medicareCMS recently put the finishing touches on a new rule that will transition the Medicare payment system for skilled nursing facilities (SNF) from its current fee-for-service status toward value by implementing the Patient-Driven Payment Model. The shift is expected to kick off in the fall of next year.

The Patient-Driven Payment Model involves paying SNF for the needs of a patient as opposed to the volume of services the patient receives. The model will utilize ICD-10 diagnosis codes, the characteristics of a patient and additional pertinent factors to determine how to classify a patient. Upon classification, the model will alter Medicare reimbursement based on the care the patient received, most notably for non-therapy ancillaries, or items and services unrelated to the provision of therapy. These services and/or items may include drugs and medical supplies, for example. By adjusting payments reflecting the type of care received, CMS aims to have a better grasp of what the costs would be when patients considered medically complex are being treated.

CMS believes the Patient-Driven Payment Model could result in savings of more than a billion dollars within the next decade. The savings will largely come from the lesser amount of paperwork involved in the billing process.

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