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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…

Understanding PDPM and the SLP Component

For the Speech Language Pathology (SLP) component, the Patient-Driven Payment Model (PDPM) uses a number of different patient characteristics that were found to be predictive of increased SLP costs. These include identification of any diagnosis in the Acute Neurologic clinical classification and identified SLP-related comorbidities.There are twelve SLP-related comorbidities. These include aphasia, CVA, TIA or stroke, hemiplegia or hemiparesis, traumatic brain injury, tracheostomy or ventilator, laryngeal cancer, apraxia, dysphagia, ALS, oral cancers, or speech and…