Welcome to the HealthPRO Heritage Blog

We can all agree: the value of a solid, efficient Restorative Nursing Program for SNFs should not be underestimated!

There’s a lot of BUZZ in the industry about increasing restorative programming in preparation for PDPM. Many SNFs have Restorative Nursing programs. Many do not. Some have a program, but it doesn’t function the way it should.

Here’s the stone cold truth…
Restorative Nursing may (or may not) make sense for your organization. Hear us out. 

Coding will be instrumental to your agency’s success under PDGM. Performing an audit of your coding practices now will provide the opportunity to educate your staff on accurate and cohesive coding guidelines and targeted aspects of the OASIS to ensure you are prioritizing both patient needs and accurate reimbursement. 

Success under PDPM – and beyond! – in large part, boils down to this: A SNF’s ability to build positive, sustainable outcomes. As such, HealthPRO Heritage advises providers to focus on the strategies, processes, and initiatives that will support consistent delivery on exceptional clinical and performance outcomes.  

Accurate OASIS coding has always been important, but with PDGM on the horizon, our ability to master the OASIS will be imperative! After all, accurate OASIS coding will directly impact an agency’s ability to achieve optimal outcomes and support reimbursement in today’s and tomorrow’s world.

Today, CMS published the FY 2020 Skilled Nursing Facility Proposed Payment System (SNF PPS) in the federal register. It contains the SNF PPS payment update is 2.5% for FY 2020, which is an increase in payments of $887 million, compared to FY 2019.  This estimated increase is attributable to a 3.0 percent market basket increase factor with a 0.5 percentage point reduction for multi-factor productivity adjustment.

Implementation of the new case-mix classification model, the Patient Driven Grouping Model (PDGM), on January 1, 2020 will bring BIG changes to the home health profession! HealthPRO Heritage at Home is ready to help you start preparing TODAY for the most dramatic Medicare reimbursement change since PPS.

Late Friday afternoon, April 19, CMS released the FY 2020 SNF PPS Proposed Rule, specifying a few changes for the Patient-Driven Payment Model (PDPM). HealthPRO Heritage is looking forward to reporting out on all the modifications, but can’t wait to share the following good news…

As of April, CMS has implemented important modifications for the Quality Reporting Program (QRP) and Quality Measures (QMs) that may have significant fiscal, clinical, and compliance implications as well. Not only will these changes enable CMS to better monitor SNF outcomes, the modifications raise the bar on performance measures and will challenge SNFs to drive care differently. 

What should SNFs know?  HealthPRO Heritage offers guidance. 

PDGM implementation is a mere 38 weeks away, bringing significant changes in episode length (60 to 30 days), resultant billing processes, revenue cycle, and ultimately, cash flow. While certification periods will continue to be 60 days in duration, reimbursement will be broken into 30-day payment periods. As such, billing will have to be processed for each 30-day payment period including Requests for Anticipated Payment (RAPs) and final claims. This will likely result in a substantial increase in claims volume in addition to an interruption in cash flow. Specifically, agencies will experience a cash flow “crunch” during the first few months of implementation as the conversion from 60-day to 30-day payments is realized with a leveling off after the initial impact and conversion.

Think about a task you routinely complete:  yardwork, cooking a meal, or a project at work.  Now imagine asking a friend or co-worker to pick up a rake or join you in the kitchen.  Your results:  being able to complete the same tasks with improved efficiency and even better outcomes.    

Apply this thought-process to providing world-class rehab services for the patients in your care.  Research supports:  There’s strength in numbers!

The post-acute world is looking forward to new rules. Learn more about best practices and potential pitfalls RE: Group Therapy Under PDPM.