Harmony Healthcare Blog

PDPM: Impact on Medicaid Case Mix States

Posted by Kris Mastrangelo on Tue, Jun 11, 2019


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

2017 AHCA Provider Lounge Series: Case Mix in a Value-Based Purchasing Environment

Posted by Kris Mastrangelo on Tue, Jan 02, 2018


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).

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Topics: Case Mix, Value-Based Purchasing

New York Medicaid Case Mix: 14 Tips for Accurate Reimbursement

Posted by Kris Mastrangelo on Fri, May 13, 2016

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.

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Topics: Medicaid, Case Mix, New York State

Case Mix Best Practices for the Skilled Nursing Facility

Posted by The Harmony Team on Thu, Mar 05, 2015

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.

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Topics: Case Mix, Case Mix Reimbursement

The Importance of Preventing Artificially Low Case Mix Reimbursement

Posted by The Harmony Team on Wed, Mar 19, 2014

The New York State Executive Budget, as proposed by Governor Cuomo, is considering a 2% Cap on increases in New York’s Skilled Nursing Facilities’ Case Mix Index.  The effect on SNF provider’s Medicaid reimbursement (already the largest gap between reimbursement and cost in the nation) could be significant.

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Topics: Case Mix, Case Mix Reimbursement

10 Tips for a Better Case Mix Index

Posted by Kris Mastrangelo on Tue, Jan 07, 2014

When the MDS is completed, it calculates a clinical score (RUG level, Resource Utilization
Group) which impacts the direct care costs under the Case Mix reimbursement system. The notion is that the higher the amount of resources rendered to care for the patient/resident, the higher the reimbursement level. There are different types of RUG systems and each state has the ability to create its own system.

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Topics: Case Mix

Rehab Case Management for Case Mix

Posted by The Harmony Team on Wed, Jul 25, 2012

Successful case management for Case Mix involves the coding of the accurate minutes of care provided by therapy on the MDS for those patients seen under Medicare Part B. There is significant opportunity to increase the case mix index with the intervention of rehabilitation during the appropriate assessment windows.  Increased communication between the Rehabilitation staff and the MDS Coordinator regarding patients receiving Medicare Part B services has the potential to increase the case mix index in two ways. 

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Topics: Rehab, Medicare Part B, Case Mix, OBRA, Assessment Schedules, Rehab Case Management, MDS Coordinator

Case Mix as a Medicaid Reimbursement System

Posted by The Harmony Team on Wed, Jun 20, 2012

Case Mix - Medicare Minute

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Topics: Medicare, Medicaid, Case Mix, OBRA, MDS, PPS, MDS assessment, Medicaid Reimbursement

Rehabilitation Services Impact on Medicaid Case Mix

Posted by Kris Mastrangelo on Mon, Jun 21, 2010

Impact Rehabilitation Services Impact Medicaid Case Mix:  Rehabilitation Therapists are integral members of the interdisciplinary team as is their participation in the process of resident assessment.  The routine therapy screen assists in identifying areas of decline or the potential for improvement, before loss becomes permanent or opportunities for improvement are missed. 

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Topics: Case Mix, ARD, Rehab Case Management

10 ways to Increase your Case Mix Index

Posted by Kris Mastrangelo on Mon, Jun 21, 2010

There are numerous ways a facility can increase their Case Mix Index.  Facilities must monitor the follow criteria to ensure proper Medicaid Reimbursement and increase your Case Mix Index.

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Topics: Case Mix, Assessment Schedules, Medicaid Reimbursement

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