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CMS Released FY 2023 SNF PPS Final Rule

FACT: SNF Providers leave ~8% of Medicare revenue on the table.*

HealthPRO Heritage breaks down CMS’s most recent SNF PPS Final Rule for FY 2023 & offers go-forward strategies.

On Friday, July 29th, the Centers for Medicare & Medicaid Services (CMS) released the SNF PPS Final Rule for FY 2023 (effective: October 1, 2022.) Read on for what this means to you!

SNF providers should breathe a sigh of relief. The Final Rule announcement outlines changes that are not as devastating as anticipated. In fact, there’s an upside!

CMS’s Proposed Rule in April 2022 outlined a parity adjustment to PDPM rates of 4.6% for FY 2023, but thanks to the industry’s advocacy efforts, SNFs will instead see rates increase this upcoming FY as the decision was made to phase in the parity adjustment over 2 years (2.3% in FY 2023 and again in 2024.) 

This means SNF providers will see a 2.7% increase overall in Medicare A payments starting in October. The 2.7% rate increase – equivalent to $904 million in additional Part A payments – is attributable to a 5.1% update (inclusive of a 3.9% market basket increase; 1.5% market basket forecast error adjustment; and .3% productivity adjustment (as required by law).

Also, there’s good news regarding SNF VBP. CMS will not apply the 30-day all-cause readmission measure for FY 2023. Instead, three new measures will be added for FY 2026 and 2027. 

  1. A replacement of the low volume adjustment policy: with a minimum of 25 eligible stays established for the one-year period – less than this minimum will result in no improvement score from the baseline for that particular measure;
  2. New for 2026: Adoption of the SNF healthcare-associated infections requiring hospitalization (SNF HAI) & total nursing hours per day;
  3. New for 2027: Successful discharge to the community as a post-acute care measure

For your convenience, find CMS Fact Sheets here and details related to ICD-10 coding mapping, fire safety evaluation systems, and relaxed regulations around the Director of Food and Nutrition Services are available here.

Stay Smart & Come Out On Top
*HealthPRO Heritage data demonstrates SNF providers leave ~8% of revenue on the table due to inefficient processes and workflows. In light of CMS's Final Rule, our experts offer strategies for a go-forward approach to assure success!

HealthPRO Heritage advises that SNF providers review their current therapy contract model in the wake of reimbursement changes in the Final Rule. For example, some SNF providers may wish to consider a more progressive model based on a percentage of the full PDPM rate. With this approach, HealthPRO Heritage recommends leveraging clinical reimbursement consulting services and/or artificial intelligence in order to clinically optimize overall PDPM rates.

HealthPRO Heritage strongly advises SNF providers to remain vigilant and continue to focus on well-laid strategies for readmission mitigation. Despite CMS’s decision to not apply the 30-day all-cause readmission measure for FY 2023, SNF providers must stay competitive and be well-positioned to leverage the changes outlined for 2026/2027.

CMS acknowledged the high volume of comments RE: in opposition to April's proposed rate cuts, proving that advocacy works! (It’s also encouraging to note how advocacy efforts resulted in new legislation against the Proposed Rule for Home Health (June 2022) that outlined a devastating $1.33 billion in cuts.) 

HealthPRO Heritage says, "Keep it up!” We remain committed to leading advocacy efforts and will continue to share information on how healthcare providers and industry insiders can participate in advocacy campaigns. For example, advocacy will continue to be important as SNFs await the Final Rule related to the Medicare Physician Fee Schedule proposed cuts for CY 2023 that will impact Medicare Part B payments in addition to the above Part A Final Rule. 

HealthPRO Heritage clients should continue to take advantage of our TeleMDS HotlineAnnual PDPM Audits, Intentional Training, and other strategic resources. Likewise, learn about our new TeleDNS Hotline that provides support, and training for Nursing Teams RE: readmissions, infection prevention, QAPI, etc. SNFs currently partnered with HealthPRO Heritage for therapy and/or consulting services have unlimited, free access to resources that minimize/eliminate missed reimbursement opportunities.

For current HealthPRO Heritage customers who are not currently taking advantage of the complimentary services listed above, please reach out to info@healthpro-heritage.com to get started today!

Not a current HealthPRO Heritage partner? Contact us to learn more.

What's On The Horizon? 
CMS has continued to delay releasing an updated version of the MDS, but industry watchdogs anticipate this may change in 2023. In order for CMS to be compliant with the transfer of health information measures/standardized patient assessment data elements, it will require aligning this information with data being collected by IRFs, LTACHs, and home health agencies. As such, SNFs will be required to get on board sooner rather than later in order for CMS to move toward a unified post-acute care payment system.

A new measure for SNFs to require a new influenza vaccine may be on the horizon. SNF staff historically have lower adoption rates, so CMS is requiring SNFs to start submitting data on October 1, 2022. HealthPRO Heritage advises all SNFs to review staff participation in influenza vaccines and prioritize ways in which to encourage/provide easy access. 

Let’s Stay Connected!
HealthPRO Heritage – a rehab & health innovations company – delivers an array of clinical and consulting services for all levels of the care continuum.  We are a team of passionate clinicians, strategists, and thought-leaders eager to help assure the overall success of our customers. Ask about rehab solutions, census & network development, MDS support, managed care contracting, leveraging emerging technologies, telehealth, compliance and billing assistance, data analytics, and most importantly, how to leverage data to improve overall fiscal success. Contact us today!