Welcome to the HealthPRO Heritage Blog

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.

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:  

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

Step one to ensuring your facility delivers positive patient outcomes, maintains regulatory compliance, and achieves financial viability in the New PDPM World is to perform a RUGs-to-PDPM Crosswalk on all your patients.

How Will the Recent Home Health Proposed Rule Affect the PAC Industry?

NOW WHAT?
PDGM (Patient-Driven Groupings Model) was recently announced in July as part of the Proposed Rule published by CMS and is anticipated to be THE biggest change in home health reimbursement 20+ years!

If the 2019 proposed rule is finalized, which we anticipate is likely, it will cement the shift in Medicare’s payment system from a prospective payment system to value based purchasing model.  With these mega changes it can feel like a daunting task to provide clinical excellence while maintaining a profit, thus it will be paramount that detailed analysis and strategies be developed to ensure that we keep patient care as our number one priority.

Following a thorough review of the 599-page “Proposed Rule”, HealthPRO Heritage experts offer the following highlights on the PDGM section of the rule:

On Monday, July 2, 2018, Centers for Medicare and Medicaid Services (CMS) released the 2019 Proposed Rule. Our industry has been anxiously awaiting this announcement since the introduction of “Home Health Groupings Model,” or HHGM in July 2017.