Article by McKnights Long-Term Care News

“Many providers are not properly capturing several services on the MDS and therefore are missing out on higher reimbursements under the new Patient Driven Payment Model, consulting experts cautioned Wednesday.

“We’re clearly seeing that there is an awful lot of acuity that’s being missed on the MDS. People are still not capturing the MDS accurately in order to capture the best PDPM rates — and they won’t be for awhile. It’s just an incredible learning curve that we’re on,” Steven Littlehale, chief innovation officer for Zimmet Healthcare Services Group, a consulting firm for post-acute providers, told McKnight’s.

Zimmet Healthcare released a reimbursement analysis that examined October Medicare billing for skilled nursing facilities under PDPM. The analysis reviewed more than 20,000 claims from 623 SNFs (both for-profit and nonprofit facilities) across 35 states and the District of Columbia. PDPM, which began Oct. 1, is the new payment system for nursing home providers that replaced the Resource Utilization Group (RUG) system.”

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