| | | SNF providers are on the edge of their seats as they anticipate CMS’ consideration of a replacement for the resource utilization group (RUG) system, which will change the way facilities are reimbursed for SNF Medicare Part A residents beginning FY2019.
The resident classification system, version I (RCS-1) will be the most significant change in the current reimbursement model, which has been in place for nearly two decades. Since being published in the Federal Register on April 27, 2017, providers and advocacy groups have submitted public comments and recommendations on the SNF prospective payment system (PPS) payment methodology proposed in the Summary of Advance Notice. Many concerns have been raised, especially regarding the reimbursement methodology for therapy services.
How to Prepare for RCS-1: - Focus on MDS accuracy to ensure the appropriate RCS-1 category and reimbursement rate for each resident
- Focus on diagnosis code accuracy to appropriately capture residents' diagnoses and conditions
- Ensure that documentation thoroughly supports MDS assessment and Medicare claims with comprehensive and accurate observations of residents' clinical, cognitive, and functional impairments
- Establish policies and procedures to effectively monitor residents for significant changes and complete significant change assessments timely, as needed, to ensure that reimbursement appropriately reflects each resident’s needs
- Evaluate and strengthen quality improvement efforts to achieve and maintain high-quality outcomes
- Assess your facility’s unique dynamics, resident population, and competencies
- Evaluate therapy and nursing staffing models based on your facility’s needs and changes in nursing and therapy reimbursements (i.e., group/concurrent treatments, extensive nursing services, etc.)
Click here to sign up for PPS Alert for Long-Term Care and read the full article. This monthly digital newsletter will guide you every step of the way as the long-term care industry shifts to a new payment system. You’ll also receive practical tips, how-to-guidance, vital tools, and top industry news that tackle tough topics such as documentation, person-centered care strategies, and data analysis to help your facility remain compliant and quality-focused.
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