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SNF PPS Patient-Driven Payment Model: Get Ready for Implementation on October 1

Health Policy
Centers for Medicare and Medicaid (CMS), Practitioners
March 28, 2019

On October 1, the new Patient-Driven Payment Model (PDPM) is replacing Resource Utilization Group, Version IV for the Skilled Nursing Facility (SNF) Prospective Payment System (PPS). The Centers for Medicare & Medicaid Services (CMS) has resources to help you prepare.

The Society has scheduled a webinar for Thursday, April 18, on this important topic: Patient-Driven Payment Model (PDPM): An Opportunity for PALTC Clinicians. Go here for additional details.

For more information:

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CMS Releases 2017 Quality Payment Program Experience Report

Health Policy
Centers for Medicare and Medicaid (CMS), Alternative Payment Models (APM), Medicare Access and CHIP Re-authorization Act (MACRA), Merit-Based Incentive Program Payment System (MIPS), Quality Payment Program (QPP), Practice Management, Practitioners
March 22, 2019

This week the Centers for Medicare & Medicaid Services (CMS) released its 2017 Quality Payment Program (QPP) Experience...

Fourth Snapshot of 2018 APM Participant and MIPS APM Data Released

Health Policy
Centers for Medicare and Medicaid (CMS), Alternative Payment Models (APM), Medicare Access and CHIP Re-authorization Act (MACRA), Merit-Based Incentive Program Payment System (MIPS), Quality Payment Program (QPP), Practice Management, Practitioners
March 22, 2019

The Centers for Medicare & Medicaid Services (CMS) updated its Quality Payment Program Participation Status Tool based on the fourth snapshot of data from Alternative...

Congress Introduces Legislation to Ensure Medicare SNF Coverage and Stop Surprise Billing

Health Policy
Skilled Nursing Care, Centers for Medicare and Medicaid (CMS), Observation Status, Practitioners
March 14, 2019

Reps. Joe Courtney (D-CT) and Glenn ‘GT’ Thompson (R-PA), and Sen. Sherrod Brown (D-OH) reintroduced bipartisan, bicameral legislation to fix an arbitrary Medicare policy that excludes coverage of skilled nursing care for certain patients, resulting in exorbitant and unexpected out-of-pocket costs. The Improving Access to Medicare Coverage Act of 2019 (H.R. 1682 & S. 753) would ensure Medicare covers doctor-recommended post-acute care by counting the time spent under “observation status” toward the requisite three-day hospital stay for coverage of skilled nursing care....

President Trump Releases FY2020 Budget

Health Policy
Long-Term Care, Post-Acute Care, Skilled Nursing Care, Practitioners
March 14, 2019

On March 11, the president released to Congress his budget request for fiscal year (FY) 2020. The budget request proposes significant reductions to Medicare and Medicaid over 10 years.  The president’s budget is non-binding.  Congress will now develop the budget and pass the measure for fiscal year 2020. 

Medicare

Medicare spending would be reduced under this budget by $845 billion over 10 years.  Significant provisions include proposed changes to the physician fee schedule and post-acute payments.

The budget establishes a...

Data Interoperability across the Continuum: CMS Data Element Library Call on March 19

Health Policy
Long-Term Care, Post-Acute Care, Centers for Medicare and Medicaid (CMS), Electronic Health Records (EHR), Health Information Technology (HIT), Practitioners
March 14, 2019

During this call on Tuesday, March 19, from 1:30-3 PM ET, you’ll learn about the recently released CMS Data Element Library (DEL), a database of post-acute care patient assessment content mapped to nationally accepted health IT standards to support interoperable health information exchange between providers and with patients. A question and answer session follows the presentation, including an opportunity to provide feedback on the DEL. Topics include:

  • The patient story: Use cases for health information exchange

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OIG Report Finds CMS Paid for SNF Care When 3-Day Inpatient Stay Not Met

Health Policy
Centers for Medicare and Medicaid (CMS), Practitioners
February 28, 2019

The Office of Inspector General (OIG) recently released a report looking at nursing home claims between 2013 and 2015 that had hospital stays of less than three consecutive calendar days and as such did not meet Medicare’s three-day stay requirement. The report found that the Centers for Medicare & Medicaid Services (CMS) improperly paid many of them anyway. OIG estimated that CMS improperly paid more than $84 million for nursing home services that didn’t meet the 3-day stay rule during that time, based on its audit...

Interoperability and Patient Access to Health Data: New Proposals

Health Policy
Centers for Medicare and Medicaid (CMS), Practice Management, Electronic Health Records (EHR), Health Information Technology (HIT), Practitioners
February 28, 2019

The Centers for Medicare & Medicaid Services (CMS) proposed policy changes supporting the MyHealthEData initiative to improve patient access and advance electronic data exchange and care coordination throughout the health care system. The Interoperability and Patient Access Proposed Rule outlines opportunities to make patient data more useful and transferable through open, secure, standardized, and machine-readable formats while reducing restrictive burdens on health care providers.

In addition to the policy proposals, CMS released two requests for information to obtain...

Explore the Business and Clinical Side of PALTC

Health Policy
Centers for Medicare and Medicaid (CMS), Alternative Payment Models (APM), Medicare Access and CHIP Re-authorization Act (MACRA), Merit-Based Incentive Program Payment System (MIPS), Quality Payment Program (QPP), Practice Management, Practitioners
February 21, 2019

AMDA – The Society for Post-Acute and Long-Term Care (PALTC) Medicine’s 2019 Annual Conference, March 7-10 in Atlanta, GA, is the only place to get the latest clinical developments in geriatric medicine, best practices in medical direction, policy/regulatory updates, opportunities for networking and socializing, and much more.

The conference’s practice management sessions will explore the business and clinical leadership...

SNF PPS Patient Driven Payment Model: Updated Resources

Health Policy
Care Settings/Types, Centers for Medicare and Medicaid (CMS), Payment, Practitioners
February 21, 2019

On October 1, 2019, the new Patient Driven Payment Model (PDPM) is replacing Resource Utilization Group, Version IV for the Skilled Nursing Facility (SNF) Prospective Payment System (PPS). Based on stakeholder feedback, the Centers for Medicare & Medicaid Services (CMS) revised resources on the PDPM webpage to help you prepare for implementation, including:

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