The Patient Driven Payment Model (PDPM) has forced skilled nursing facilities (SNFs) to make many adjustments since its launch in October 2019. SNFs must now track hundreds of activities and metrics to be successful under the new case-mix system.
Perhaps more troublesome: Many SNF insiders have been surprised by how much money is still being left on the table – despite CMS’ suggestions that PDPM will bring a positive revenue upside.
It’s always been important to correct issues or errors before submitting a claim. But with PDPM, it’s more critical than ever. During a claims analysis, you may find that something as simple as putting a wrong code in the wrong place or processing issues can cause you to miss out on money rightfully owed to your SNF.
Here are five things your SNF may be doing to leave money on the table under PDPM:
PDPM is a new world for SNFs, and facilities around the country are still trying to figure out best practices for success under the new payment model. SNFs must create and implement effective procedures so that they have the information they need to make decisions and, ultimately, find success under PDPM.
About the Author
Maureen McCarthy, RN, BS, RAC-MT, QCP-MT, DNS-MT, RAC-MTA, is President of Celtic Consulting, LLC, a clinical reimbursement, clinical operations and compliance advisory firm. She is also the CEO of MDSRescue, an organization that provides temporary MDS completion services across the country. Recognized as an industry leader in clinical reimbursement for long-term care, Maureen has been a registered nurse for more than 30 years with experience as an MDS Coordinator, Director of Nursing, Rehab Director and a Medicare biller.
Maureen is the immediate past-president for the Association of Long-Term Care Financial Managers, the Medicare & MDS 3.0 Advisor for several state affiliates, and an advisor to the J13 Medicare contractor National Government Services Provider Advisory Group. She is also an Editorial Advisor for HCPro, a national publisher for post-acute care providers. She sits on the Board of Directors for the American Association of Post-Acute Care Nurses (AAPACN) and serves as an Expert Advisory Panel member for the American Association of Nurse Assessment Coordination (AANAC). McCarthy was recently presented the ACHCA 2018 Education Award, at the ACHCA Annual Convocation & Exposition in Orlando, FL. She has been selected to join the American Health Care Association (AHCA) PDPM Academy Training Team, which provides education to the nation’s state affiliates regarding the new PDPM system.
Maureen is certified in the resident assessment process, QAPI and Director of Nursing Services, by nationally recognized organizations and holds Master Teacher status in all three certifications. She and her associates at Celtic Consulting regularly provide consultation focusing on 5-Star Quality Improvement Programs, Quality Auditing, Clinical Care Management, PDPM/PPS/MDS/CMI Services, Compliance Solutions, including Medicare Compliance Auditing and Custom Education to meet any organization’s needs.