Harmony Healthcare Blog

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

Top 5 Strategies: ICD-10 Coding and Skilled Diagnosis

Posted by Pam Duchene on Thu, Aug 22, 2019

C.A.R.E.

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


As the name states, the Patient Driven Payment Model (PDPM) compensates by patient characteristics and the associated ICD-10 Codes.  Hence, it is imperative to identify and properly document the ICD-10 Codes that best reflect the patient’s reason for Skilled Medicare Coverage upon admission to the SNF.

There are 3 outcomes when selecting patient ICD-10 Codes:

  • Return to Provider
  • Resolved in Hospital
  • Reason for Skilled Care
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Topics: ICD-10

Top 10 Things To Know About Triple Check PDPM Style

Posted by Pam Duchene on Tue, Aug 20, 2019

C.A.R.E.

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



The triple check process is a long-standing system used at Skilled Nursing Facilities (SNFs) across the country to ensure compliance in Medicare billing.   Specifically, to assure that the RUG Level accurately billed for therapy minutes and that everything matches between the UB-04, the MDS and therapy logs.

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Topics: PDPM, Triple Check

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: Admission Screening

Posted by Pam Duchene on Fri, Aug 09, 2019

C.A.R.E.

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


At Harmony Healthcare International (HHI), we are fielding massive amounts of questions on how and if the new PDPM reimbursement system will change the patient profile in a nursing home.

Some inquiries include:

  • Does the advent of PDPM change the SNF admissions criterion for patient admission?
  • Are there characteristics that define the ideal referral for skilled care in the Patient Driven Payment Model (PDPM)?
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Topics: PDPM

ICYMI: Restorative Nursing: Crucial for Patient Quality, Critical for PDPM

Posted by Pam Duchene on Thu, Aug 01, 2019

C.A.R.E.

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


What patients can do today and what they will be able to do tomorrow may be the result of Restorative Nursing Programs.  That’s been the conclusion of multiple research studies, including a study from Johns Hopkins in which 31% of patients improved their ADL self-performance at 6 months with 15 minutes of Restorative Nursing daily. 

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Topics: Patient-Driven Payment Model

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

ICYMI: PDPM Basics for MDS Coordinators

Posted by Joyce Sadewicz on Tue, Jul 23, 2019

C.A.R.E.

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


There are six components that are involved in calculating the daily payment rate for each patient for the Patient Driven Payment Model.  These include: 

  1. Facility Base Rate which is the Non-Case Mix rate that will continue to be calculated by CMS as it is currently under the RUG-IV system. This base rate will be the same for all Medicare Part A patients and will not change over the course of the patient's stay.
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Topics: PDPM

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

PDPM: Admission Screening

Posted by Pam Duchene on Tue, Jul 09, 2019

C.A.R.E.

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


At Harmony Healthcare International (HHI), we are fielding massive amounts of questions on how and if the new PDPM reimbursement system will change the patient profile in a nursing home.

Some inquiries include:

  • Does the advent of PDPM change the SNF admissions criterion for patient admission?
  • Are there characteristics that define the ideal referral for skilled care in the Patient Driven Payment Model (PDPM)?
Read More

Topics: PDPM

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