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
1 min read

Join PDPM & Five Star Sessions with Cheryl Field at LNHA Spring Conference - April 30

By Cheryl Field on Tue, Apr 16, 2019 @ 11:41 AM

LNHA Spring Conference 4_30_19

With recent changes to Five Star calculations and the new Patient-Driven Payment Model (PDPM) on the horizon, skilled nursing providers have much to understand and apply in a short period of time. These CE-eligible seminars at LNHA's Spring Conference may help provide guidance.

1:30-3:00 PM: PDPM for Executives: Outcome Metrics Essential for Success

  • Administrative level of care presumption
  • Group and concurrent therapy limits
  • Interrupted stay policy
  • Key MDS changes that impact PDPM

3:00-4:00 PM: CMS Changes to Five-Star and PBJ (April 2019)

  • Review key changes across all domains
  • How to prepare for scoring changes to your network
  • Explore future Five-Star strategies for success

I hope you can join me, so I can help you quickly get up to speed!

Topics: pbj reporting post-acute business intelligence dashboard Patient-Driven Payment Model PDPM PBJ calculation CMS and Five Star Staffing Star prediction LNHA Spring Conference CMS RN Staffing requirement