July 25, 2023

Understanding PDPM and the Interim Payment Assessment

In our “Understanding PDPM” blog series, we have discussed the specific components for Physical Therapy (PT), Occupational Therapy (OT), Speech Language Pathology (SLP), Nursing, and Non-Therapy Ancillary (NTA). The Centers for Medicare & Medicaid Services (CMS), in an effort to simplify the assessment process, has identified that the 5-day MDS can support the reimbursement for the patient’s entire length of stay under the Patient-Driven Payment Model (PDPM). This would significantly decrease the administrative burden for completion…

Skilled Nursing Billing: Understanding Which Diagnosis Code to Use

Selecting codes for your Skilled Nursing Facility (SNF) claims can often be mind-boggling. Residents are admitted to SNFs with varying length of stays and the admission reason is often different from the reason for continued stay. Diagnosis codes can be assigned at the time of admission, concurrently as diagnosis arises, and at the time of discharge. In any of these situations, a principal diagnosis may represent the admission diagnosis, the reason for continued stay, or discharge…

Physical Therapy Fraud Indictment of Owners and 18 Staff – 1 Year Later

It was just over a year ago when the U.S. Department of Justice (DOJ) in the Western District of Pennsylvania announced indictments against Hertel & Brown, an outpatient physical therapy provider, including the owners, and eighteen (18) employees for committing healthcare and wire fraud. This included Hertel and Brown’s billing specialist. The Federal Bureau of Investigation (FBI) showed up at Hertel and Brown Physical & Aquatic Therapy with search warrants and in black SUVs. The…