Welcome to the HealthPRO® Heritage Blog

2019 Year in Review

Posted on: December 6, 2019

What's been on your mind? 
More than 90,000 visitors have clicked through HealthPRO® Heritage resources to access updates & advice from our subject-matter experts. 

Don't miss out on today's most relevant topics! Click on the blog titles below: 

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

Finger on the Pulse: Initial Reactions to PDPM & Updates from the Front Line

Posted on: October 15, 2019

Gut-Check Survey Results + Feedback from the PDPM Front Line
HealthPRO® Heritage launched a survey – “PDPM Gut-Check” – to capture how the industry is feeling about the new reimbursement system.  Here’s what you and your peers had to say.

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

An Industry Gut-Check: What's Your PDPM Confidence Level?

Posted on: October 1, 2019

Now is the time for our industry to over-communicate!  Put your two cents in, and learn more about what your peers are thinking, feeling, and what’s keeping them up at night, too. 

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Tags: snf, Skilled Therapy, Patient-Driven Payment Model, PDPM, CMS Update 2019

LUPA Management: Avoiding the 4 Letter Word

Posted on: September 27, 2019

LUPA (Low Utilization Payment Adjustment), the 4 letter word that we have all been trying to avoid under the current PPS system.  Just when we thought we had it under control, CMS has decided to add a whole other level of complexity with PDGM.  The challenge to managing LUPA’s under PDGM will be two-fold; a “moving LUPA” for each 30-day payment, and the need to meticulously manage visits within each of those 30-day windows to avoid that LUPA. 

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

Considering In-House Therapy? The Good, the Bad, and the Ugly

Posted on: August 15, 2019

As one of the first therapy companies to specialize in management services for in-house therapy programs, HealthPRO® Heritage was founded 20+ years ago and has since evolved into one of the most prominent, privately-owned therapy AND consulting firms in the country. This article offers SNF providers the benefit of our years’ experience and insight into how PDPM will certainly pressure-test delivery of rehab services – especially for in-house therapy programs.

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Tags: Skilled Therapy, Patient-Driven Payment Model, PDPM, CMS Update 2019

The Only Constant is Change...and Documentation

Posted on: August 7, 2019

The Home Health industry continues to evolve: the updated Conditions of Participation (CoPs) in 2018, then OASIS-D and the Review Choice Demonstration (RCD) in 2019, and now the Patient-Driven Groupings Model scheduled for 2020, just to name a few!  Change can be exhausting, so it is comforting to know that some things aren’t changing...like documentation!

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Tags: Home Health, PDGM, CMS Update 2019

CMS' Final Rule is Here!

Posted on: July 31, 2019

Tuesday was the day! On July 30, CMS released the FY 2020 Final Rule for Medicare payment rates and quality programs. This is the moment we have all been waiting for. PDPM is 9 short weeks away, and the industry finally has clarifications RE: the new payment model.

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Tags: The Final Rule, Patient-Driven Payment Model, PDPM, CMS Update 2019

The Bright Future of Rehab Includes Student Clinical Affiliations!

Posted on: July 11, 2019

Among the many important decisions related to the PDPM transition is the question of whether SNFs and their rehab partners should accept students for clinical affiliations.  As strategy consultants and leaders in therapy, HealthPRO® Heritage offers this guidance: 

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Tags: PDPM, CMS Update 2019

PDGM and Questionable Encounters

Posted on: July 9, 2019

As PDGM edges closer, there is rising concern and tension around the submission of claims that contain primary diagnoses that do not fall into one of the 12 clinical groupings established by CMS. Such primary diagnoses are known as "Questionable Encounters" (QEs). QE codes are "too vague," meaning the code did not provide adequate information to support the need for home health services. CMS listed 43,287 eligible primary diagnoses codes in their PDGM Grouper Tool. 

Under PDGM, claims for QEs will be sent back to the agency as "Return to Provider" (RTP) since CMS will not be able to assign the 30-day period to one of the 12 PDGM clinical groups. 

Examples of the Top 25 QE Codes:

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Tags: PDGM, CMS Update 2019

(Re)Consider the Optimal Therapy Model for PDPM & Beyond!

Posted on: July 1, 2019

Decisions. Decisions. Since the industry began wrapping their heads around RCS-1 two+ years ago, SNFs continue to weigh the pros and cons of retaining in-house therapy vs. an outsourced model. Questions arise: What does payment reform mean for SNFs with their own program? Is there a financial or operational advantage to transitioning from full service to in-house or a “managed” in-house model?

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Tags: PDPM, CMS Update 2019, Therapy Model