CMS ‘Quiet’ on PDPM-Related Enforcement Even as Rates Rise, But Managed Care More Prone to Denials

The Patient-Driven Payment Model (PDPM), the overhaul to Medicare reimbursement for skilled nursing facilities that took effect in October of 2019, has proven its worth as a mechanism for paying for nursing care during a global pandemic. It has, however, been “anything but revenue-neutral,” at least in terms of how much money the government is […]

Almost a Year After PDPM’s Implementation, Providers Still Miss Key Payment Drivers

In the months leading up to the implementation of the Patient-Driven Payment Model, the overhaul of Medicare reimbursement for skilled nursing facilities that was implemented last year, several factors emerged as crucial areas for thriving under the new system. The Medicare rate of each facility is determined by a formula that draws from five care […]

Fresh Off Private Equity Pickup, Wound Care Provider AMT Seeks Skilled Nursing Expansion

A leading wound care provider sees expansion opportunity in both skilled nursing and the home despite the ongoing strains of COVID-19, with a recent private equity investment to back it up. American Medical Technologies in late August announced its acquisition by private equity firm One Equity Partners and investment management company The Silverfern Group, capping […]

Isolating COVID-19 Patients Critical for Nursing Home Safety — But PDPM Hasn’t Caught Up

The infectious nature of COVID-19 makes it imperative that skilled nursing facilities take extra precautions around any new admissions that they bring in, as well as any residents that are returning from a hospital stay. According to the Centers for Disease Control and Prevention (CDC), the procedure for SNFs is straightforward: Keep any COVID-19-positive patients […]

Though Data on Outcomes Sparse, CMS Han’t Forgotten PDPM Monitoring — While Wage Index Drops Loom

The Centers for Medicare & Medicaid Services (CMS) has been slow to make moves on audit demonstrations for the Patient-Driven Payment Model (PDPM), the Medicare reimbursement overhaul for skilled nursing facilities that took effect last year. But that doesn’t mean that the agency has forgotten its promise to closely monitor patient outcomes and scrutinize SNFs’ […]

COVID-19 Scrambles PDPM Math, Particularly Around Therapy Minutes: ‘This Will Be a Complete Rebuild’

In the lead-up to the implementation of the Patient-Driven Payment Model (PDPM) on October 1, 2019, consultants, therapists, and the federal government warned operators over and over that therapy minutes would come under intense scrutiny in the months following the start of the new Medicare reimbursement system. The model allowed for patients to receive up […]

Skilled Nursing Facilities to See 2.3% Medicare Raise — or $784M — Under Fiscal 2021 Proposed Rule

The federal government late Friday released its proposed rule for skilled nursing facility payments for the coming fiscal year, which will see the nation’s nursing homes receive a 2.3% Medicare pay bump. “This estimated increase is attributable to a 2.7% market basket increase factor with a 0.4 percentage point reduction for multifactor productivity adjustment,” the […]

Researchers Find ‘Perverse Incentives’ for Skilled Nursing Operators Under PDPM

The new Medicare payment model for nursing homes was designed to eliminate the temptation to make key care decisions based solely on reimbursements, and not on individual residents’ needs. Though the early results from the Patient-Driven Payment Model (PDPM) have largely been positive for the industry, a group of researchers this week raised concerns about […]

After PDPM, ‘More Than Half’ of Therapists Report Mandate to Provide Group, Concurrent Therapy

The Patient-Driven Payment Model (PDPM) was specifically designed to reimburse skilled nursing facilities based on the condition of the patients that they treat, rather than by the minutes of therapy provided to those patients. As part of the change, the Centers for Medicare & Medicaid Services (CMS) included a 25% cap on group and concurrent […]

Diversicare ‘A Very Different Company’ After Kentucky Exit, Touts 7.5% Medicare Rate Boost

Despite a net loss for the quarter, skilled nursing operator Diversicare Healthcare Services (OTCQX: DVCR) touted its performance at the end of 2019, pointing to a 7.5% Medicare rate boost and generally positive performance under the new Patient-Driven Payment Model (PDPM). “With our portfolio changes behind us after the Kentucky exit and the implementation of the new […]

Skilled Nursing Operators Can Find Success Under the ‘Quite Similar’ PDPM and I-SNP Models

The Patient-Driven Payment Model (PDPM) overhauled the way skilled nursing facilities are paid for their services to Medicare fee-for-service patients when it took effect last year – removing therapy as a driver of reimbursement and putting an emphasis on patient conditions. That gives it more than a passing resemblance to a lightning rod in the […]

CMS Confirms Some PDPM Claim-Processing Errors, Promises Fix by October

The federal government on Thursday acknowledged some errors in processing Medicare claims under the new payment system for nursing homes, promising to make a full correction by the start of its next fiscal year. The main issue has to do with the sequence of initial claim filings for Patient-Driven Payment Model (PDPM) reimbursements, the Centers […]

Rise of Data Could Bring More False Claims Act Cases, CMS Scrutiny to Skilled Nursing

Attend any conference geared toward long-term and post-acute health care operators, and you’ll hear a common thread: Data is king. In a landscape defined by value-based payment models such as Medicare Advantage plans and accountable care organizations (ACOs), investing in data analytics has become almost a prerequisite for success. If a given operator can prove […]

Verma: CMS’s Nursing Home Oversight Push More ‘Internal’ Amid PDPM Shift

Seema Verma on Tuesday laid out a sweeping plan for data-driven oversight and enforcement across the health care spectrum, and took a similarly broad view of her agency’s regulatory plans when directly asked about potential changes to the new Medicare payment model for nursing homes. Specifically citing the early success of the agency’s recent push […]

‘CMS Loves That’: Moderate Therapy Shifts, Bureaucratic Reality Could Slow PDPM Changes

Despite steady reports of increasing reimbursements under the new Medicare payment model for nursing homes, at least one industry leader believes that the federal government will be happy with the early returns — and that any changes are fairly far down the road. Skilled nursing operators have not gone overboard with the strategy changes that […]