New PDPM shows great promise - SpecialtyRx
September 3, 2018
New PDPM shows great promise

Experts say the new payment system signals the end of false claims

Here’s how skilled nursing stands to benefit

This summer, eleven skilled nursing facilities and consulting companies were ordered to pay millions in restitution stemming from a string of false claims violations.

The Medicare providers were sued aſter evidence revealed they had engaged in ‘deceptive billing practices’ by ordering unnecessary treatments to pad their own pockets. Such actions not only put countless patients in danger, but also paint the greater skilled nursing industry in a negative light.

Now, the Justice Department has reinvigorated its commitment to implementing the Patient Driven Payment Model (PDPM), which was introduced earlier in 2018. The new model will reward quality over quantity in an effort to deter facilities from pushing rehabilitative therapies on patients when they are ‘medically unnecessary.’

New PDPM shows great promise


Patient Driven, Provider Approved

In addition to simplifying paperwork and introducing other cost-saving initiatives, the government’s ‘value-based transformations’ promise to reimburse providers based on value—not volume. The prospect signals huge changes for the Medicare community, and especially for skilled-nursing facilities working closely with the senior population.

In reference to the recent lawsuit and Medicare milestones, acting Attorney General Chad Readler said, “[The settlement] demonstrates our continuing commitment to ensure that Medicare providers do not place their own financial gain over patients’ clinical needs.”

Representatives from the Department of Health & Human Services also celebrated the landmark case, noting that “Those engaging in deceptive billing practices can expect an aggressive investigation to recover inappropriately obtained funds.”

So, what does it all mean for SNF administrators? Now more than ever, we stand confidently behind our quality care practices. When the PDPM debuts next year, we can expect to see significant profits knowing our patient outcomes are always superior.