Q&A: Therapy will still tie into your bottom line under PDPM

Apr 25, 2019
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Billing Alert for Long-Term Care

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.

Department of Labor proposes changes to overtime rules

Apr 12, 2019
 | 
The Bottom Line

The Department of Labor has published three Notices of Proposed Rulemaking (NPRM) regarding the minimum salary requirement for an employee to qualify for overtime, which forms of payment can be included and excluded in the “time and one-half” calculation when determining workers’ overtime rates, and clarifications of and revisions to the responsibilities of employers and joint employers to employees in joint employer arrangements.

AMBR Journal, Issue 1, available for download

Apr 12, 2019
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The Bottom Line

Download the first issue of AMBR Journal! In this issue we discuss how to focus on new incentives under PDPM without scrapping therapy; how to get your compliance and ethics program into shape before November 1; ICD-10 training for your staff; a breakdown of consolidated billing, category I; and what billers can do to properly handle long-term care insurance policies.

Making the case for implementing a revenue cycle management model in your facility

Apr 05, 2019
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Billing Alert for Long-Term Care

by Deborah Collum, national director of revenue cycle management at Covenant Retirement Communities and AMBR Advisory Board member

Implementing a revenue cycle management (RCM) model in your facility will help you streamline your billing process to prepare for the Patient-Driven Payment Model (PDPM) to be implemented October 1, 2019. If your billing office still follows an accounts receivable (AR) model that only focuses on outstanding accounts, you’re not alone—but it may be time for a change.

TKA removed from Medicare IPO list: Implications for SNFs

Mar 22, 2019
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Billing Alert for Long-Term Care

In the final 2018 outpatient prospective payment system (OPPS) rule released by CMS, total knee arthroplasty, also known as total knee replacement (TKA/TKR), was removed from the Medicare inpatient-only (IPO) list. The IPO list includes procedures that are only paid under the hospital inpatient prospective payment system.

MedPAC makes recommendations for FFS payment updates in annual report

Mar 22, 2019
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The Bottom Line

In their annual report to Congress, the Medicare Payment Advisory Commission (MedPAC) made policy recommendations for nine provider sectors in fee-for-service (FFS) Medicare, including recommendations against raising payment rates for both skilled nursing facilities (SNFs) and home health agencies. MedPAC recommends that Congress not increase base payment rates for SNFs in 2020 and suggests that Congress reduce base payment rates for home health agencies by 5 percent for 2020.

Updates to QIES won’t change the way providers submit data

Mar 01, 2019
 | 
The Bottom Line

CMS announces that starting in March, the Quality Improvement and Evaluation System (QIES), Certification and Survey Provider Enhanced Reports (CASPER) and Automated Survey Processing Environment (ASPEN) will undergo a series of modernizing enhancements. The agency clarified that once updated, the new system, Internet Quality Improvement and Evaluation System (iQIES), will not change how providers currently submit data to CMS.

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