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The Public Health Emergency Renewal of January 11, 2023: What is the Impact on Skilled Nursing Facilities?

The U.S. Department of Health and Human Services (HHS) announced the twelfth extension of the Public Health Emergency (PHE) on January 11, 2023. With each PHE extension, several flexibilities and waivers remain in effect. One that has the greatest impact on skilled nursing facilities (SNFs) is the 3-day prior hospitalization requirement for Medicare beneficiaries. Although the 3-day prior hospitalization for Medicare Part A coverage in a SNF continues to be waived, providers must be aware…

Understanding PDPM and the Nursing Component

There has been much talk about the upcoming proposed switch to the Patient Driven Payment Model or PDPM for reimbursement of Medicare Part A patient stays in Skilled Nursing Facilities (SNFs). The proposed change is effective on October 1, 2019. The model includes the per diem payment as the sum of five case-mix adjusted clinical components based on the patient characteristics and a non-case-mix adjusted rate for every patient. The case-mix adjusted components include: Physical Therapy…

Understanding PDPM and the Medicare Benefit Policy Manual Chapter 8

With the focus on changes in reimbursement requirements related to the Patient Driven Payment Model (PDPM) that has taken effect October 1, 2019, one might not be thinking about the Medicare requirements that remain unchanged.  The Medicare Benefit Policy Manual (MBPM) Chapter 8, provides fundamental rules and regulations that are the foundation of Medicare Part A for the Skilled Nursing Facility (SNF). It is important to remember that these rules are NOT changing.  One might…