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). 

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). 

C.A.R.E.

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

Interview with Stephen Hanse, President of New York State Health Facilities Association

Kris Mastrangelo, President of Harmony Healthcare International (HHI) interviews Stephen Hanse, President of New York State Health Facilities Association (NYSHFA), in the 2017 AHCA Provider Lounge.  Stephen talks about the process of transitioning the Case Mix payment system to a Value-Based Purchasing environment and how it is affecting providers in New York State.   Partnering with the Department of Health has helped providers better understand both the Value-Based Purchasing environment and also the New Survey Process.  (Audio transcription below).

Understanding the criteria and components of RUG Leveling (53 levels) and Categorization is imperative for accurate and appropriate reimbursement under the New York Case Mix reimbursement system. Protocols and defined processes are essential for success and require implementation throughout the year, (not just during the case mix "window").  Ongoing MDS coding oversight and refinements are even more important given the regulatory and reimbursement changes impacting quality measures and the ultimate crescendo of value based purchasing. The following tips may help you in preparing your documentation to properly reflect all necessary data to support the appropriate payment level.

In many states, Medicaid reimbursement is already transitioning to managed care, striking fear in the hearts of most operators and administrators - and for good reason.  Providing quality care for the Medicaid population has been part of the Skilled Nursing Facility (SNF) industry for years even with per diem reimbursements far below cost.   While not always the case, managing the Medicaid population can mean potentially delayed reimbursement and lead to more administrative hoops to jump through.