It has been found that almost 100% of the prior authorization levels given by the Medicare Advantage Plans do not match the PDPM score calculated by the facility MDS. In many cases the difference is $200-$500 per day in reimbursement. NaviHealth is the approved vendor who authorizes SNF stays for Humana and Security Health Plan. In this session we will discuss the request for recalculation process and the financial ramifications.
SNF PDPM has been in effect for over 2 months, we have learned many lessons as well as identified coding practices which result in reduced reimbursement to the SNF. In this session, we will use case studies to review the impact of diagnosis coding on reimbursement.
Quality healthcare is more than visiting a provider and receiving treatment for an illness. Many people can’t even get to a doctor appointment, or if they do, they may be unable to follow their treatment plans. How can providers improve health for individuals that are facing barriers to accessing the healthcare system such as poverty, lack of transportation, or lack of adequate housing? Collecting Social Determinants of Health data is a first step to identifying people who need help and working to establish programs to assist them.