‘Audits are back,’ and COVID-19 care is in the hot seat
By
Kimberly Marselas
Apr 21, 2021
Flexibilities granted to providers during the ongoing public health emergency are likely to result in increased medical reviews and automated denials, a therapy billing specialist is warning.
Guess what’s coming to nursing homes next
By
Kimberly Marselas
Apr 03, 2024
I remember when the Patient Driven Payment Model rule was just a proposal inching its way toward finalization, its concept of assigning points for specific non-therapy ancillary costs a pretty exciting...
Providers ‘on notice’ as CMS pressures states to shift Medicaid pay metrics
By
Kimberly Marselas
Nov 10, 2022
Providers still struggling to accurately capture diagnoses that drive federal reimbursement will be doubly left behind as more states start to use Patient Driven Payment Model-like systems to determine...
CMS eyeing PDPM case-mix additions, changes
By
Kimberly Marselas
Apr 24, 2023
Federal regulators are weighing changes to the three-year-old Patient Driven Payment Model to account for missed opportunities — and potentially inappropriate coding choices — a top Medicare official...
Need a PDPM boost? A new study points to physiatrists for $34,000 monthly kick
By
Kimberly Marselas
Oct 20, 2022
Physiatrists can help skilled nursing facilities more accurately capture reimbursement under the Patient Driven Payment Model, a leading payment consultant said Tuesday.
BREAKING NEWS: CMS gives skilled nursing 2.4% Medicare pay raise, unveils another new resident classification...
By
Kimberly Marselas
Apr 27, 2018
In a flurry of activity late Friday, the Centers for Medicare & Medicaid Services announced an $850 million pay raise for skilled nursing facilities for fiscal 2019 that comes along with major simplifications...
CMS let the cat out of the bag, but it’s managed care that’s ready to pounce
By
Kimberly Marselas
May 05, 2021
If you work with managed care (and who doesn’t anymore), chances are pretty good you’re already on a collision course that’s been accelerated lately
Pay good providers more to care for dementia patients, researchers urge
By
Kimberly Marselas
Feb 09, 2023
Policymakers should consider incentivizing nursing homes to take patients with Alzheimer’s disease and related dementias, argue the authors of a new study that finds such patients currently are more...
Providers tell CMS it’s ‘decidedly’ the wrong time to toy with PDPM rates
By
Kimberly Marselas
Jun 03, 2021
Providers need more time before the Centers for Medicare & Medicaid Services would implement any adjustments to PDPM payment rates, operators and associations have told the agency in official comments.
On PDPM cuts, Congress ‘stands ready’ to exert its authority — but where’s the checkbook?
By
Kimberly Marselas
Jul 05, 2022
Providers will no doubt be overjoyed to learn today that members of Congress — a whopping 40 of them! — are stepping into the fray over proposed cuts to the nursing home sector’s new payment model....