2 min read

The Buzz from Zimmet Healthcare's Reimbur$ement-Con 2021

By Prime Care Tech Marketing on Mon, Aug 23, 2021 @ 01:49 PM

Recently, CEO Jim Hoey and Sales VP Jae Sparks attended Reimbursement-Con by Zimmet Healthcare. CMS' Patient-Driven Payment Model (PDPM) was a hot topic, with speakers offering strategies for skilled nursing facilities (SNF) to maximize reimbursement.

To fully appreciate these strategies, let's back up to what we know, what we expect, and some wildcards with PDPM. 

What We Know

  • PDPM was the biggest overhaul in SNF payments in a generation.
  • PDPM was supposed to be budget neutral.
  • Before the March 2020 public health emergency, experts said PDPM was more generous than CMS intended. 

What We Expect

  • CMS wants $1.7 billion back, which could mean a 5% recalibration.
  • Using average daily rates in a post-pandemic world could cause a larger recalibration next year, more like 10-12%.

The Wildcards

  • CMS did not compensate SNFs for COVID care until April 1, 2020.
  • CMS assumed all SNFs were affected by COVID in the same way.
  • ACOs and value-based purchasing are forcing shorter lengths of stay with sicker patients.
  • Due to transitional care units, hospitals are seeing most of the PDPM benefits.

While legislators seek reform, SNFs must still try to survive in the PDPM world. To this point, speakers discussed the best practices. An overriding theme here was using Interim Payment Assessments (IPAs). Only 3% of SNFs are, and it's to your disadvantage.

IPAs

  • CMS wants IPAs to help SNFs track the status of a patient’s conditions and needs for a higher level of care.
  • The purpose of IPAs is to establish a payment rate or billing code for billing Medicare Part A.
  • Implement IPAs when a resident condition changes and may last 14 days or more.
  • Conduct IPAs as a routine when resident stays hits day 21; a lot can change in three weeks.

Other Suggestions

  • Offer specialty care and therapy, like speech and language.
  • Stress the importance of documenting all work, using multiple documenters, where possible.
  • Correct coding, correct coding, correct coding; billers may need refresher courses.
  • Applaud payers when they do the right things, but never take that as enough.

Technology can help.

  • Our primeVIEW and Managed Care MASTER solutions allow you to customize alerts on certain clinical conditions or changes that should trigger staff to conduct an IPA. 
  • Our primeCLAIMS solution makes coding and editing simple and its backed by a support team experienced in post-acute billing.

Request a demo

Topics: primeVIEW Managed Care MASTER PDPM IPA Interim Payment Assessment
1 min read

Mcknight's recaps points from  managed care PDPM webinar

By Prime Care Tech Marketing on Fri, May 07, 2021 @ 11:12 AM

In a May 5 article, 'CMS let the cat out of the bag, but it’s managed care that’s ready to pounce,' McKnight's Long-Care News recapped critical points from our recent Managed Care Webinar: Goodbye PDPM, Hello Levels! with Mix Solutions.

  • Webinar poll: 42% of attendees said they’d already had to convert at least some contracts from PDPM to levels.
  • Susie Mix: "They (the plans) are very aggressive in not only cutting our rates 30% to 40%, but they’re also very aggressive in starting this right now."

If you missed advice offered during our webinar, there's still time to tune in.

On-Demand Webinar

Topics: Webinar managed care Mcknights PDPM newsmention

3 Key CMS Updates You Should Know

By Prime Care Tech Marketing on Mon, Apr 19, 2021 @ 01:01 PM

The one constant in senior care is change, right? A lot is changing right now. If the headlines flew past you, we've got your back. This infographic will bring you up to speed.

3-Key-CMS-Updates-You-Should-Know

 

You should also know we have tools to help you flexibly adjust to change. Get in touch with us to hear more.

Get in Touch

Topics: SNF QRP PDPM reimbursements
1 min read

[Webinar Series with Pathway Health] Operationalizing PDPM: ICD-10 Code Management

By Prime Care Tech Marketing on Fri, Mar 06, 2020 @ 12:00 PM

Karolee-Alexander

Under PDPM, ICD-10-CM codes and diagnoses will impact OT, PT, SLP, NTA, and nursing components – so it's essential to stay on top of these critical operations. 

On March 25, we'll kick off a series of educational webinars with Pathway Health to help you "operationalize PDPM," starting with ICD-10 Code Management - presented by Karolee Alexander, ICD-10-CM expert and trainer.

We'll offer Q&A after, so don't miss this lunchtime learning  to keep the positive PDPM momentum going! 

REGISTER NOW

 

 

Topics: ICD-10 coding ICD-10 training PDPM PDPM revenue
3 min read

Not So Fast: The Truth About Those Initial PDPM Payment Boosts

By Prime Care Tech Marketing on Thu, Feb 13, 2020 @ 04:17 PM

Traditionally, additional revenue is a good thing. However, things aren’t always what they seem. Shortly after the Patient Driven Payment Model was implemented, skilled nursing facilities and nursing homes started reporting boosts in reimbursement. But many analysts are urging providers not to get used to the increased payments.

“The illusion of PDPM budget-neutrality is already over,” writes Michael Zimmet, President and CEO of Zimmet Healthcare Services Group. Zimmet contributed his thoughts on the future of skilled nursing for a January 2020 article in Skilled Nursing News. “We should enjoy the largesse while it lasts,” he continues, “but [we should] prepare for the inevitable correction long before 2020’s back-to-school sales are over.”

But why is PDPM leading to payment boosts in the first place? And what does that mean for future reimbursements?

When New Patients Aren’t New Patients

When the Patient Driven Payment Model was rolled out, most skilled nursing facilities and nursing homes saw an immediate boost in reimbursements. This was due to CMS counting all residents of a care community as new admissions, regardless of how long they had been already been there. Understandably, this rate boost won’t be replicated in the future.

Be Prepared for Inevitable Rate Adjustments

It seems that 9 is a magic number. According to Zimmet Healthcare Services Group, nine out of ten skilled nursing facilities saw a reimbursement boost after PDPM went into effect. On average, SNFs saw an increase of 9 percent or more in Medicare reimbursement. Because the model was designed to be revenue-neutral, industry experts expect that reimbursement rates will be recalculated soon.

The failed attempt at revenue-neutrality has many concerned that CMS could claw back reimbursements or adjust future payments to recoup losses. After all, the goal of model was to cut back on what it saw as inappropriate spending on therapy services that may not be needed.

Length of Stay Issues: When More Can Still Be Less

While per-diem rates are on the rise, the average length of stay is on the decline. This effectively erases any potential boost from per-day payment increases. In fact, CMS data shows that fee-for-service days have decreased by over 17 percent since 2010. Covered days per skilled nursing admission have also dropped by just over 7 percent.

As patient care and outcomes improve, lengths of stay are going to naturally decrease. Unfortunately, this also means that reimbursement will, as well.

What You Can Do to Protect Your Community

The best way to optimize your Medicare reimbursements is to check and double-check your data. Make sure that every diagnosis is captured and reported accurately so you don’t leave money on the table. Inaccurate recording can lead to missed Medicare payment opportunities.


PDPM was designed to be revenue-neutral. CMS didn’t plan to spend any more under this model than it did before. But that’s exactly what is happening, and we don’t expect it to keep happening for long.

 

Topics: Skilled Nursing Facility Medicare PDPM length of stay reimbursements

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