Harmony Healthcare Blog

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

PDPM Q & A: Respiratory, Diagnoses Codes, Shortness of Breath and More

Posted by Pam Duchene on Thu, Sep 12, 2019


C.A.R.E.

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


  1. Regarding nursing performing respiratory therapy. Assuming they have their competencies, can an LPN provide respiratory therapy or does it need to be an RN? Does the nurse need to present with the resident the entire 15 minutes?

    A licensed nurse (either RN or LPN) can provide respiratory therapy as long as they have demonstrated/documented competence.  However, you need to check the state practice act because some states are more stringent (New York) in that the LPN cannot perform assessments.
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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.
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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

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

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