Welcome to the HealthPRO® Heritage Blog

The NTA Tightrope of Risk and Reward

Posted on: February 21, 2019

Reminder: HealthPRO® Heritage customers can participate in the second webinar of our PDPM University series: 
Contact education@healthpro-heritage.com for more information.

Under PDPM, CMS has broken the singular nursing component of RUG-IV into two separate components – Nursing and Non-Therapy Ancillary (NTA) – to adeptly account for the wide-ranging variations within the skilled population. This change represents a very different and much-needed approach to efficiently managing patients with higher complexity and/or multiple conditions. It also opens many doors of opportunity for providers and patients alike. For example, providers will now be able to identify specific groups of conditions – and subsequently build specialized care programs recognized by referring hospitals as best practice. 

So this all makes sense, and there’s nothing to worry about.  Right?  Not so fast! 

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Tags: PDPM

Get Some Clarity: Measuring Cognitive Baselines Under PDPM

Posted on: February 15, 2019

In today’s world of Medicare, the use of cognitive testing – specifically the Brief Instrument for Mental Status, or BIMs – is completed in order to satisfy Section C: Cognitive Patterns on the Minimum Data Set (MDS) to effectively guide care planning for residents with confusion or a cognitive impairment. 

Under PDPM, cognitive testing will become more important.  Knowing whether a resident has a mild-to-severe cognitive impairment will truly impact:

  • Care planning and the interdisciplinary team’s approach, and
  • SNF revenue – by increasing the Case Mix Index related to the SLP component under PDPM  (because a cognitive impairment requires more resources, it will therefore will pay more in the new system).

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Tags: PDPM

What Your SLP Brings to the Dinner Table: Supporting Coding & Mechanically Altered Diets with Clear Clinical Rationale

Posted on: February 5, 2019

Please read on for our latest input on coding support. Register to watch any of our pre-recorded PDPM webinars here. 

As we look to the future of skilled therapy under PDPM, it is important to remain focused on documentation that not only supports the provision of skilled therapy but the provision of skilled nursing services and accurate coding on the MDS. Case in point: during a recent review of documentation, a reviewer denied speech therapy services because of clear discrepancies between the speech pathologist’s documentation and nursing documentation. The reviewer argued that while the Speech Therapy Evaluation reported swallowing problems as evidenced by results from the MASA (Mann Assessment of Swallowing Ability), the 30-day MDS had not identified a swallowing disorder and according to the physician’s History and Physical, “the beneficiary had no problems with swallowing.” The reviewer’s conclusion? That skilled speech therapy was not medically necessary.

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