What You Need to Know About Managed Care & PDPM: Ask the Experts 

Recently, BKD Director John Harned and Managing Director Julie Bilyeu teamed up with Jeremy Mercer, Netsmart senior living community strategist, to talk about how skilled nursing facilities can navigate both PDPM and different reimbursement methods of their managed care partners.

From tips for contracting with Medicare Managed Care organizations to preventing hospital readmissions and getting reimbursed correctly, the three provide actionable ways skilled nursing providers (SNFs) can achieve success with managed care and PDPM. 

In short, this webinar addresses key questions on how SNFs must operationalize managed care programs in areas such as contracting, screening, admission, care plan and discharge, to name a few. 

To give you a glimpse, here are some of the top questions from the webinar.

What does every SNF have to consider when it comes to working with Medicare Managed Care  organizations? (3:40) - John Harned, BKD

“Medicare Managed Care is something you don’t dabble in. Rather, it’s something you have to master or the managed care organizations will take advantage of your organization, and you will wind up with little or no margins in providing care.

How can you leverage technology to meet the requirements of managed care organizations?  (8:30) - Jeremy Mercer, Netsmart

“Knowing your data is critical. These managed care relationships are very much data dependent. They probably know your data better than you do … they must know why you are the right partner to send referrals to.”

What tips do you have for contracting with Medicare Managed Care organizations, and how do you start accepting patients who are in bundles? (11:04) - Julie Bilyeu, BKD

“The first thing you really want to do is to take an inventory of your existing contracts and then consider how you can set yourself apart from the competition, such as …”

PDPM billing: How do we know if we are being reimbursed correctly due to the hundreds of case mix groupings (CMG) possibilities? 40:33 - Julie Bilyeu, BKD

We, as well as state and national organizations, have rate calculators on their websites. You can search BKD rate calculator, download the calculator, then you can easily put in the HIPPS code and it will show what your payment will be for all 100 days of the stay.”  

Do you recommend post-discharge follow up, and, if so, what does that look like? 42:33 - John Harned, BKD

“I would really challenge everyone to make this a goal for 2020: Start reaching out to your patients after they’ve been discharged …. at 7 days, 15, 30 days. Building that relationship with the family and the patient is so important. Because they will then realize that your organization really cares about mom’s care.”

You can watch the full recording below.

WATCH THE WEBINAR

About the Author

Ashley Hartswigen, Director, Post-Acute Client Strategy

Ashley is the Director of Post Acute Client Strategy at Netsmart and focuses on supporting providers by serving as a trusted advisor to organizations in their business processes and their use and adoption of technology. She has worked in the financial and technology industry for over 25 years, with 14 years focused in post-acute healthcare and has advanced experience in consulting, product strategy and development, operations, and business development.