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Patient Driven Payment Model (PDPM) - Have you started preparing for PDPM?


  • Discuss PDPM with your therapy department to access their knowledge and preparation for PDPM.
  • Discuss PDPM changes with your EHR software partners such as:

                  How will you determine I0020B diagnosis?

                  How will NTA related conditions be identified and tracked?

                  How will cognition be identified and tracked?

                  How will SLP co-morbidities be identified and tracked?

Contact Stephanie Eaves or your client manager to discuss PDPM in detail or to schedule training.


Expect Medicaid Facility Capital Appraisals in First Quarter of 2019

Beginning January 2019, capital appraisals will be performed on all KY price-based nursing facilities.  The appraisal fee is $1,150. If a re-appraisal has occurred since 2014, no fee is required.


Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedules for Calendar Year 2019

· The final 2019 PFS conversion factor is $36.04, a slight increase above the 2018 PFS conversion factor of $35.99.

· The 2019 KX threshold amount is $2,040 for PT and SLP services, combined, and $2,040 for OT services.

· CMS is discontinuing the functional status (G codes) reporting requirements for services furnished on or after January 1, 2019.

· In the 2019 PFS final rule, CMS finalizes two new modifiers to identify services furnished in whole or in part by physical therapy assistants (PTAs) and occupational therapy assistants (OTAs).

-The new therapy modifiers for services furnished by PTAs and OTAs are not required on claims until January 1, 2020. 

For more information on the above policies click here




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Bed Hold Census Sheet

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January Billing Update, 2018

January Tax Update, 2018

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CON Changes--Urgent

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September 30, 2016

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Medicaid Meeting, 2016

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Anthem Medicare Replacement B Claims

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