Managed Care Companies Take Lead on PDPM Denials — But CMS Could Step Up Scrutiny During 2021

Over the course of 2020, as skilled nursing facilities battled the COVID-19 pandemic, the Patient-Driven Payment Model (PDPM) was one of the bright spots for operators, allowing them to secure payments for caring for the clinical needs of patients at a time when those needs grew markedly more complex. The Centers for Medicare & Medicaid […]

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 […]

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’ […]

Research, Ability and Track Record: How SNFs Have to Help Referrers Under PDPM

With the Medicare reimbursement overhaul taking place in a few short months, skilled nursing facilities — ideally — are moving into the last stages of preparation and training for staff and workflow procedures. But according to post-acute care partnership strategist Mike Wetula of therapy company TMC, SNFs can’t ignore their referral partners in the process. […]