Are You Checking for Interim Payment Assessments in Your SNF?

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The transition from the Resource Utilization Groups (RUGs) system to the Patient-Driven Payment Model (PDPM) in Skilled Nursing Facilities (SNFs) has brought about significant changes in how facilities are reimbursed for the care provided. One of the critical tools in optimizing reimbursement under PDPM is the Interim Payment Assessment (IPA). When used correctly, the IPA can play an important role in ensuring that SNFs receive the appropriate reimbursement to reflect the level of care provided…

 What Do Providers Need to Know About Future Non-Therapy Ancillary (NTA) Changes?

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The Centers for Medicare & Medicaid Services (CMS) has been collecting feedback from healthcare providers on how to improve the Non-Therapy Ancillary (NTA) component of the Patient-Driven Payment Model (PDPM) in Skilled Nursing Facilities (SNFs). In response to concerns and data analysis from Fiscal Year (FY) 2019-2022, CMS has proposed several changes to simplify and improve how NTA points are assigned. While the NTA changes were not in effect on October 1, 2024, CMS has…

Understanding Assistant-At-Surgery and Co-surgeon Claims

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The Office of Inspector General (OIG) recently completed an audit on their work plan of co-surgeon claim payments to determine if the payments complied with federal requirements. Per the OIG, their findings were as follows: “From our 100 statistically sampled services, we found that 69 did not comply with Federal requirements. Specifically, these statistically sampled services included 49 that were incorrectly billed without the co-surgery modifier, 14 that were incorrectly billed without an assistant-at-surgery modifier,…