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HI 225 Ch08 snfpps pp ts.ab202017
1.
© 2018 American
Health Information Management Association© 2018 American Health Information Management Association Principles of Healthcare Reimbursement Sixth Edition Anne B. Casto, RHIA, CCS
2.
© 2018 American
Health Information Management Association Chapter 8 Medicare-Medicaid Prospective Payment Systems for Postacute Care • Learning Objectives – Describe Medicare’s all-inclusive per diem rate for skilled nursing facilities – Differentiate the specialized collection instruments that exist in postacute care – Explain the classification models and payment formulae associated with reimbursement under Medicare and Medicaid prospective payment systems in postacute care 2
3.
© 2018 American
Health Information Management Association Skilled Nursing Facility Prospective Payment System • Key Terms – Postacute care (PAC) – Base rate – Skilled nursing facility (SNF) – Consolidated billing (CB) – Minimum Data Set (MDS) – Activities of daily living (ADLs) – Resource Utilization Group (RUG) – Nursing component – Therapy component – Non-case-mix adjusted component – Non-case-mix component – Non-case-mix therapy component – Nursing per diem amount – Nursing index – Therapy per diem amount – Therapy index 3
4.
© 2018 American
Health Information Management Association Introduction to Postacute Care (PAC) • Settings that provide patients with healthcare services for their recuperation and rehabilitation after illness or injury – PAC allows continuing safe recovery in settings less intensive and more appropriate than acute- care inpatient hospitals • Medicare’s overarching goal for PAC: – Ensure beneficiaries receive appropriate high-quality care in least costly settings appropriate for their clinical conditions • Four settings designated by Medicare Payment Advisory Commission (MedPAC) 4 Skilled nursing facilities (SNF) Long-term care hospitals (LTCH) Inpatient rehabilitation facilities (IRF) Home health agencies (HHA)
5.
© 2018 American
Health Information Management Association PAC Similarities Require data collection Based on a classification system Base rate converts relative weight to dollars Geographic adjustment for cost of labor Provisions and adjustments for patients with atypical characteristics and facilities with special situations 5
6.
© 2018 American
Health Information Management Association IMPACT of 2014 • Improving Medicare Post-Acute Transformation Act of 2014 – PAC providers will report standardized patient assessment data, standardized quality measures, and resource-use measures – CMS will modify existing data collection tools to meet the requirements of IMPACT 6
7.
© 2018 American
Health Information Management Association Skilled Nursing Facility PPS Nursing Home • Healthcare facility licensed by states • Offers 24-hours per day skilled nursing care and personal care services Skilled Nursing Facility • Provides short-term skilled nursing care and rehabilitation services to beneficiaries after an acute-care inpatient hospitalization 7
8.
© 2018 American
Health Information Management Association Basic Concepts ADL Basic personal activities such as bathing, eating, dressing, etc. Used to measure person’s dependency on requiring assistance to perform any or all activities Personal Care Services Custodial care Assistance with ADLs, self-administration of medications, light housekeeping, etc. Person would typically complete if they did not have a disability Rehabilitation Services Restore function Physical therapy, occupational therapy, speech therapy or any combination of these therapies 8
9.
© 2018 American
Health Information Management Association SNF Facilities • Sites of SNFs – Freestanding facilities (~95% of stays) – Hospital-based units – Swing beds in acute care hospitals • Small, rural hospitals or critical access hospitals • Swing beds used for inpatient acute care and skilled nursing care 9
10.
© 2018 American
Health Information Management Association Reimbursement Methodology • Per diem payment – Includes all costs that efficient facilities would be expected to incur furnishing most SNF services • Operating – Skilled nursing care – Rehabilitation services – Ancillary services • Capital costs • Other goods and services – Excludes high-cost, low-probability services (reimbursable separately) 10
11.
© 2018 American
Health Information Management Association Consolidated Billing • Requires the SNF to pay for outpatient services that a resident may receive from a vendor – Includes • Laboratory • X-ray • Pharmacy – Excludes emergency medical services; inpatient services; extensive procedures; and certain high- cost, low probability-ancillary services 11
12.
© 2018 American
Health Information Management Association Data Collection • Data collection tool – Minimum Data Set (MDS) 3.0 • Extensive data base of clinical data that represents documentation of the resident’s care • Part of the health record • Assessments must be completed within required time frames – See table 8.1 in the textbook 12
13.
© 2018 American
Health Information Management Association Structure of Payment • Per diem base rate – Based on SNF cost reports – Wage index adjusted • See figure 8.2 in the textbook 13
14.
© 2018 American
Health Information Management Association Structure of Payment • Resource Utilization Groups (RUGs) – Adjusts the base rate for patient resource intensity 14 Nursing component Therapy component Non-case- mix adjusted component
15.
© 2018 American
Health Information Management Association RUGs IV 66 RUGs 52 Upper Groups Minimum 45 total therapy minutes per week or require skilled or extensive services 14 Lower Groups Residents typically do not require skilled care 15
16.
© 2018 American
Health Information Management Association RUGs IV – Upper Groups 66 RUGs 52 Upper Groups Rehabilitation Plus Extensive 9 RUGs Rehabilitation 14 RUGs Extensive Services 3 RUGs Special Care High 8 RUGs Special Care Low 8 RUGs Clinically Complex 10 RUGs 14 Lower Groups 16
17.
© 2018 American
Health Information Management Association RUGs IV – Lower Groups 66 RUGs 52 Upper Groups 14 Lower Groups Behavioral Symptoms and Cognitive Performance 4 RUGs Reduced Physical Function 10 RUGs 17
18.
© 2018 American
Health Information Management Association RUGs IV Assignment • Takes into consideration – Total therapy minutes, type of therapy, number of days in therapy, mode of therapy – Presence of conditions and diagnoses; for example, tracheostomy status, ventilator status, depression – ADL score • See figure 8.4 in the textbook 18
19.
© 2018 American
Health Information Management Association Reimbursement • See table 8.2 in the textbook for sample payment calculation – The per diem rate for the RUG is wage index adjusted to create the adjusted per diem rate – The adjusted per diem rate is multiplied by the number of Medicare days (LOS) to determine the reimbursement amount 19
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