Webinars

Shortly after PDPM’s implementation, during the Public Health Emergency, the Centers for Medicare and Medicaid Services(CMS) and Managed Care companies temporarily suspended medical reviews. For months, we had no external regulatory feedback on our documentation and billing practices under this new and complex payment system.  But now, all payors have resumed medical reviews.  All but one of the Medicare Administrative Contractors are currently doing SNF-PDPM TPEs and CMS just announced their expectations for every SNF to receive a 5 claim SNF-PDPM probe and educate review.   It is safe to say that the medical review oversight is back in the SNF Part A arena.

 

It is a misconception that therapy is no longer important or a focus for medical review and denials under PDPM. Therapy still contributes to the criteria for a skilled level of care and the therapy documentation should support the coding of many MDS components that contribute to the SNF daily reimbursement rate. This session will discuss the continued relevance of therapy collaboration with the MDS Coordinator and interdisciplinary team to mitigate denial risk.