As Hopforce Summer School wraps up, I want to spotlight what matters most in today’s environment: accuracy and optimization in PDPM coding for Medicare Part A reimbursement. Skilled nursing facilities are under historic pressure — rising staffing costs, supply chain strains, and Medicare payment reductions are squeezing margins. The average
CMS just finalized the FY 2026 PPS base rates, but the biggest increases this year aren’t spread evenly: · Urban facilities saw their strongest gains in Nursing (+$4.32 per diem) and NTA (+$3.26). · Rural facilities had more movement in therapy, with PT (+$2.83) and OT (+$2.60)
We all know CMS is raising the bar on staffing. But when leadership asks, “How far off are we from the next star?”—too often the answer is a guess. Take this facility with an average daily census of 114.8 residents. Here’s what Hopforce’s Five Star Calculator
Under PDPM, PT reimbursement is built on two things: Functional Score and Clinical Category. First, your 𝗳𝘂𝗻𝗰𝘁𝗶𝗼𝗻𝗮𝗹 𝘀𝗰𝗼𝗿𝗲 can drive a huge influence on your CMI. At scores 0-5, your patients are most dependent, and at 24, they're most independent. Yet it's not always that "most-dependent"
In PDPM, your SLP case-mix group is determined by just four questions. The trick is making sure each one is captured before the 5-day assessment locks. Here’s how to keep future assessments accurate — and your rates where they should be: 1. Acute neurologic condition? — Confirm diagnosis coding in Section
I just heard this story from a partner SNF that's keeping $23k more in their budget with one smart move. At their facility, 2 residents came in with similar infections—both were carefully placed in single rooms. But this SNF took their coding seriously. For one resident, the
The Medicaid landscape for skilled nursing facilities is changing rapidly. This year, there are two urgent Case Mix Index (CMI) updates you can’t afford to ignore: 1. Every State Plays By Different Rules * Many states are blending PDPM with older RUGs approaches, customizing case mix weights, clinical groupings, and
As we reach the midpoint of 2025, I’ve been looking at the latest updates from CMS impacting SNF’s Medicare reimbursement. ONE Quick Tip: CMS has increased Medicare SNF payment rates by 4.2% for FY 2025 last August, reflecting adjusted wage indexes and new SNF market basket analyses.
The volume of concern around the “Big Beautiful Bill” is unlike anything I’ve seen. My inbox is full of questions from operators, billing managers, and MDS coordinators: “How is this going to affect our bottom line?” For the average SNF, Medicaid accounts for 59% of total revenue. Given that
Today we’re talking about the NTA component of PDPM—and how to get paid fairly for complex care. NTA stands for Non-Therapy Ancillary. It includes conditions like: – IV meds – Severe infections – Complex wounds – Cystic fibrosis – Ventilator use More NTA points = higher reimbursement. In fact – in the first 3 days
Ever stare at Section GG and wonder, "Am I even doing this right?" Incorrectly scoring Section GG directly affects payment, audit exposure, and your peace of mind. Here’s some ways to keep everything in line: 1. Schedule a short GG huddle weekly. (Nursing, therapy, and MDS all
Let's be honest, ICD-10 codes are intimidating. Letters, numbers, periods – feels like you're reading a foreign language. But here’s the quick, human version: ICD-10 codes are how CMS knows what clinical conditions your patient has. Each code directly determines your patient's reimbursement level.