Winners Still Outnumber Losers in Latest PDPM Analysis, But Length of Stay Trends Could Erase Rate Gains

The latest analysis of the new Medicare payment model for nursing homes again shows more operators scoring gains than suffering losses, but the change from the previous system may not be quite as straightforward — particularly as fee-for-service Medicare continues to lose ground to other payment sources. A little more than 67% of skilled nursing […]

Tips for Early PDPM Success: Demand More Data from Hospitals, Market Higher-Acuity Services

The early returns for the new Medicare nursing home payment model have been positive, but providers aren’t seeing gains by sitting back and watching the changes. Several key strategies for success have emerged in the Patient-Driven Payment Model’s first four months, with a particular focus on data — as well as clearly communicating the availability […]

Weighing the Promise and Perils of Skilled Nursing Ventilator Care Under PDPM

Among the many unknowns of the new Patient-Driven Payment Model (PDPM) is its effect on the types of patients coming into the skilled nursing facility. But one place to watch resident patterns is around the addition of ventilator services and care to facilities — especially if they haven’t offered those options before. Respiratory therapy — along with […]

Early PDPM Reactions: Therapy Companies’ Reimbursement Optimism, Continued Coding Challenges

With intense attention on therapy cuts and reimbursement changes during the transition to the Patient Driven Payment Model (PDPM) on October 1, operators and lead clinicians have focused on continuing education and training to remain financially sustainable amid this historic shift. SNN spoke to four therapy companies to see how operators and clinicians are faring […]

Early PDPM Claims Data Reveals Far More Winners Than Losers, ‘Impossible Combinations’ of Conditions

The first round of claims data under the new Medicare payment model for nursing homes shows that the majority of operators are seeing reimbursement boosts — while some are also making key billing mistakes that could result in missed payments for certain services. The average skilled nursing facility saw Medicare reimbursements of $614.96 per patient […]

Some Medicare Contractors Holding Up Claim Payments Amid the Shift to PDPM

Some of the private insurance companies that process Medicare claims on behalf of the federal government are holding up claims for skilled nursing facilities after the implementation of the Patient-Driven Payment Model (PDPM) in October. But it’s not clear how widespread that is, BKD director John Harned and senior managing consultant Sherri Robbins said on […]

A Month into PDPM, Breaking Down the Pros and Cons of Third-Party, In-House Therapy

About a month into the Patient-Driven Payment Model (PDPM) for skilled nursing facilities, operators are taking stock of reimbursement strategies — including how they are tracking clinical outcomes and overall margins. Shifting from a third-party provider to an in-house model, or vice-versa, might also be part of that equation, though the answer isn’t quite straightforward.  […]

Why Signature Believes 18 Months of PDPM Prep Will Pay Off

The first round of earnings calls these past two weeks revealed few firm outcomes related to the new Medicare payment model for nursing homes, but one provider was identified as potentially ahead of the curve: Signature HealthCARE. Omega Healthcare Investors (NYSE: OHI) chief investment officer Robert Stephenson on Wednesday praised Signature, one of its tenants, […]

Therapy Cuts Were ‘Inevitable’ Under PDPM — and Providers Must Prepare for Possible Payment Drops

Reports of therapist layoffs and cuts in therapy hours hit the news within days of the implementation of the new Medicare reimbursement system for skilled nursing facilities, sending shock waves throughout the rehab provider community. But according to one major skilled nursing trade group, the cuts to therapy were baked into the system of the […]

Each Medicare Advantage Plan Can Treat PDPM Differently — and SNFs’ Mileage Will Vary

Skilled nursing providers looking for a simple answer to how managed care plans will react to the new Medicare payment model will likely have to face an inconvenient truth: It’s complicated. Private Medicare Advantage insurers didn’t have to follow the old Resource Utilization Group (RUG) model when deciding how to reimburse for skilled nursing services, […]

It’s Here: Skilled Nursing Providers, Investors Weigh in on PDPM Opportunities, ‘Stumbling Blocks’

The long wait is over: The new Medicare payment system for nursing homes has arrived. October 1 marks the official start of the Patient-Driven Payment Model (PDPM), just about 18 months after the federal government first announced the change in April 2018. Since then, the skilled nursing industry has trained a laser focus on preparations […]

Unpacking the New Therapy Contract Math for Skilled Nursing Providers Under PDPM

Faced with a sea change in the Medicare reimbursement system for nursing homes, operators have spent the last year asking a key question about their therapy offerings: outsource or in-house? And if the answer is outsource, what will that relationship look like moving forward in unfamiliar payment landscape? There’s no one correct answer for contract […]