Harmony Healthcare Blog

SNF PPS Final Rule FY2019: Principal Diagnosis and Expected Decline

Posted by Sally Fecto on Tue, Oct 30, 2018

C.A.R.E.

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


The Final Rule is in play and a recent webinar conducted by Kris Mastrangelo spurred some relevant questions that require sharing.  One of these questions spurs thought on the included and excluded diagnoses for the SNF Value-Based Purchasing Rehospitalization metric.

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Topics: Final Rule

SNF PPS Final Rule FY19: Top 10 Things You Need to Know

Posted by Kris Mastrangelo on Thu, Aug 02, 2018

C.A.R.E.

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


The SNF PPS Final Rule was released 7.31.18.  The Top 10 things you need to know:  

  1. There is a 2.4% Medicare Part A Rate increase effective October 1, 2018 (Fiscal Year 2019). This equates to 820 Million dollars for the SNF industry.                                                                                      
  1. Patient Driven Payment Model (PDPM) is the SNF Payment System that correlates payment to the patients’ conditions and care needs rather than volume of services (Cost Based) provided or resources rendered (PPS RUGs System).
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Topics: Final Rule

Top 6 Nuggets: SNF PPS Final Rule FY 2017

Posted by Kris Mastrangelo on Thu, Aug 25, 2016

C.A.R.E.

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


Reimbursement will dramatically change for skilled nursing homes over the next two and a half years.  The August 5th, 2017 Final Rule for the Medicare program is robust with history, a payment rate update for fiscal year 2017, as well as a detailed description of how the value based purchasing program will be implemented. 

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Topics: Final Rule

Is it Too Late to Prepare for SNF Quality Reporting?

Posted by Elisa Bovee on Thu, Jul 14, 2016

Did you hear what CMS said? One of the big nuggets derived from the CMS SNF Quality Reporting call conducted July 12th was that payment for FY 2017 will be based on data collected between October 1, 2016 – December 31, 2016.  Yes, you are reading this correctly, you have approximately two months to get your ducks in a row with your QMs to stay ahead of the curve for your anticipated reimbursement for FY 2017.  This may not be new information for you or your team, yet the time is nearing when MDS data and claims data culled from your facility will impact your facility’s future payment rates. The overview provided by CMS during the call detailed some key points from the IMPACT Act for applicable PAC settings. The speakers discussed the SNF Quality Reporting Program with regards to the PPS FY2016 Final Rule.

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Topics: SNF Quality Reporting, CMS, Final Rule, IMPACT Act

Centers for Medicare and Medicaid Services (CMS) Proposed Rule FY2015

Posted by Kris Mastrangelo on Mon, Jun 09, 2014

CMS Proposed Rule FY2015:  On May 6,2014, the Centers for Medicare and Medicaid Services (CMS) issued a Proposed Rule [CMS-1605-P] under the Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities. The Proposed Rule illustrates the proposed Fiscal Year 2015 Medicare payment rates for skilled nursing facilities (SNFs).  The Proposed Rule outlines an estimated increase in SNF payments of 2.0%.  This estimated increase is attributable to the 2.4% market basket increase, reduced by the 0.4% point multifactor productivity adjustment required by law.  As the actual amount of change in the market basket index at -0.3 did not exceed the 0.5 percentage point threshold, the payment rates for FY2015 do not include a forecast error adjustment. 

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Topics: Final Rule, Medicare, CMS, OIG, PPS, Skilled Nursing Facility

CMS SNF PPS Final Rule for FY 2014 Published

Posted by Kris Mastrangelo on Sat, Aug 10, 2013

On August 1, 2013, the Centers for Medicare & Medicaid Services (CMS) published the Final Rule for the Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNF) for FY 2014. The Medicare rates posted in Final Rule will go into effect October 2013.

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Topics: CMS, Medicare Part A, PPS, SNF, Final Rule, RAI

New Final Rule FY 2012 Therapy Documentation Requirements

Posted by Peter Mastrangelo on Wed, Nov 16, 2011

In the Final Rule FY2012, CMS provided clarification on therapy documentation and expectations in regards to changes in therapy treatment plans.  Harmony recommends facilities are vigilant when documenting on patients that have a change in intensity resulting in increased reimbursement for the facility.  Changes to the mode and/or intensity of therapy must be justified by the changes in the beneficiary's underlying health condition.  In order to demonstrate that such changes are medically necessary, the provider should clearly describe in the plan of care the reasons for deviating from the original plan.  The following statements are examples of documentation that would assist in justifying an increase in therapy intensity:

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Topics: CMS, Therapy Documentation, Final Rule

FINAL RULE FY 2012: RUG DISTRIBUTION

Posted by Peter Mastrangelo on Fri, Sep 16, 2011

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Topics: CMS, MDS, Final Rule, Rug Distribution

SNF PPS Final Rule FY2012: Strategies For The Transition

Posted by Peter Mastrangelo on Tue, Sep 13, 2011

 

The SNF PPS FY2012 Final Rule (76 FR 48486) outlined several policy changes in the SNF PPS effective for FY 2012.  These changes include:  a revised MDS assessment schedule, the Change of Therapy (COT) Other Medicare Required Assessment (OMRA), a resumption of therapy option for the End-of-Therapy OMRA, the allocation of group therapy time, and a revised student supervision policy.  CMS has posted a transition document for implementation of these changes scheduled for October 1, 2011.

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Topics: PPS, SNF, OMRA, MDS, MDS 3.0, Final Rule

Final Rule - Change of Therapy OMRA. What you need to Know!!!

Posted by Peter Mastrangelo on Thu, Aug 18, 2011

CMS has mandated the initiation of the new type of OMRA, a Change of Therapy, which may just be the most discussed element in the Final Rule to date. Details of this OMRA are discussed on pages 196 - 217 of the Final Rule. Effective October 1st, 2011, for all Medicare Part A SNF residents, a COT OMRA is required if the therapy services a resident receives during the COT observation period do not reflect the RUG-IV classification level given on the patient's most recent PPS assessment used for payment and would instead cause the patient to be classified into a different RUG category. The term "COT observation period" refers to a successive 7-day window beginning the day following the Assessment Reference Date (ARD) of the resident's last PPS assessment used for payment.

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Topics: CMS, Medicare Part A, OMRA, Final Rule

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