Harmony Healthcare Blog

ICYMI: Restorative Nursing: Crucial for Patient Quality, Critical for PDPM

Posted by Pam Duchene on Thu, Aug 01, 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: PDPM: Impact on Medicaid Case Mix States

Posted by Kris Mastrangelo on Thu, Jul 25, 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

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

HIV/AIDS State Coding Prohibited

Posted by Kris Mastrangelo on Thu, Jul 11, 2019

C.A.R.E.

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


There are 16 states with laws that prevent healthcare providers from reporting HIV/AIDS diagnosis information to CMS through the current MDS Assessment System and/or prevent CMS from seeing said diagnosis within that system.

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Topics: HIV

PDPM: Admission Screening

Posted by Pam Duchene on Tue, Jul 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

PDPM: Top 3 Areas for Systems Implementation

Posted by Pam Duchene on Tue, Jul 02, 2019

C.A.R.E.

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


The Patient Driven Payment Model incorporates a multitude of changes into the current Medicare Part A SNF payment model.  Some of the criteria that require immediate application include:

  1. Interruptions in Stay;
  2. Interim Payment Assessments; and
  3. Administrative Level of Care Presumption.
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Topics: PDPM

PDPM Basics for MDS Coordinators

Posted by Joyce Sadewicz on Thu, Jun 27, 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.
Read More

Topics: PDPM

SNF QRP (Quality Reporting Program) Time Tables

Posted by Kris Mastrangelo on Tue, Jun 25, 2019

C.A.R.E.

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


The ‘‘FY 2021 SNF QRP’’ refers to the fiscal year for which the SNF QRP requirements applicable to that fiscal year must be met for a SNF to receive the full annual update when calculating the payment rates applicable to it for that fiscal year.

The below table provides the data collection time frames and final submission deadlines for the Fiscal Year (FY) 2021 Skilled Nursing Facility Quality Reporting Program (SNF QRP).

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Topics: Quality Reporting Program, QRP

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

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