Harmony Healthcare Blog

Kris Mastrangelo

Recent Posts

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

HIV/AIDS State Coding Prohibited

Posted by Kris Mastrangelo on Thu, Jul 11, 2019

C.A.R.E.

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


There are 16 states with laws that prevent healthcare providers from reporting HIV/AIDS diagnosis information to CMS through the current MDS Assessment System and/or prevent CMS from seeing said diagnosis within that system.

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Topics: HIV

SNF QRP (Quality Reporting Program) Time Tables

Posted by Kris Mastrangelo on Tue, Jun 25, 2019

C.A.R.E.

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


The ‘‘FY 2021 SNF QRP’’ refers to the fiscal year for which the SNF QRP requirements applicable to that fiscal year must be met for a SNF to receive the full annual update when calculating the payment rates applicable to it for that fiscal year.

The below table provides the data collection time frames and final submission deadlines for the Fiscal Year (FY) 2021 Skilled Nursing Facility Quality Reporting Program (SNF QRP).

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Topics: Quality Reporting Program, QRP

Therapy Caps (Medicare Part B) KX Modifier Thresholds: Top 4 Things to Know

Posted by Kris Mastrangelo on Tue, Jun 18, 2019

C.A.R.E.

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


Through your feedback and requests (thank you by the way) today’s blog is a clarification of the Therapy Caps. 

In 2018, the Bipartisan Budget Act of 2018 (HR 1892), canceled the existence of Medicare Part B Therapy Caps. The historically named Medicare Part B Therapy Caps (now known as the KX Modifier Thresholds) went into effect January 1, 2019. 

The Act maintained the requirement that a modifier be included on claims over the exception threshold.  The modifier represents confirmation that the services are medically necessary.

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Topics: Medicare Part B, Therapy Caps

PDPM: Impact on Medicaid Case Mix States

Posted by Kris Mastrangelo on Tue, Jun 11, 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

ICYMI: Long-Term Care and the Data Dilemma

Posted by Kris Mastrangelo on Thu, May 23, 2019

C.A.R.E.

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


Interview with Billie Nutter, President of Casamba, Inc.

Tom Mack, Senior Vice President of Client Development at Harmony Healthcare International (HHI), interviews Billie Nutter, President of Casamba, Inc., in the 2018 AHCA Provider Lounge.  As a leading expert in the post-acute care industry, Billie believes a big pain point facing LTPAC providers is data fragmentation.  Providers are being asked to collect and report data to a wide array of entities, be it hospital partners, bundled payment groups and/or ACO networks.  Billie notes that the amount of data being collected is at times staggering.   With that said, it is often hard to compare one skilled nursing facility's data to another because the industry lacks standardized outcomes (and how those outcomes are measured).   Billie believes long-term care providers need to find a way to share their data stories in order to truly show their successes and highlight their progress.  As a response to this data dilemma, Casamba has developed tools to assist their clients in tracking real time data and provide predictive analytics.

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Topics: Data Analytics

ICYMI: Mark Parkinson's Advice for SNFs in 2019

Posted by Kris Mastrangelo on Thu, May 16, 2019

C.A.R.E.

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


Interview with Mark Parkinson, President and CEO of American Health Care Association (AHCA)

Tom Mack, Senior Vice President of Client Development at Harmony Healthcare International (HHI), interviews Mark Parkinson, President and CEO of American Health Care Association, in the 2018 AHCA Provider Lounge.   Parkinson says there are two key things providers should be focusing on when it comes to reimbursement and regulatory change.  First off, he says facilities need to prepare for Patient Driven Payment Model (PDPM) right now.  He emphasizes that PDPM doesn't just change rates, it's a completely new payment system.  Secondly, Parkinson encourages providers to take risks when it comes to these reimbursement changes.  More and more of his member facilities are developing their own insurance plans known as I-SNPs (Institutional Special Needs Plans).  Parkinson admits that it can be a complicated process, but the 22 facilities that have implemented such plans have seen positive results that not only benefit operators, but residents as well.

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Topics: Patient-Driven Payment Model

ICYMI: Therapy Utilization under Patient-Driven Payment Model (PDPM)

Posted by Kris Mastrangelo on Wed, May 15, 2019

C.A.R.E.

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


Interview with Irene Henrich, Director of Quality and Compliance at Flagship Rehabilitation

Tom Mack, Senior Vice President of Client Development at Harmony Healthcare International (HHI), interviews Irene Henrich, Director of Quality and Compliance at Flagship Rehabilitation, in the 2018 AHCA Provider Lounge.   Irene discusses the challenges facing contract therapy companies under Patient-Driven Payment Model (PDPM).  While the goal for contract therapy companies will remain the same - to provide quality care - it will be extremely important to position themselves as a true healthcare partner and not simply a staffing agency.   As demonstrated by Flagship Rehabilitation, therapy companies have the ability to become an integral educational resource to skilled nursing facilities under this new payment model.

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Topics: Patient-Driven Payment Model

Requirements of Participation (RoP): Overview Phase III

Posted by Kris Mastrangelo on Thu, Mar 28, 2019

C.A.R.E.

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


Phase III
Requirements of Participation (RoP)
Implemented by November 28, 2019 

Highlights 

  1. QAPI Plan/Program Governing Body
  2. Person-Centered Care Planning
  3. Trauma Informed Care / Behavioral Health Services for History of Trauma PTSD
  4. Infection Preventionist
  5. Compliance and Ethics Program
  6. Physical Environment
  7. Training Requirements Competencies of Staff
  8. Dietary 

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Topics: Requirements of Participation

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