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5 key things to look for in your PDPM financials

Consonus Healthcare is the sister company to Marquis Companies. Therefore, as an owner/operator of Skilled Nursing Facilities, we’re facing the same challenges as our Consonus customers. We understand the strategic operations and challenges and are committed to being a trusted resource within the industry.

Since PDPM went into effect on 10/1/2019, we’ve been pouring over financial statements to better understand the impact this new reimbursement system is having on our bottom line. We are sharing 5 things to look for in your new financial statements.

5 Questions to Ask Yourself:

1. What is your trending month-over-month average PDPM Revenue per patient day (PPD)?

New workflows, IDT coding optimization, and high acuity patients could all be contributing factors in your PPD trends. Knowing your PPD allows you to monitor revenue fluctuations and better understand how it impacts your EBITDA. Need help calculating your PPD? Try our free PPD Calculator.

2. How has your rehab delivery model changed “PPS -vs- PDPM” and how has that translated to overall cost per patient day?

This new reimbursement system is no longer incentivizing based on rehab minutes. Therefore, many providers have chosen to change their rehab delivery model to include group and concurrent therapy, when appropriate. It’s important to continue to track average minutes per week, per resident episode. This documentation will help protect against potential audits and denials.

3. Are you measuring your therapy outcomes and are you seeing any changes?

When CMS implemented PDPM, they did not want providers to change their therapy delivery model to a point that impacted patient outcomes. Providers should be tracking readmission rates, functional outcomes, discharge to community, and LOS. Hopefully these outcomes have maintained since 10/1/2019, rather than declined.

4. What has the overall net bottom line impact been since the transition to PDPM?  Have you seen cost increases and or savings in other areas related to this transition?

When CMS implemented PDPM, their goal was to remain budget neutral. If that does not appear to be the case, CMS may plan a payment adjustment. It will be important for providers to identify possible payment adjustment scenarios and recognize how a payment adjustment could impact their bottom line.

5. Has your Medicare Billing Accounts Receivable gone up, down, or remained about the same post 10/1/19?

Early in the transition, there were material challenges with claims submissions being processed/paid. Most, if not all, of these challenges have been rectified and claims should be paying cleanly. Be mindful of your Medicare Advantage AR as well, if applicable, especially with those Payors that have a PDPM rate methodology.

Having trouble answering any of these questions while viewing your financial statements?

We’re happy to review and provide guidance. Contact us to discuss ways Consonus can help identify missed opportunities.