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Chicago, IL March 22, 2019 – HealthPRO Heritage, one of the largest independently owned therapy and consulting service providers in the country, is proud to announce that its Quality Assurance Compliance Coordinator Berenice Galvez Soto was named to the inaugural class of Rising Stars in the McKnight’s Women of Distinction program.

PDGM implementation is a mere 42 weeks away and is anticipated to be the biggest change in home health payment reform in over 20 years. HHAs will need to completely revise care management and billing processes, as well as documentation and coding practices, in order to make the transition successfully. One of the most dramatic areas of change relates to ICD-10 coding, which is a significant determinant of revenue in the new paradigm. Both timing and accuracy of ICD-10 Coding (primary diagnosis and comorbidities) will play a role in how patients are grouped and, ultimately, reimbursed. Given that this is a completely new core competency for HHAs, it is prudent to take action today to assess related risk and begin to identify the changes that will need to occur in order to minimize transition risk.

Check back here in the upcoming weeks for this blog post.  In the interim, please contact us for specific inquiries related to PDPM contracting at info@healthpro-heritage.com.

It seems everyone’s roles are changing with the onset of PDPM.  Even referring clinicians (MDs, NPs and PAs) who send their patients  to a skilled nursing facility will need to commit to a new more comprehensive, faster-paced process. 

Imagine a world where reimbursement isn’t based on the volume of therapy visits. Instead, therapists care for patients and drive outcomes based exclusively on clinical need. 

HealthPRO Heritage experts agree: PDGM will breathe new life into how, when, and why therapists deliver care. We are, in fact, excited for a new world where our success will be measured by the evidence-based therapy we provide and the outcomes we achieve.

McKnight's Long-Term Care News recently featured an article – "PDPM Has Possibilities" – with input  from HealthPRO Heritage's Hilary Forman, Chief Clinical Strategies Officer and Ian Tucker, VP of Clinical Informatics and Product Management: 

Reminder: HealthPRO Heritage customers can participate in the second webinar of our PDPM University series: 
DEEP DIVE INTO NTA AND NURSING COMPONENTS • 1pm EST 
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! 

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).

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.

 With ~8 months to go, ask yourself: Are you on track for the transition to PDPM? Do you have the right therapy partner? This PDPM "To-Do" Checklist offers direction:

TODAY: PDPM “To-Do” Checklist