HomeResourcesBlogSponsored Post: Therapy Providers: Now is the Time to Prepare for CMS’ Payment & Policy Changes for Skilled Nursing Facilities

Sponsored Post: Therapy Providers: Now is the Time to Prepare for CMS’ Payment & Policy Changes for Skilled Nursing Facilities

Posted on: in [ Education, Payment Reform ]

When CMS issued an Advanced Notice of Proposed Rulemaking (ANPRM) seeking comments on replacing the existing SNF PPS case-mix RUG-IV payment methodology with a new model, the Resident Classification System, Version 1 (RCS-1), therapy providers everywhere began to wonder how it might affect their businesses. The ANPRM, entitled Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities, is subject to a 60-day comment period; the comment period was extended until August 25, 2017, which means there are still a lot of unanswered questions regarding the impact of RCS-1.

Michael Katri, Optima Healthcare Solutions’ Senior Product Strategist, is hosting a webinar with Cathy de Verteuil (Optima Director of Customer Success) and Rita Cole (Optima Clinical Director) on July 11 at 1:00PM ET.

This webinar will outline the key points of RCS-1, discuss unanswered questions the industry is asking of CMS and talk about what you should expect from your therapy software vendor to prepare for the changes.

To register for the webinar, click here. 

How could RCS-1 change the way you provide therapy?

Not only will RCS-1 require therapy providers to manage care completely differently from how it’s currently managed under the RUG-based payment system, the industry consensus is that it could have a negative impact on therapy utilization and revenue. It’s crucial for therapy providers to become well-versed in RCS-1 now, so they can start preparing for the changes that lie ahead while continuing to achieve outstanding clinical outcomes.

How does RCS-1 work?

RCS-1 is separated into four case-mix components based on objective, verifiable resident characteristics: PT/OT (a combined component), SLP, non-therapy ancillary (NTA) and nursing. The facility payment is calculated by adding the four components and the non-case-mix component together to create a SNF PPS per diem rate for each day the patient is receiving care. These daily rates are then added together to create a total per diem payment rate for that patient, wherein therapy payment is the sum of costs for the three disciplines. 

What does it mean for reimbursement?

Since RCS-1 is a resident classification system, it removes therapy minutes as a means of classifying patients, which means it separates therapy minutes from actual payment.

Though CMS envisions this model to be budget neutral, some language in the advanced notice could indicate that there is an expectation for the cost of services to decrease throughout a patient’s stay. According to CMS research, “In examining costs over a stay, we found that for certain categories of SNF services, notably therapy and NTA services, costs declined over the course of a stay.”