Post-acute_PPS - PPSforPostAcuteCareFacilities...

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PPS for Post-Acute Care Facilities An Introduction
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Introduction to Prospective Payment  (PPSs) in Post-acute care (PAC) Post-acute care (PAC) allows patients to  safely continue their recovery in settings less  intensive and more appropriate than acute  care inpatient hospitals PAC includes services delivered in skilled  nursing facilities (SNFs), long-term care  hospitals (LTCHS), inpatient rehabilitation  facilities (IRFs) and home health agencies  (HHAs)
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Skilled Nursing Facilities PPS Skilled nursing facilities (SNFs) Effective date—July 1, 1998 Major features Per diem payment Consolidated billing
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SNF PPS:  Major Features Per diem prospective, case-mix adjusted payment for all covered SNF services Includes Routine care Ancillary services Capital costs Excludes Operational costs associated with defined, approved educational activities
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SNF PPS:  Major Features  (cont’d) Consolidated Billing Requires SNF to pay for outpatient services resident may receive from outside vendors Outside vendors cannot bill medicare (bill SNF and SNF pays) Includes Therapists Laboratory X-ray Pharmacy Excludes Emergency services Inpatient care Extensive (such as radiation therapy)
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SNF PPS:  Data Collection Basis is minimum data set (MDS 3.0) Reporting required since 1980s Extensive clinical database Clinical data Treatment plan critical Services outside scope of treatment plan may be excluded from payment HCPCS coding
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SNF PPS:  Data Collection  (Cont’d) MDS data determine classification into resource utilization group (RUG) (IV version) 1 of 66 RUGs-IV – see figure 8.2 Homogeneous groups of similar health & resource use – based on Therapy and service use Presence of certain conditions Activities of daily living (ADLs)
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SNF PPS:  Grouping and  Payment CMS analysts believe that admissions  classified by MDS data into one of the  upper level RUGs are justified The coverage of patients classified into  the lower level RUGs is determined on  an individual basis
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Structure of RUGs code Structure 3-character alphanumeric Ex: RMB, RMA, SE3, SSB, CC2, IA2, BB2, PA1
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Grouping based on MDS data Federal per diem rate attached to RUG Urban and rural rates Geographic wage adjustment Ranges from about $170 - $625 per day Add-on adjustments - AIDS
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SNF Calculation-Urban RUG IV Cat. Labor
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This note was uploaded on 05/09/2011 for the course HCA 580 taught by Professor Hazelwood during the Spring '11 term at University of Louisiana at Lafayette.

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Post-acute_PPS - PPSforPostAcuteCareFacilities...

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