If you are all over your PEPPER (Program for Evaluating Payment Patterns Electronic Report), you probably noticed the most recent release for Q4 2017 shows a new risk for improper payment – the 20-day episodes of care.
Length of stay has become a hot topic with bundled payments and accountable care organizations. Now, episodes at 20 days are being looked at to consider potentially skilling residents beyond their true skilled need, meaning using the full first 20 days of Medicare coverage since it is covered 100%. Day 21 drops to only 80% Medicare coverage.
This can be tricky; some residents require more than 20 days, but they opt to return home because they do NOT want to pay that co-pay. CMS is tracking this because they do NOT want providers to skill when there is not a skilled level of care need in order to optimize the full Medicare reimbursement.
You will need to track this and be vigilant that your documentation supports the continued need for skilled services through day 20.
If you haven’t looked at your most recent PEPPERs, make sure you do! Reach out with any questions. We're here to help!