Is Your Documentation PDPM-Ready?
July 30, 2019
By Jennifer Gross, BSN, RN-BC, RAC-CT, CPHIMS As Skilled Nursing Facilities (SNFs) prepare for the implementation of the Patient-Driven Payment Model (PDPM) on October 1, 2019, much of the focus of training has been on diagnosis coding. Rightly so, since ICD-10 coding can make or break a facility’s capture of the correct PDPM Clinical Categories…
PDPM: We’ve Talked about SNFs – What about Hospitals?
July 14, 2019
by Pam Kaiser, MSN, RN In the past, changes to the payment system for Skilled Nursing Facilities (SNFs) impacted other health care sectors. When the Balanced Budget Act of 1997 (BBA) went into effect, many hospital dialysis patients had a hard time getting places in SNFs. Under Consolidated Billing at the time, the SNF was…
The Changing Tides of Compliance under PDPM
May 21, 2019
By Janine Savage, RN, RAC-CT, CHC Since the CMS Final Rule announcing the Patient-Driven Payment Model (PDPM) was released, there has been much speculation among SNF providers and industry experts about what compliance will look like under the new reimbursement system. Under RUG-IV, compliance primarily depends on one key metric: medical necessity for therapy services….
The Big Thaw: Five-Star Update
March 14, 2019
CMS is “thawing out” the freeze on Five-Star Ratings effective April 2019. We were all expecting the thaw this spring, and CMS doesn’t disappoint! Remember that spring showers bring May flowers, and for some of you, “flowers” will take the form of an improvement in your Five-Star Rating. CMS did more than just unfreeze the Five-Star…
Five-Star’s Early Adolescence and the Growing Pains that Go Along with It
January 15, 2019
by Steven Littlehale December 2018 marked Five Star’s ten-year “birthday.” When you read its birth certificate, you’ll see its given name is: “Five-Star Quality Rating System,” though interestingly enough, the only direct measures of quality (the CMS quality measures) carry the least weight. Over the last ten years Five-Star has certainly matured considerably and if…
Readmissions, Care Transitions, and Value-based Programs
January 9, 2019
by Pam Kaiser, MSN, RN If it seems that hospitals have been focused on readmission rates for years, they have. Starting in fiscal year 2013, hospitals have been penalized for readmission rates for Medicare beneficiaries with certain diagnoses. Those penalties have been increasing with each year until the penalty cap of 3% was reached. Progress…
CEO Steven Scott Looks Ahead to 2019 – PDPM & More
December 18, 2018
Thank you PointRight clients, partners and friends for a great 2018. It’s been quite a year for our industry to say the least. Wild fires in California turned hero care-givers into hero rescuers, CMS’ continued its commitment to value-based reimbursement with the announcement of PDPM and Five Star turned 10. Looking to 2019, PointRight is preparing our clients to…
“Happy Birthday Dear Five-Star, Happy Birthday to You!”
December 12, 2018
We are celebrating Five-Star’s 10th year birthday this December 2018. Over the last ten years, Five-Star has certainly matured considerably, and if you believe it measures quality, then you also must accept that nursing home quality has also improved. [We at PointRight believe that quality has improved but choose other ways to validate the industry’s improvement.]…