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.