Harmony Healthcare Blog

Patient Driven Payment Model: Bootcamp #1 Questions & Answer

Posted by The Harmony Team on Thu, Jun 20, 2019

C.A.R.E.

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


Question and Answer with Joyce Sadewicz, VP of HarmonyHelp and Pam Duchene, VP of Education & Training Harmony Healthcare International (HHI)

  1. Please address the need for restorative nursing when PDPM is launched.

    See blog dated 6.4.19
    Restorative Nursing: Crucial for Patient Quality, Critical for PDPM
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Topics: Patient-Driven Payment Model, PDPM

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

Immunization: What does “up to date” mean?

Posted by Pam Duchene on Fri, Jun 14, 2019

C.A.R.E.

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


The World Health Organization identifies Vaccine hesitancy as one of the top threats to global health.  While the target of education is largely centered around education for parents of young children, vaccinations for preventable disease is an important concept for all individuals.  Older adults, in particular, are at risk for communicable disease since immune systems weaken with age.  The Centers for Disease Control and Prevention (CDC) recommends the Shingles vaccine for individuals over 50 years of age, and Pneumococcal vaccines for adults over 65 and for those under 65 with certain chronic health conditions. 

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Topics: Immunizations

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

Restorative Nursing: Crucial for Patient Quality, Critical for PDPM

Posted by Pam Duchene on Tue, Jun 04, 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: 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

Transition to Patient Driven Payment Model (PDPM): Nurse Leader Strategies

Posted by Pam Duchene on Fri, May 10, 2019

C.A.R.E.

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


When you think of October, you may think about cooler weather, brightly colored leaves, crisp apples and stocking up on candy for Halloween.  Unless of course, you are working in post-acute or sub-acute care, in which case, you are probably contemplating the massive change involved in conversion from RUGS to PDPM.  During a recent MDS Competency course, several nurse leaders from New England took time to share their strategies for preparing for the Patient Driven Payment Model.  Following are some of their thoughts.  

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Topics: Patient-Driven Payment Model

ICYMI: Competency Assessment for Nursing Homes

Posted by Pam Duchene on Thu, May 02, 2019

C.A.R.E.

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


According to William Glasser, 

“No human being will work hard at anything unless they believe that they are working for competence.”

This is particularly true with healthcare.  Nurses and staff in long term care work to make a difference in the lives of those entrusted into their care.  While nursing in skilled care may not be packed with the adrenaline rush of the emergency department, it is filled with adventure and activity and an opportunity to deliver person-centered, compassionate care to those in need. 

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Topics: Core Competencies

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