Harmony Healthcare Blog

[ICYMI] Therapy Contract Negotiation for PDPM

Posted by Kris Mastrangelo on Thu, Oct 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

[ICYMI] Top 10 Things You Need to Know About PDPM Transition

Posted by Kris Mastrangelo on Thu, Oct 10, 2019


C.A.R.E.

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


It's October and the phone is off the hook with PDPM 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

[ICYMI] PDPM Transition Tips: MDS Nurse Assessment Coordinators

Posted by Pam Duchene on Tue, Oct 08, 2019


C.A.R.E.

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


As the saying goes, “Change is inevitable, except from a vending machine!” 

The transition to the Patient Driven Payment Model (PDPM) certainly exemplifies the constancy of change.  With the transition date nearing, it seems most appropriate to hear from those who are most impacted by the change ~ the MDS Nurse Assessment Coordinators.  So, I reached out to some of the brilliant Nurses with whom I am privileged to know and asked them for their last-minute preparation strategies.

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Topics: PDPM

PDPM Transition Tips From the Field: MDS Nurse Assessment Coordinators

Posted by Pam Duchene on Tue, Sep 24, 2019


C.A.R.E.

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


As the saying goes, “Change is inevitable, except from a vending machine!” 

The transition to the Patient Driven Payment Model (PDPM) certainly exemplifies the constancy of change.  With the transition date nearing, it seems most appropriate to hear from those who are most impacted by the change ~ the MDS Nurse Assessment Coordinators.  So, I reached out to some of the brilliant Nurses with whom I am privileged to know and asked them for their last-minute preparation strategies.

Read More

Topics: PDPM

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).

Read More

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.
Read More

Topics: PDPM

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

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

ICYMI: PDPM Basics for MDS Coordinators

Posted by Joyce Sadewicz on Tue, Jul 23, 2019

C.A.R.E.

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


There are six components that are involved in calculating the daily payment rate for each patient for the Patient Driven Payment Model.  These include: 

  1. Facility Base Rate which is the Non-Case Mix rate that will continue to be calculated by CMS as it is currently under the RUG-IV system. This base rate will be the same for all Medicare Part A patients and will not change over the course of the patient's stay.
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Topics: PDPM

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