Welcome to the HealthPRO® Heritage Blog

Introducing HealthPRO® Heritage's new weekly blog series: "QUESTIONS WORTH ASKING"

Posted on: July 31, 2018

You work hard: To stay on top of your game in an industry wrought with complexity, change and challenges.

You ask: What questions should you be asking your team? What questions should you be asking yourself? What are the key success drivers for 2018 and beyond?

You wonder: Can a blog offer you valuable intel related to the future of your community? Yes! Check in every week for ideas to jump-start strategic thinking in areas that drive success now and into the future:

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

PDPM & PDGM: Let's Break Down the Confusion...Pt 2

Posted on: July 25, 2018

If the 2019 proposed rule is finalized, which we anticipate is likely, it will cement the shift in Medicare’s payment system from a prospective payment system to value based purchasing model.  With these mega changes it can feel like a daunting task to provide clinical excellence while maintaining a profit, thus it will be paramount that detailed analysis and strategies be developed to ensure that we keep patient care as our number one priority.

Following a thorough review of the 599-page “Proposed Rule”, HealthPRO® Heritage experts offer the following highlights on the PDGM section of the rule:

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Tags: PDGM, CMS Update 2019, Patient-Driven Grouping Model

CMS Considers Cutting the Fluff

Posted on: July 20, 2018

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

Posted on: July 17, 2018

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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Tags: MDS 3.0, Section GG, Patient-Driven Payment Model, PDPM, MDS Coding

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

Posted on: July 12, 2018

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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Tags: Patient-Driven Payment Model, PDPM, PDGM, CMS Update 2019, Patient-Driven Grouping Model

Case Mix Medicaid Excellence

Posted on: July 10, 2018

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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Tags: Long Term Care Facilities, MDS Coding, CMI, Case Mix Index

Data is the Future of Senior Living

Posted on: July 6, 2018

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, Senior Living Community, Independent Living, AL/IL, Assisted Living

A Surefire Way to Increase Audits Under PDPM

Posted on: July 3, 2018

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