Harmony Healthcare Blog

Kris Mastrangelo

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[ICYMI] Top 10 Things You Need to Know About PDPM Transition

Posted by Kris Mastrangelo on Thu, Oct 10, 2019


C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency


It's October and the phone is off the hook with PDPM questions.  This blog started as a HIPPS informational narrative but morphed relatively quickly into a twitter on steroids PDPM transition blitz of information.  

In true Harmony Healthcare International (HHI) fashion, here are the Top 10 things you need to know about PDPM Transition:

  1. PDPM Begins October 1, 2019 with no overlap from RUGS-IV.
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Topics: PDPM

MDS Transmission Timeframes

Posted by Kris Mastrangelo on Thu, Oct 03, 2019


C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency


We are 3 days into PDPM (Patient Driven Payment Model) and we are still here!  As discussed on the Freaky Friday Webinar, just breathe and create a process for you and your staff to complete MDS assessments and related evaluations that is conducive to optimal MDS accuracy and MDS compliance.

The Harmony Healthcare International (HHI) strategy (process) for our monthly clients is to wait to transmit until the Regional Harmony Healthcare International (HHI) Specialist reviews the MDS Assessments.  This system provides a safeguard against submitting inaccurate MDS Assessments.

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Topics: Respiratory Therapy

Respiratory Therapy: MDS Coding and Documentation Support

Posted by Kris Mastrangelo on Tue, Oct 01, 2019


C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency


With the advent of PDPM October 1st, 2019, questions regarding the delivery and coding of respiratory therapy services is top of everyone’s list of question.

The coding of the Respiratory Therapy on the MDS requires:

  • Respiratory Therapy 7 days a week
  • At least 15 minutes per day
  • Equivalent to 5 minutes per shift (105 minutes total/week)
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Topics: Respiratory Therapy

Immediate Jeopardy: Revised Parameters and Referring Crimes to Law Enforcement

Posted by Kris Mastrangelo on Thu, Sep 19, 2019


C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency


This past year, The Centers for Medicare and Medicaid Services (CMS) made multiple adjustments to the guidelines on Immediate Jeopardy.   

For those new to the industry, Appendix Q is the section of the State Operations Manual (SOM) that defines Immediate Jeopardy and Surveyors use this guidance when making citations during health inspection surveys. 

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Topics: Immediate Jeopardy

Therapy Contract Negotiation: Top 11 Things You Need to Know for PDPM

Posted by Kris Mastrangelo on Tue, Sep 17, 2019


C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency


With the advent of PDPM (Patient Driven Payment Model) October 1st, 2019, two of the hottest questions are:

  • Should a Skilled Nursing Facility (SNF) outsource therapy services?
  • What is the best fee structure between the Skilled Nursing Facility (SNF) and therapy contractor?

Approximately 50% of Skilled Nursing Facilities (SNFs) use outside vendors to perform Physical, Occupational and Speech Therapy services for the Skilled Nursing Facility (SNF)  patient population inclusive of all payer sources (Medicare Part A, Medicare Part B, Managed Care, Managed Medicare, Medicaid, Private and ACOs).

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Topics: PDPM

Top 10 Things You Need to Know About PDPM Transition

Posted by Kris Mastrangelo on Tue, Sep 10, 2019


C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency


With the PDPM less than a month away, the phone is off the hook with questions.  This blog started as a HIPPS informational narrative but morphed relatively quickly into a twitter on steroids PDPM transition blitz of information.  

In true Harmony Healthcare International (HHI) fashion, here are the Top 10 things you need to know about PDPM Transition:

  1. PDPM Begins October 1, 2019 with no overlap from RUGS-IV.
Read More

Topics: PDPM

ICD-10 Coding and Skilled Nursing Care

Posted by Kris Mastrangelo on Mon, Sep 09, 2019


C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency


MDS Nurses do not need to be expert coders, but it is essential that they connect the dots between the diagnoses and rationale for skilled care.  

PDPM flips the script and highlights nursing care.  For the last 2 decades, therapy dominated the RUGs classification at 92%.  This means that skilled claims leaned on therapy as the skilled qualifier.  Although Harmony Healthcare International (HHI) consistently preaches that “nursing rules the world” and that “nursing always anchors the patient for skilled coverage”, many providers may have relied solely on therapy for coverage.

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Topics: ICD-10

Consolidated Billing in a Skilled Nursing Facility: Top 4 Things to Know

Posted by Kris Mastrangelo on Tue, Aug 27, 2019


C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency


The Balanced Budget Act of 1997 (BBA), Public Law 105-33, Section 4432(b) contains the SNF Consolidated Billing requirements that state the SNF itself must submit all Medicare claims for the services that its residents receive.  Except for specifically excluded services that will be highlighted in this blog post.

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Topics: Consolidated Billing

Just Breathe: Top 4 Reasons Why Respiratory Therapy Makes a Comeback

Posted by Kris Mastrangelo on Fri, Aug 16, 2019

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency


It has been over two decades since the Skilled Nursing Facility (Nursing Home) industry has undergone an overhaul of the reimbursement for Medicare Part A patients.  I remember the transition back in 1998 like it was yesterday.  The May 12th, 1998 Proposed Rule outlined a RUGS III-34 level Prospective Payment System (PPS) that dramatically shifted the platform of patient care and reimbursement from a cost-based (retroactive) to a per diem based (prospective) system.  The industry was upside down. 

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Topics: Respiratory Therapy

ICYMI: PDPM: Impact on Medicaid Case Mix States

Posted by Kris Mastrangelo on Thu, Jul 25, 2019

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency


At Harmony Healthcare International (HHI), we are receiving many inquiries on how the PDPM payment system will impact Medicaid Case Mix States.  

Effective October 1, 2019, CMS will replace the existing Resource Utilization Group (RUG), Version 4 Case Mix methodology that is used to classify Skilled Nursing Facility (SNF) patients in a covered Part A stay for payment purposes under the SNF Prospective Payment System with a new Case Mix classification model, the Patient Driven Payment Model (PDPM). 

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Topics: Case Mix, Patient-Driven Payment Model

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