Implementing an efficient preadmission screening process to determine potential revenue under PDPM

Jan 04, 2019
The Bottom Line

Most hospitals like for facilities to respond to referrals within 15 minutes, and that can be a very ambitious goal. It usually includes running insurance, speaking with the director of nursing, or calling the pharmacy to get an idea of drug costs. Facilities are used to relying on their admissions coordinator to conduct many of these tasks, but under the Patient Driven Payment Model (PDPM), providers will have to involve more team members in the preadmission screening process.

If it takes a little bit longer to prescreen admissions thoroughly, you want to take that time on the front end to ensure you’re properly screening residents for cost and potential revenue. As far as managing efficiencies, facilities should team up a staff member who has a clinical background, perhaps the MDS coordinator, to work alongside admissions staff to help make those clinical decisions and projections as far as resident care needs. The facility administrator should also be very involved in making these decisions, and should be asked questions such as:

  • What type of residents are you comfortable admitting?

  • Are there certain types of residents you would feel comfortable having admissions make a very quick, efficient decision on?

  • Are there certain decisions you would like admissions to include other team members in?

The more you clarify and set a standard protocol for admissions, the quicker and more efficient the process will be. Stefanie Corbett, DHA, post-acute regulatory specialist for HCPro recommends asking the following additional questions to help your facility accurately project revenue and care costs during prescreen admissions:

  • Will the resident be admitted in a Medicare Part A covered stay?

  • What skilled services does the resident need?

  • What is a ballpark estimate of the reimbursement rate for the resident?

  • What resident risk factors may impact utilization and length of stay (i.e., comorbidities, lifestyle, etc.)?

  • What drugs does the resident need?

  • Are any costly drugs included in consolidated billing (refer to the HCPCS tables, fee schedules, pharmacy, etc.)?

  • What is the Medicare allowable amount for the drugs (refer to published fee schedules)?

  • May all drugs be administered in the facility (or a hospital or physician’s office)?

  • Will the resident need appointments with external specialists during their Medicare Part A stay (i.e., follow-up appointments, services, treatments, procedures, special drug administration, etc.)?

  • Where will those appointments take place (i.e., inpatient hospital, ambulatory surgery center, physician’s office, etc.)?

  • What services will be performed during the appointment? Will they be included in consolidated billing (refer to the HCPCS tables, fee schedules, etc.)?

  • Will the resident require ambulance/transportation to/from the appointments?

  • What type of non-therapy ancillary needs does the resident have (i.e., bariatric bed, special wheelchair, woundvac, etc.)?

  • Are there contracts for vendors? Have they agreed on the Medicare allowable amount?

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