Reliant Reveal May

Headlines in This Issue…

Patient-Driven Payment Model (PDPM)
PEPPER Updates
Clinical Services: The Client Connection Monthly Webinar Series
Clinical Appeals Corner: Low Volume Appeals Initiative
HIPAA Happenings: Email Hacking
Care Matters Spotlight

Let the Countdown to PDPM Begin!

Whether it’s saying goodbye to the old or hello to the new, we are counting down to a new payment model for skilled nursing facilities. Unveiled in the FY2019 Proposed Rule, the Patient-Driven Payment Model (PDPM) is CMS’s response to the hundreds of comments to the 2017 ANPRM which introduced the first structured version of a new payment model: Resident Classification System, Version 1 (RCS-1). PDPM highlights the post acute care industry shift of payment determination from quantity of therapy minutes to quality of care, and, as proposed, would be implemented in October, 2019.
The nuts and bolts of RCS-1 formulated a payment structure built with resident characteristics, a significant shift from the current structure which bases payment largely on the quantity of therapy provided. RCS-1 introduced a predictive payment model, formulated with 5 case mix groups, new ADL scoring, and clinical characteristics determined through the presence of diagnostic categories. Stakeholders from around the country joined together in work groups and summits to deconstruct the model and provide data and evidenced-based feedback to CMS. The result is PDPM, which although work still needs to be done, is an encouraging step in the right direction. Significant changes from RCS-1 to PDPM include:

Below are the 6 case-mix groups summed to determine PDPM payment. Classification in the 5 clinical case-mix groups (PT, OT, SLP, Nursing, and NTA) is determined based on clinical characteristics CMS has identified as significant predictors of payment for each.
  • Physical Therapy: Grouped by diagnostic mapping to clinical category
  • Variable adjustment rate in payment based on resource use trends
  • Occupational Therapy: Grouped by diagnostic mapping to clinical category
  • Variable adjustment rate in payment based on resource use trends
  • Speech Language Pathology: Grouped by diagnostic presence and mapping to clinical category
  • Nursing
  • Non-Therapy Ancillary
  • Variable adjustment in payment based on resource use trends
  • Non-Case-Mix
PDPM is a significant stride in the right direction; however, questions and concerns remain as it is currently presented. As your organization prepares for the inevitable shift to a new payment model there are several key takeaways from these two systems that guide us in how to begin preparing now, regardless of what the final system is called.
  1. The resident’s clinical characteristics will determine payment. Begin discussions with your facility admission, nursing, and therapy teams now regarding the system successes and failures of obtaining hospital records PRIOR to admission. Take a look at section I8000 of the MDS. How has it been treated for the last 20 years? It’s possible what you enter in this box, will largely impact payment classification.
  2. Section GG is in. Data collection for the past few years may have seemed a tedious burden, but it will now directly impact the resident’s payment classification. In addition, new items are being added to section GG this October. Solidify processes for GG data collection and collaboration, get through the novice bumps now, and your facility will be an expert by October, 2019.
  3. Never underestimate the power of therapy. Wonderers wonder, will therapy matter? Veterans know, yes, therapy will matter. Your therapy department will be what allures families to your facility. A solid therapy department providing quality care and producing quality outcomes will be what makes you stand out in the market place. This will be the gold standard which marks facilities who maintain a culture of customer service, quality care, and exceptional outcomes during an industry shift.
If you haven’t already, join in the educational opportunities and work group calls offered by various long term care associations such as
AHCA and
Reliant Rehab know if you have questions, concerns, or want to know more about how we are planning for the future. Not only will you find yourself better prepared for the years ahead, but you’ll be able to contribute to the future of our industry.

SNF PEPPER Review Recording Available

The recording and transcription of the May 10, 2018, PEPPER Review WebEx session is now available along with the handout and Q&A document on the SNF Training and Resources page.


Every month on the third Thursday, Reliant’s Clinical Services offers a webinar to our partners on relevant topics within our industry.
In May, The Client Connection reviewed the FY2019 Proposed Rule including the proposed market basket increase, updates to SNF QRP and VBP, and introduced the proposed payment system: PDPM.
Stay tuned for June’s presentation on Falls. Discussion will include prevention techniques to improve your quality indicator scores and a look at what therapy can do for your residents.
We hope you’ll join us!

Low Volume Appeals (LVA) Initiative is being extended to
June 8, 2018

The Low Volume Appeals (LVA) Initiative is a limited settlement opportunity for qualifying providers. This initiative is an administrative process for appellants with fewer than 500 appeals pending at OMHA and the Council, combined, as of November 3, 2017. The process allows the appellant to settle the portion of their pending appeals that have total billed amounts of $9,000 or less per appeal in exchange for timely partial payment of 62% of the net Medicare approved amount.
The deadline to submit an expression of interest (EOI) for the LVA Initiative has been extended to June 8, 2018.
Details about the process including EOI forms can be downloaded


Over the last 10 years there has been a 31% increase in deaths related to falls in individuals age 65 and older? Addressing this staggering statistic can be achieved through screening and intervention for gait, strength, vision, and balance issues.

HIPAA Happenings will bring you information relevant to protecting the security, privacy, and integrity behind the many facets of technology in business and healthcare.

What is Email Hacking?

Email hacking is when someone gains unauthorized access to your email account. This month’s HIPAA Happenings answers your questions on email hacking including:
  • How does your email get hacked?
  • What can you do to prevent your email from being hacked?
  • What should you do if your email is hacked?
Download the full article

Did You See That Strike and Hear That Bingo?
It Must Be Ms. Hammond!

Pictured above: Amy “Shay” Stanford, PTA, Flo Hammond, and Sheena Barzart, PTA

What motivates you to keep going? For many of us it’s our community of family, friends, and activities. Flo Hammond agrees. Following a fall Ms. Hammond began therapy to improve her balance and reduce risk for future falls. As a resident of our partner facility in Brownwood, Tx, she loves her community. She enjoys spending time with her sister and, together, they don’t miss an event. Of all the activities they attend, Bowling and Bingo are their favorites.
Following therapy, Ms. Hammond has improved her balance and is able to achieve a single leg stance safely. Ms. Hammond, you are an inspiration. Your success demonstrates that with motivation, support, and quality therapists our favorite activities don’t have to be a compromise!


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