditing process: Targeted Probe and Educate audits, otherwise known as TPE audits. Sounds unnerving, right? Do you know if you are at risk? We’ll tell you some of the behaviors that are landing providers into this group and what you can do to ensure you are prepared if you do receive word you are in one.

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Tags: CMS Update 2018, TPE, Audits