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Terms in this set (5)
Case-Mix Group (CGM)
Classification system used in Medicare Skilled Nursing Facility Services Payment System's patient-driven payment model to group residents into groups based on clinical reason for stay and function level
Patient-Driven Payment Model (PDPM)
Reimbursement model that assigns residents to payment categories based on individual patient characteristics
Skilled Nursing Facility (SNF)
Facility that is certified by Medicare to provide 24-hours skilled inpatient nursing care and rehabilitation services in addition to other medical services for short-term care
Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP)
Medicare value-based purchasing program that ties facility performance for established quality measures into the Skilled Nursing Facility Services Payment System
Variable Day Adjustment
Adjustment in the Skilled Nursing Facility Services Payment System that adjusts the case-mix index value on specified days of the resident's stay for physical therapy, occupational therapy, and non-ancillary therapy components
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•UB92 not matching MDS and/or Rehab billing logs
•MD signatures on Certifications
•Inaccurate ICD-10 coding
•Improper tracking/reporting of therapy time on MDS
•Lack of skilled documentation or justification of services in daily or weekly notes
•Repetitive Gait Training, Exercises, Activities, or ADL's
•Evaluations only- (Should be Screens or have follow up treatment)
•Downgrading of Diets
•Reevaluations for Falls
•Lack of therapy functional progress
•Carryover and Justification for Rehab missing from Nursing notes
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