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Ask the expert: Medicare Part A coverage for a PEG tube

Q: I have a patient that has 100 days of Medicare Part A and a percutaneous endoscopic gastrostomy (PEG) tube—the primary source of nutrition—in place since 2008 due to laryngeal cancer. All rehab therapy is discontinuing in three days. Can I continue Medicare Part A, related to the PEG tube? A: As long as 26% […]

Resources for a smooth transition to PDPM

Brought to you by Biller’s Association for Long-Term Care. As SNF and nursing home providers familiarize themselves with CMS’ new Patient Driven Payment Model (PDPM), The Bottom Line is here to keep you educated and up to date on the latest resources, guidance, and best practices as they are made available. Here are this week’s […]

Therapist layoffs reported as a result of PDPM

Since the implementation of PDPM on October 1, thousands of therapists have been laid off, reports Modern Healthcare. The payment system prior to PDPM, RUG-IV, allowed SNFs to bill therapy services they deemed necessary, but some took advantage by ordering superfluous therapy services to gain additional reimbursement from Medicare. PDPM seeks to stop this practice. […]

Ask the expert: Tube feeding coverage

Q: We have a lot of questions in our facility about tube feeders and Medicare Part A eligibility. Here is one example: A person getting tube fed uses 100 days of their benefit, goes off Medicare Part A, has a 60 day break in illness, and was then readmitted to hospital with a hip fracture. He […]

Essential tools for the MDS coordinator

Whether you are just beginning your career or are a veteran MDS coordinator, you play a pivotal role in managing the long-term care residents’ care.

Proposed rule: CMS moving forward with PDGM in 2020

CMS is staying true to plans to implement a new payment model. The 2020 PPS proposed rule, which was posted to the Federal Register July 11, reinforces the plan to implement the Patient-Driven Groupings Model (PDGM) beginning on or after Jan. 1, 2020. The model will move from 60-day episodes to 30-day payment periods. While […]

Educate clinicians about M1820, an item affecting functional points under PDGM

Source: Home Health Line Ensure clinicians have proper training about how to respond to the OASIS-D item involving patients’ ability to dress their lower body safely. M1820 (Ability to dress lower body) is one of six OASIS items that affect functional case-mix adjustment under the PPS, and it will be one of eight items that […]