As skilled nursing facilities (SNF) transition to the Patient Driven Payment Model (PDPM), effective October 1, 2019, there are two primary coding changes that will impact reimbursement: the use of Minimum Data Set (MDS) Section G to Section GG for functional components for physical therapy, occupational therapy and nursing case mix indexes; and diagnosis coding as the primary reason for the SNF stay to support patient characteristics for physical therapy (PT), occupational therapy (OT), speech therapy (ST), nursing and the non-therapy ancillary (NTA) case mix indexes and reimbursement.
- Understand the transition from Section G to Section GG coding for the functional component and reimbursement starting October 1, 2019.
Become aware of current coding inaccuracies of the submitted Section GG on the 5-day MDS.
- Demonstrate an understanding of the intent and guidelines of Section GG as outlined by the Centers for Medicare & Medicaid Services (CMS).
- Be able to define and explain each component of Section GG for PT, OT and nursing items.
- Apply the coding scale accurately to capture the usual performance utilizing real SNF patient examples.
- Demonstrate documentation supporting coding of Section GG for reimbursement purposes.
- Understand the PDPM requirements for identifying the reason for the SNF stay.
- Review risks associated with incorrect diagnosis coding, including the impact of return to provider codes.
- Learn to utilize the CMS tools for correct diagnosis coding under PDPM.
- Practice coding scenarios for SNF admission examples using coding manuals and other tools.
About the Presenters:
Kay Hashagen is a seasoned senior consultant with more than thirty-five years of healthcare industry experience, specializing in geriatric rehabilitation in a variety of care settings. She has a proven record of accomplishment in providing excellent customer service, managing operations with strong performance metrics, and developing creative programs while maintaining appropriate compliance monitoring for Medicare and regulatory requirements.
After starting her career as a physical therapist in acute care hospitals and inpatient rehab facilities, she spent the next 15 years specializing in industrial rehabilitation and worker’s compensation, opening two work hardening centers. Kay spent many years operating rehabilitation departments in skilled nursing facilities and then served as a director at a national rehabilitation company. She is proficient in developing and managing contract rehabilitation relationships from start-up to successful business ventures and also understands the post-acute care continuum.
Part of her experience is supporting ongoing training and resource needs for in-house therapy departments through LW Consulting Inc.'s Therapy Resource Partner program. She has expertise in completing patient assessments using the FIM instrument and Section GG, and applies this experience to inpatient rehabilitation facility audits.
Kay has received extensive training in ICD-10 from AHIMA and has ongoing training in ICD-10-CM requirements necessary for PDPM and coding across the continuum of care.
Kay received her Bachelor of Science in physical therapy from Temple University and her M.B.A. from the University of Central Florida. She is currently licensed as an active physical therapist in Maryland and is a member of the American Physical Therapy Association and the Maryland state chapter. She is well-versed in PPS and MDS management and maintains her certification as a Resident Assessment Coordinator.
Terry Raser has more than 39 years of experience in the healthcare industry. As a consultant for 19 years, she dedicates her career to compliance, quality improvement, MDS education and improvement in the long-term care nursing profession. A nurse since 1980, Terry served in multiple roles including infection control and wound care nursing. In her position as an LW Consulting, Inc. Senior Consultant and a 39-year Registered Nurse Assessment Coordinator, Terry provides RNAC support and education and performs audits to assist facilities with regulatory compliance and survey performance. She has Pennsylvania and Maryland Medicaid Case-Mix expertise and has been training skilled nursing staff on the Case-Mix Index (CMI) system.
With her long-term care background in survey, compliance and MDS knowledge, Terry is instrumental in helping facilities with survey sucess, the Pennsylvania Medicaid Case-Mix system, the new Patient-Driven Payment Model (PDPM) and the RAI process. She enjoys educating the interdisciplinary team, nurses and CNAs on how their roles affect the CMI, and how to establish effective restorative nursing programs to manage CMI in low acuity settings. Terry conducts facility CMI analyses to identify strengths and weaknesses and has a proven track record of helping facilities increase their CMI. Recently, Terry trained two interdisciplinary teams to develop and implement CMI optimization strategies. As a result, one facility's CMI grew from 0.95 to 1.04, and the other from 0.88 to 1.12.
Terry represented Pennsylvania as one of 16 Gold Standard Nurses in the country who participated in the Centers for Medicare & Medicaid (CMS) Minimum Data Set (MDS) 3.0 pilot program. When CMS implemented the MDS 3.0 in 2010, she trained more than 85 Pennsylvania, New Jersey, and Delaware RNACs. As an RNAC training expert for 19-years, Terry developed a proprietary three-day education course. As a QAPI Certified Professional, she worked with Quality Insights of Pennsylvania to assist 65 nursing homes with their quality improvement processes and compliance systems.
Terry graduated from the Nursing School of Wilmington in Delaware. She is an AANAC-certified RNAC (RAC-CT) and Director of Nursing Services (DNS-CT). She is on the board of the Pennsylvania Association of Nurse Assessment Coordinators (PANAC) and is a well-known speaker for learning sessions, compliance, MDS education, care planning and clinical reimbursement.