Accurate and comprehensive patient documentation is crucial for skilled nursing facilities (SNFs) to ensure optimal reimbursement and maintain financial stability. Under the Patient-Driven Payment Model (PDPM), reimbursement rates are determined by a range of factors, including patient characteristics, diagnoses, and treatments (CMS, 2021). Thorough documentation of these factors can significantly impact a facility's revenue.
One of the primary ways accurate documentation affects SNF revenue is by ensuring that all relevant conditions and treatments are captured. Under PDPM, certain conditions, such as depression, cognitive impairment, and pressure ulcers, can lead to higher reimbursement rates (Morley, 2019). Failing to document these conditions properly can result in lost revenue for the facility. A study by Pesis-Katz et al. (2020) found that more comprehensive documentation of patient characteristics and diagnoses was associated with higher reimbursement rates in SNFs.
Accurate documentation also helps SNFs avoid costly denials and appeals processes. When patient files lack sufficient information to support the level of care provided, reimbursement claims may be denied (Stephens, 2018). This not only delays payment but also requires additional staff time and resources to appeal the decision. By ensuring that patient documentation is complete and accurate from the start, SNFs can reduce the risk of denials and streamline the reimbursement process.
In addition to optimizing reimbursement, accurate patient documentation also enables SNFs to provide better quality care. Comprehensive documentation helps staff identify and address potential issues, such as changes in a patient's condition or gaps in treatment (Smith et al., 2018). This proactive approach can lead to improved patient outcomes, reduced hospitalizations, and higher patient satisfaction, all of which can positively impact a facility's reputation and financial performance.
Investing in technology and processes that support accurate patient documentation is essential for SNFs to maximize reimbursements and maintain financial stability. Software solutions that use artificial intelligence to identify commonly overlooked conditions and ensure comprehensive documentation can be particularly valuable (Davenport & Kalakota, 2019). By prioritizing accurate documentation, SNFs can optimize revenue while providing the highest quality of care to their residents.
References:CMS. (2021). Patient-Driven Payment Model. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/PDPM
Davenport, T., & Kalakota, R. (2019). The potential for artificial intelligence in healthcare. Future Healthcare Journal, 6(2), 94-98. https://doi.org/10.7861/futurehosp.6-2-94
Morley, J. E. (2019). The New Patient Driven Payment Model (PDPM) for Skilled Nursing Facilities. Journal of Nutrition, Health & Aging, 23(2), 180-182. https://doi.org/10.1007/s12603-019-1156-3
Pesis-Katz, I., Barish, E., Wang, H., Temkin-Greener, H., Mukamel, D. B., & Li, Y. (2020). Comprehensive Assessments and Evidence of Unmet Needs Associated with Higher Reimbursement Levels in Skilled Nursing Facilities. Journal of the American Medical Directors Association, 21(9), 1282-1287. https://doi.org/10.1016/j.jamda.2020.04.028
Smith, J. M., Sullivan, S. J., & Baxter, G. D. (2018). Nurses' documentation of comprehensive assessments in the resident assessment instrument/minimum data set (RAI/MDS): a review of the literature. Journal of Clinical Nursing, 27(7-8), 1280-1291. https://doi.org/10.1111/jocn.14154
Stephens, A. (2018). The Impact of Inaccurate MDS Documentation on Skilled Nursing Facility Reimbursement. Journal of Health Care Compliance, 20(4), 23-26.
