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The Harmony Team

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PDPM - Where are We Now Q&A: Part 5

Posted by The Harmony Team on Thu, Feb 20, 2020

C.A.R.E.

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


Question 5 of 9: Is it appropriate to use diagnoses added by consulting physicians?

It is appropriate to use diagnoses added by consulting physicians, in addition to those listed by the admitting physician and those identified by non-physician providers such as nurse practitioners and physician assistants.  According to the RAI User’s Manual, active diagnoses are intended to code diseases that have a direct relationship to the resident’s current functional status, cognitive status, mood or behavior status, medical treatments, nursing monitoring, or risk of death. 

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Topics: MDS, PDPM, Physician Diagnosis

PDPM - Where are We Now Q&A: Part 4

Posted by The Harmony Team on Tue, Feb 18, 2020

C.A.R.E.

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


Question 4 of 9: For the certification form on admission, how many days does the MD/NP have to sign? If a person admits late on a Friday and the practitioner is not in the facility until Tuesday or after, would that suffice?

According to the Medicare Benefit Policy Manual Chapter 8 – Coverage of Extended Care (SNF) Services under Hospital Insurance. 40- Physician Certification and Re-Certification for Extended Care Services,

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Topics: PDPM, Certification Form, Admission

PDPM - Where are We Now Q&A: Part 3

Posted by The Harmony Team on Fri, Feb 14, 2020

C.A.R.E.

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


Question 3 of 9: In a patient with a hip fracture, is there a need to code “muscle weakness",“difficulty walking” listed by PTs? These diagnoses are usually not listed/signed by a physician.

“Physical therapy services are those services provided within the scope of practice of physical therapists and necessary for the diagnosis and treatment of impairments, functional limitations, disabilities or changes in physical function and health status.” 230.1 - Practice of Physical Therapy, Medicare Benefit Policy Manual Chapter 15 – Covered Medical and Other Health Services.

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Topics: Coding, PDPM

PDPM - Where are We Now Q&A: Part 2

Posted by The Harmony Team on Mon, Feb 10, 2020

C.A.R.E.

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


Question 2 of 9: If the main reason for intensive rehab is because the resident is debilitated from being ill can I use the rehab treatment code that maps from CMS as the primary in I0020B?

The Harmony HealthCARE Specialist recommends that the Rehabilitation treatment codes should not be coded in 10020B if they are symptoms codes, return to provider codes and do not represent the primary reason for the SNF stay.  However, they do support the need for therapy and should be reported in other areas of the MDS.

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Topics: PDPM, 10020B

PDPM - Where are We Now Q&A: Part 1

Posted by The Harmony Team on Fri, Feb 07, 2020

C.A.R.E.

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


Question 1 of 9: Should the NTA diagnosis be listed on the UB?

Harmony Healthcare International (HHI) recommends that all active NTA diagnoses be included and properly sequenced on the UB-04 for the time period covered by the claim.  For MDS purposes, an active diagnosis is defined as one that has a direct relationship to the patient's functional status, cognitive status, mood and behavior status, nurse monitoring, medical treatment or risk of death. 

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Topics: PDPM, NTA

PDPM: Lessons Learned from Month One of PDPM

Posted by The Harmony Team on Tue, Jan 07, 2020

C.A.R.E.

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


Many teams in the field have been asked what they have learned over the last month of dealing with the Patient Driven Payment Model (PDPM) and MDS Assessments.

  1. Choice of the primary diagnosis and the ICD-10 Code really counts. It impacts not only the Case Mix Groups but needs to be supported in the Nursing Documentation.  The Nursing Notes must connect the dots between the assessments being completed, the Nursing Notes and the primary diagnosis.
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Topics: PDPM

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

ICYMI: Patient Driven Payment Model: Q & A (Part 3 of 3)

Posted by The Harmony Team on Tue, Apr 30, 2019

C.A.R.E.

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


Is your Skilled Nursing Facility ready for the October 1, 2019 implementation of Patient Driven Payment Model (PDPM) as CMS proposed in the SNF PPS Final Rule FY 2019?  We encourage you to use this 3 Part Blog Series to gain an understanding of the Patient Driven Payment Model Reimbursement System.  Questions were submitted to HHI during our recent webinar:  Patient Driven Payment Model: 5 Things to Do Now!

  1. Any idea how Case Mix states will handle this new classification system for Medicaid only facilities since section GG isn't done for these residents?
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Topics: Patient-Driven Payment Model

ICYMI: Patient Driven Payment Model: Q & A (Part 2 of 3)

Posted by The Harmony Team on Fri, Apr 26, 2019

C.A.R.E.

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


Is your Skilled Nursing Facility ready for the October 1, 2019 implementation of Patient Driven Payment Model (PDPM) as CMS proposed in the SNF PPS Final Rule FY 2019?  We encourage you to use this 3 Part Blog Series to gain an understanding of the Patient Driven Payment Model Reimbursement System.  Questions were submitted to HHI during our recent webinar:  Patient Driven Payment Model: 5 Things to Do Now!

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Topics: Patient-Driven Payment Model

ICYMI: Patient Driven Payment Model: Q & A (Part 1 of 3)

Posted by The Harmony Team on Thu, Apr 25, 2019

C.A.R.E.

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


Is your Skilled Nursing Facility ready for the October 1, 2019 implementation of Patient Driven Payment Model (PDPM) as CMS proposed in the SNF PPS Final Rule FY 2019?  We encourage you to use this 3 Part Blog Series to gain an understanding of the Patient Driven Payment Model Reimbursement System.  Questions were submitted to HHI during our recent webinar:  Patient Driven Payment Model: 5 Things to Do Now!

  1. Is there an actual table of rates that we can access?

    Yes, per the Federal Register / Vol. 83, No. 153 Final Rule 
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Topics: Patient-Driven Payment Model

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