The Potential and Risks of Maintenance Therapy

The Jimmo Settlement Agreement in January 2013 states that qualification for Medicare coverage depends on the beneficiary’s or patient’s need for skilled care, either nursing or therapy (PT, OT, and SLP) services, and NOT on their potential for improvement. This agreement made the Centers for Medicare and Medicaid Services (CMS) update and clarify the Medicare Benefit Policy Manual (MBPM) Chapter 1 – Inpatient Rehabilitation Facility (IRF), Chapter 7 – Home Health, Chapter 8 – Coverage…

Pitfalls of the Patient-Driven Payment Model (PDPM) – Capturing Parenteral/ IV Feeding While Not a Resident

Welcome back to our blog series on PDPM! You can find the previous two blogs here:  blog #1 & blog #2. The Patient-Driven Payment Model (PDPM) is the reimbursement methodology for Medicare Part A that has been implemented for Skilled Nursing Facilities (SNFs) since October 1, 2019. The PDPM was designed to improve the accuracy of Medicare reimbursement to SNFs by basing the payment on the patient’s clinical characteristics and care needs rather than on…

What You Need to Know about a Compliance Gap Analysis

How do you know if you NEED a Compliance Gap Analysis when you might not even know what a compliance gap analysis is? A compliance gap analysis is a detailed review of your company’s compliance health. It reviews your plans and controls within the organization to see if they are maintaining the state of compliance that you desire. To put it simply, if you start with an outline of your current state of compliance, then…