ED Coding & Reimbursement Alert - 2014 Issue 1
Know These Crucial SNF Target Area Definitions
Subscribe or sign in to view the full article.
Article Overview
This article provides a high-level overview of the Skilled Nursing Facility (SNF) target areas CMS uses in PEPPER analysis to identify potential improper Medicare payment patterns. It is aimed at billing, compliance, and coding professionals who need to understand how the report’s measures are structured and what broad categories of SNF activity are included.
Why This Topic Matters
Understanding these target area definitions helps SNF stakeholders interpret PEPPER results and focus review efforts on the measure categories CMS monitors.
Article Sections
-
Therapy RUGs with High ADLs
Introduces one CMS PEPPER target area related to therapy resource group activity and resident assessment levels.
-
Non-Therapy RUGs with High ADLs
Describes a second target area focused on non-therapy resource group activity within the PEPPER framework.
-
Change of Therapy Assessment
Covers the assessment-based target area used in PEPPER monitoring.
-
Ultrahigh Therapy RUGs
Summarizes another therapy-related target area included in the CMS report analysis.
-
Therapy RUGs
Describes a broad therapy utilization target area used in the PEPPER measures.
-
90+ Day Episode of Care
Covers the episode-length target area related to SNF stays and CMS monitoring.
What You Will Learn
- How CMS defines the SNF target areas used in PEPPER
- What broad measure categories are included in the report
- How therapy, non-therapy, assessment, and episode-based measures are organized
- Why these definitions matter for reviewing Medicare payment patterns
Who Should Read This
- Skilled nursing facility coders
- SNF billers
- Compliance staff
- Revenue cycle staff
- Healthcare auditors
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com