In nearly all provider segments of health care, revenue maximization and integrity are directly tied to compliance and quality ratings. Beginning October 1, 2019, skilled nursing facilities (SNF) that failed to meet the 80% threshold reporting requirement on quality measures (QM) will experience a 2% payment reduction. The cut-off date to meet the compliance level for the quality reporting period October 1, 2018 to December 31, 2018 was May 15, 2019.
Skilled nursing facilities (SNF) are not new, and yet there are often limited sessions at healthcare conferences that focus on the challenges that these organizations face. Education for the business office can be particularly difficult to find, but its members often wear multiple hats and serve as the last line of defense before a claim is submitted. The many tasks completed by billers and business office managers have reverberating effects on reimbursement, including the complicated and complex process of completing cost reports.
This year, AMBR for Long-Term Care is partnering with the National Association for Healthcare Revenue Integrity (NAHRI) to offer a track at the Revenue Integrity Symposium dedicated to the unique billing and reimbursement challenges in that setting.
The Medicare Guide for SNF Billing and Reimbursement, Second Edition will help tackle the newest and most complex billing issues. This book will help billing staff understand the PDPM rate calculation methodology, identify opportunities to maximize reimbursement and accurately project revenue, correctly bill for Medicare Part A and Part B claims, and more!
Communication disconnects between the biller and other departments happen frequently. Billers do not always receive information that affects compliant billing. This may be due to fragmentization of departments, lack of meaningful Medicare utilization systems, differences in software (e.g., MDS vs. billing) that are not interoperable, or an unawareness from the interdisciplinary team (IDT) as to the importance of billers in the Medicare reimbursement process.
During a Skilled Nursing Facilities (SNF)/Long Term Care Open Door Forum (ODF) held Tuesday, April 23, 2019, Centers for Medicare and Medicaid Services (CMS) officials discussed the Proposed Fiscal Year 2020 Payment and Policy Changes for Medicare Skilled Nursing Facilities (CMS-1718-P) published in the Federal Register on April 25, 2019.
Q. Should therapy treatment practices change under the Patient-Driven Payment Model (PDPM)?
A. Even though therapy minutes are no longer relevant to the provision and payment for therapy, CMS has assumed that most therapy will continue to be provided one-on-one. SNFs with contract providers need to take great care to ensure that the contractor does not automatically ramp up inpatient therapy on a group and concurrent basis to the 25% threshold!
Unless the facility has experienced a significant change in overall case mix from when under resource utilization groups (RUG) to PDPM (fewer therapy-qualified residents), there would be no logical clinical reason to change treatment practices.