Payment Reform Preparedness/Strategy

The FY2016 rule marks the transition away from fee-for-service and towards value-based payment in the Medicare system.

The Value-Based Purchasing (VBP) program under Medicare requires providers to become dependent on quality services for a portion of reimbursement. Beginning October 1, 2018, Medicare will make incentive payments to providers that reduce hospital readmissions using a readmission measures developed by CMS. Medicare payments to SNFs will be reduced by 2%. Payments equaling no more than 70% of these reductions may be used to fund the incentive payments under Value-Based Purchasing.

How can Harmony Healthcare International, Inc. (HHI) help?

Harmony Healthcare International, Inc. (HHI) can assist facilities to prepare for these changes to ensure ongoing accurate and appropriate reimbursement by developing, implementing and auditing medical records to refine clinical policy and procedure.

The scope of work will include, but not be limited to:

  • Quality Measure Analysis
  • Selective medical record review of patients triggering for focused Quality Measures
  • Selective medical record review of re-hospitalized patients
  • Review of Medicare skilled coverage criteria
  • Medicare Part A Revenue RUG analysis
  • Written report containing Audit Findings and Recommendations
  • Staff in-service related to findings (Falls Management, Dementia Management…)
  • Exit conference with Management team to review significant findings
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