Patient-specific conditions – not arbitrary therapy volume – determine clinical eligibility and reimbursement under PDPM. This concept is both mundane and novel (it’s been there all along but lacked reimbursement-sensitivity) and demands improved accuracy of primary and tertiary diagnoses upon admission and throughout the benefit period. This program will highlight best-practices to capture, coordinate, report and defend accurate ICD-10 coding that serves as the foundation for the PDPM Composite rate specific to every resident in our care.

Physical, Occupational and Speech therapy literally turn from “revenue center” to “cost center” overnight. As volume is untethered from payment, new protocols must be cost-efficient and clinically effective – regardless of whether your department is outsourced or in-house. Assessing (and continually reassessing) therapy department staffing needs/ratios based on the “human array” of clinical profiles will determine a facility’s win/lose status in a Budget Neutral payment system transition. This program will discuss the operational implication of PDPM on therapy department financial…

PDPM will require at least modest new technology solutions to augment the traditional approach to reimbursement management. The SNF market is heavily saturated with newfangled technology “solutions” claiming to be the comprehensive answer to PDPM efficiency, reimbursement optimization and quality improvement. Spoiler Alert: Few SNFs can afford them all; even fewer take advantage of the full functionality offered by any system. The result is an industry plagued with technology fatigue, counter-productive initiatives and buyer’s remorse. The session will empower SNF…

PDPM marks the official end to predictability in the Medicare budgeting process. While the transition to PDPM is intended to be Budget Neutral, the aggregate figure will be comprised of per diem rates that vary by hundreds of dollars per-day, per facility, and that will change drastically from month-to-month. This session will provide strategies for managing (and explaining) the budgeting process to Board members, investors and lenders, in addition to introducing compliant protocols to monitor and reconcile variances in compliance…

The weeks leading up to October 1, 2019 will undoubtedly be stressful. This panel discussion will provide final thoughts and insight regarding the thousands of rate “Composite” risks and opportunities that await. This session will address the full spectrum of PDPM issues discussed in the preceding eight sessions, from review of longstanding eligibility requirements detailed in the Medicare Beneficiary Manual to care coordination/capture policies, technology, ancillary services, benchmarking, compliance concerns and optimization strategies. Bring the entire team together to participate…

PDPM uses the 5-day MDS to establish the “Composite Rate” for the entire benefit period. However, changes in patient condition allows SNFs the opportunity to reassess and change scores. The IPA is an optional tool (per the 2019 Final Rule). While it can serve as a powerful payment driver, compliance will require continuous monitoring of qualifying clinical conditions by professionals who are able to make the distinction between opportunity and oblivion, given the inverse relationship among Component rate drivers. This…

Despite systemic change from therapy as payment driver, third-party reimbursement compliance audit risk may intensify under PDPM. Instead of defending Ultra High delivery, we expect auditors to focus on far more dynamic (and objective) payment drivers that will be harder to overturn on appeal. This session will review strategies for maintaining compliance (i.e. accurate documentation) for new risk areas specific to SLP end splits, nursing RUG qualifiers and non-therapy ancillaries.