The new Medicare payment model for post-acute care providers has largely gotten lost in the more pressing concerns of COVID-19, but as operators continue to struggle with increased costs related to the pandemic, some are still making mistakes that could cause them to lose out on money they earned. The … Read More
FY 2021 PDPM ICD-10 mappings posted
CMS has posted the ICD-10 PDPM Mappings for FY2021 on this webpage. Scroll down the page to find: https://www.cms.gov/files/zip/fy-2021-pdpm-icd-10-mappings.zip-0 is the direct link to this .zip file. You’ll find these spreadsheets when you access that .zip file. Want to keep up with the changing COVID-19 situation in skilled nursing? Subscribe … Read More
SNF patient-driven payment model interrupted stay issue
A new issue is affecting some inpatient hospital and Skilled Nursing Facility (SNF) claims when an interrupted stay is billed at the end of the month. The system incorrectly assigns edits U5601-U5608 (overlapping a hospital claim). If you billed the interrupted stay correctly, and your claim is rejected, modify your … Read More
PDPM Boosts Medicare Rate 9% Early in COVID-19 Crisis: ‘RUGS-IV Would Have Been a Fiscal Disaster’
Skilled nursing facilities received a 9% Medicare reimbursement boost during the early days of the COVID-19 crisis under the new Patient-Driven Patient Model, a new analysis has determined — providing a crucial fiscal lifeline that may not have existed under the structure that PDPM replaced. “RUG-IV would have been a … Read More
The COVID Effect: A Comparative Analysis of April 2020 Medicare SNF Claims
The human mind is a poor processer of large numbers (“large” in this case is any figure with more than two digits). Accounting for fatalities from 1918’s influenza pandemic is, unfortunately, a logical place to begin a discussion about this evolutionary shortcoming. As curiosity naturally piqued interest about that strain’s … Read More