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PDPM is here!

CMS Releases Medicare General Information, Benefit Policy, and Claims Processing Manual Updates Related to PDPM Implementation see here.

Humana has partnered with naviHealth to review, approve or deny all inpatient authorization requests for post-acute care (PAC) services in Skilled Nursing Facilities (SNF).  Effective 10/1/19, Humana adopted PDPM for reimbursement with naviHealth approving PDPM HIPPS scores.

It has been brought to our attention that Skilled Nursing Facilities (SNF) are receiving lower PT, OT, ST, Nursing and NTA Components than expected from naviHealth.  It is very important for SNF’s to provide your naviHealth Skilled Inpatient Care Coordinator (SICC) ALL appropriate information to support each of the 5 components of PDPM.

For example, if your patient has COPD and Diabetes Mellitus and you do NOT send supporting documentation the facility will receive $46 per day vs $85 per day for the NTA component (amounts vary due to Rural vs Urban and VBP).  Documentation must be sent to the SICC in order for to receive the appropriate NTA score and reimbursement.

If you need PDPM reimbursement or billing training, assistance updating your software for PDPM, or have general PDPM questions contact one of our client managers today.


As of January 1, 2020, you must submit your claims to CGS using the Medicare Beneficiary Identifier (MBI) See more here.


Influenza (Flu) Resources for Health Care see here.




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CON Changes--Urgent

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Anthem Medicare Replacement B Claims

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