Part II: The PDPM and PDGM
PART II - Key Features and Key Compliance Implications for Longterm Care Facilities and Home Health Agencies
In both the home health and skilled nursing facility industries, new payment methodologies are being introduced in 2019-2020. This creates new opportunities for optimizing revenue and improving patient and resident care, but may also introduce new compliance risks. In this webinar, we will provide an overview of key changes brought in by the Patient Driven Groupings Methodology (PDGM) under the Medicare home health prospective payment system (PPS), as well as the Patient Driven Payment Model (PDPM) under the Medicare skilled nursing facility PPS. Then, we will review items recently added to the Work Plan of the Department of Health and Human Services Office of Inspector General (HHS OIG) relating to Medicare payment to home health agencies and longterm care facilities, including issues relating to payment for dual eligible (Medicare-Medicaid) beneficiaries. We will identify both key revenue opportunities and key compliance touchpoints relating to the new payment methodologies. We have designed this webinar as a high-level overview of the payment changes and associated compliance risk areas.
The regulatory landscape for providers of post-acute care has changed dramatically in recent months. New requirements of participation for longterm care facilities, promulgated by the Centers for Medicare & Medicaid Services (CMS) in 2016, have been implemented in three phases, with the last and arguably most significant set of changes implemented in November 2019. On October 1, 2019, and January 1, 2020, respectively, CMS implemented new “patient-driven” Medicare payment methodologies for skilled nursing facility services (SNF) and for home health services.
This series of four sixty-minute webinars will provide information and guidance to post-acute care providers on emerging topics relating to the revised requirements of participation and Medicare payment methodologies. Three of the webinars will focus on provider policies that will be under increased scrutiny as a result of the revised requirements of participation: compliance and ethics programs, emergency preparedness plans, and policies and procedures related to patient/resident privacy and information. One webinar will provide an overview of the Patient-Driven Payment Methodology (PDPM) for SNF services and the Patient-Driven Groupings Methodology (PDGM) for home health services, as well as identifying key compliance risks associated with the implementation of these methodologies. Each webinar will provide practical advice on how longterm care facilities and other post-acute care providers can most effectively develop and implement policies to respond to the new or revised requirements, and to strengthen the patient experience and patient care.
- CEOs and Leadership
- Finance and Billing Staff
- Compliance Officers and Risk Managers
- Quality Officers and Managers
After this webinar, you will be able to:
- Learn how the PDGM and PDPM have altered Medicare’s methods of paying for home health and skilled nursing facility services, respectively
- Identify actions your organization might take to improve care and enhance revenue under the new Medicare payment methodology
- Identify compliance risk areas associated with Medicare payment and actions your organization can take to mitigate risks
An Associate in the firm's Health Law practice group, Noori assists with transactional matters as well as litigation pertaining to managed care, the Medicare and Medicaid programs, the 340B program, the federal anti-kickback and self-referral prohibitions, and the Federal Tort Claims Act. Complementing her legal experience, Noori is a registered nurse who previously worked on a medical-surgical floor in a DC hospital. She has basic medical code training and experience with hospital IT systems including EPIC Portfolio, EPremis, Medipac, Midas, and Aegis. [Full Bio]
SUSANNAH VANCE GOPALAN
Susannah is a Partner in the firm’s health law practice group where she focuses on health care litigation and regulatory counseling, with a focus on Medicaid and Medicare payment, financing, and compliance issues. Susannah brings regulatory expertise to bear when advising clients and pursuing litigation on their behalf. She has experience negotiating Medicaid waivers and managed care arrangements on behalf of providers, provider associations, and governmental entities. She represented a group of providers in reaching a settlement in major Medicaid litigation. [Full Bio]
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