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: 
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! 

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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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Tags: SLP, PDPM

Under PDPM, CMS Holds the Line on the Definition of Skilled Requirements

Posted on: January 16, 2019

The more things change the more things stay the same.

CMS has been very clear that in order to receive Medicare Part A reimbursement under PDPM, the following will still hold true:  

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Tags: PDPM, Patient-Driven Payment Model

Waiting on the World to Change: Are EMRs Ready for PDPM?

Posted on: January 7, 2019

Are you concerned about whether your EMR is equipped to handle the transition?  You’re not alone!

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Tags: PDPM

The New PDPM Paradigm: Nursing in the Limelight

Posted on: December 3, 2018

The tide is turning! Imagine a world where revenue is not based on managing therapy treatment minutes, but will be aligned to care delivery. PDPM will set reimbursement based on patients’ clinical profiles, as captured within various coding and assessment scoring factors from the interdisciplinary team (IDT).

This fundamental change will rely on input from all clinical team members, however, nursing and MDS will be under exponential pressure to understand the nuances of PDPM, document and code accurately, and communicate effectively. In the “Brave New World of PDPM”, there are huge financial implications for anything less than thorough and flawless documentation and coding.

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Tags: Patient-Driven Payment Model, PDPM, Payment Reform

CMS’ Newly Released Fact Sheets for PDPM: What Do You Need to Know?

Posted on: November 21, 2018

While we here at HealthPRO® Heritage are thankful for many things this holiday season, this week we were able to add one more item to our list of “thanks”! We are always so grateful when we come upon new information to share with each of you, but even more thankful when that new information is PDPM clarification that we have anxiously been awaiting. So, while you are enjoying some well-deserved quality time with your loved ones this holiday, here is some light reading for you to digest alongside the turkey and pie!

On November 19, 2018, CMS released nine updated “Fact Sheets” to clarify additional areas and help providers strengthen their understanding of the changes to come on 10/1/19. We have reviewed these thoughtfully-crafted Fact Sheets and here is what you need to know:

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Tags: PDPM, Patient-Driven Payment Model, CMS Update 2018

Denial Uncertainty in the Wake of PDPM: What Will Risk Look Like?

Posted on: November 8, 2018

When thinking about the future of skilled nursing and therapy services one quote comes to mind: “The biggest risk a person can take is to do nothing.” (Robert T. Kiyosaki) This has never been more true.

Under RUGS-IV, therapy utilization, by and large, has been the main driver for Medicare Part A reimbursement. When the skilled stay is supported by therapy, justification for nursing services can be overlooked. Under PDPM, however, each discipline, nursing and/or therapy, must justify the level of services provided and the patient’s condition as coded within the medical record. Without proper coding, claims could be denied or reimbursement will not be aligned with treatments. 

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Tags: PDPM

Nine (Really Important) Reasons Why Therapy Still Matters in PDPM

Posted on: November 1, 2018

Imagine a world where reimbursement isn’t based on managing treatment minutes. Instead, therapists are empowered with the freedom to care for residents and drive outcomes based exclusively on clinical need. Let’s face it: Therapy services and reimbursement under PPS has not always served our industry well.

HealthPRO® Heritage experts agree: CMS’ PDPM system 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 on behalf of our clients and patients.

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Tags: PDPM, Patient-Driven Payment Model, CMS Update 2018

Which PDPM Therapy Pricing Method is Best?

Posted on: October 22, 2018

Since the RCS-1 Proposed Rule was released in Spring 2017, through the PDPM Final Rule and up to today, we’ve spent hundreds of hours thinking and pressure testing different ideas. We’ve had ongoing conversations with customers, colleagues, and consultants about PDPM therapy pricing. Our goal was simple: Develop a pricing approach which equally addresses and ensures the success of our patients, customers, and employees under PDPM. 

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Tags: PDPM, Patient-Driven Payment Model, CMS Update 2018, Payment Reform