With focus primarily on successful implementation of the Patient Driven Payment Model (PDPM) in recent months, now is a good time to revisit the importance of a solid process for the Medicare Meeting, or Utilization Review Meeting. Under PDPM, some providers have shifted away from the traditional Medicare Meeting in favor of an initial meeting to collaborate and review the record for completion of the Initial Medicare (5 Day) Assessment.

Coming together as the interdisciplinary team and formalizing communication processes will be more important than ever moving forward. Facility processes should still include an ongoing review of the need for skilled level of care. The Medicare Meeting is an ideal opportunity for the IDT to review the care plan and support continued progress toward meeting discharge goals. When nursing or rehab identifies barriers to progress, collaboration during the meeting is essential to make patient-centered adjustments to the treatment plan. The team should always be driving the care plan toward the patient’s discharge goal and showing analysis and team consensus for continued skilled needs, length of stay, and the discharge plan.

As you evaluate your process and incorporate PDPM into your Medicare Meeting for 2020, here are 10 tips to consider:

  1. Review the entire skilled caseload, but especially the traditional Medicare part A patients.
  2. Identify and review the primary SNF diagnosis and reason for inpatient SNF care weekly.
  3. Review the discharge plan and discuss updates from social services related to service and equipment needs, family meetings, home assessments etc.
  4. Discuss the patient’s response to skilled rehab services. If the patient is responding well, how is rehab evolving the treatment plan in the coming week? If the patient is not meeting rehab goals, what are the barriers and how will the treatment plan be adjusted to facilitate progress toward discharge goals?
  5. Consider updates related to the Function Score (GG) patient performance, cognitive function, new conditions identified, and new services warranted. Assess the ongoing clinical needs of the patient and whether or not they are changing to warrant IPA is necessary.
  6. Assess the ongoing clinical needs of the patient and whether or not they are changing to the point that an IPA is necessary.
  7. Identify teaching and training opportunities that may allow the patient to function at a more independent level, or have contributed to the skilled services provided since the last meeting.
  8. Confirm IDT agreement that the patient continues to meet skilled coverage criteria and is receiving the appropriate amount of rehab services.  Evaluate outcomes since start of care and since the last meeting.
  9. Check for errors, omissions, contradictory statements in the medical record since the last meeting.
  10. Make a strong weekly documentation entry in the nursing notes supporting the past week’s skilled services and describing why there is an ongoing need for a particular skill.

You may also consider including  technical checks as part of the Medicare Meeting process to prepare for the Triple Check meeting.  Remember, the patient, family, nursing, therapy and interdisciplinary team should all be working toward the same Good systems for communication, such as an effective Medicare Meeting,  help us manage the patient clinically, coordinate services, and plan for safe discharge transitions.

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Blog by Stacy Baker, OTR/L, CHC, RAC-CT, Proactive Medical Review

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