This text is a written transcript of the seminar, “Managing PPS for Skilled Nursing Facilities”, presented by Shelley Mesure, M.S., OTR/L.”
Click here for supplemental handouts.
>> Shelley Mesure: Today we are going to learn about the terminology and the way that the Prospective Payment System (PPS) comes together in terms of managing your Medicare Part A patients in nursing home settings. PPS is about the reimbursement structure that we receive for inpatient healthcare. There is PPS for nursing homes and there is PPS for hospitals, but unfortunately other than having the same name, that is about as much as they have in common.
The hospital systems are very different, using diagnostic related groups, whereas the nursing home systems use a Resource Utilization Group (RUG) category and have a very different approach to handling the reimbursement. The reason that I put this course together is because PPS and the reimbursement structure for nursing homes falls heavily on the shoulders of rehab. Whether you are physical, occupational, or speech therapy, you play a very important role in helping the facility receive the different levels of reimbursement when they have Medicare Part A patients. Having a good understanding of how the system works, and looking at it from the rehab point of view versus the nursing point of view, is critical to ensuring a successful relationship and achieving your best reimbursement levels.
