Who needs to prepare for RCS-1?

On July 31, 2016, CMS announced that the payment levels currently used in the prospective payment system (PPS), resource utilization group (RUG) IV, will be replaced in FY2019 by the resident classification system (RCS-1). This replacement is currently scheduled to be implemented by October 2018.
This will be a complicated and significant change for providers. The majority of the changes that will occur with the implementation of RCS-1 are based on claims history and MDS data …

Two-year budget deal repeals therapy caps, cuts skilled nursing spending by $1.96 billion

Last week, President Donald Trump signed a two-year federal budget deal that left long-term care providers sighing with relief at the repeal of therapy caps for Medicare Part B beneficiaries retroactive to January 1, followed by a sigh of disappointment with a $1.96 billion cut to skilled nursing facility (SNF) spending. The cuts include a payment reduction of 15% for therapy assistants, making the actualization of the wished for therapy cap repeal bittersweet.
The budget cut, which …

Tip: Defend against new targeted probe by scrutinizing therapists’ documentation

Conduct a quality audit of documentation your therapists submit. CMS’ targeted probe-and-educate review is ongoing, and it’s clear that therapy and therapists’ documentation will be among the things Medicare Administrative Contactors (MACs) review.
When agencies conduct quality audits involving therapy, they should pull five evaluations that each therapist completed in the past week and see if individualized, prescriptive programs are being carried out, recommends Diana Kornetti, a physical therapist and chief operations officer of Kornetti & …