A healthcare worker is handed money
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Skilled nursing providers should be prepared for the federal government to move forward with planned reductions in reimbursements rates, even as they await a final decision on the recommendation, according to a top payment expert. 

“I think providers should also take this opportunity to prepare for the worst … hope for the best and prepare for the worst,” Robin Hillier, a reimbursement expert and president of RLH Consulting, recently told McKnight’s Long-Term Care News

The Centers for Medicare & Medicaid Services in early April announced plans to lower nursing home Patient Driven Payment Model (PDPM) rates by 4.6% — a $1.7 billion decrease — to account for unintentional overpayments.

The agency in April2021  originally announced that it intended to recalibrate PDPM’s parity adjustment after it found  aggregate spending under PDPM unintentionally increased by $1.7 billion.

CMS is soliciting comments on the matter through June 10. Hillier said providers’ best move is to submit comments to CMS asking for the cuts to be phased in, and encouraged them to also include how the cut would impact their own reimbursement rate. 

Even with that, she stressed that they also start “trying to think about ways now that if this cut is implemented on Oct. 1, that you might be able to adjust to that” so they’re fully prepared either way. 

“Providers should be taking this opportunity to prepare to take this full cut this year — even if they’re going to comment that they’d like to see it phased in,” Hillier told McKnight’s in a new Newsmakers Podcast

“[They should] truly look at their own facility based on what their average PDPM rate is and their Medicare utilization, what would the proposed cut actually mean to them,” Hillier added.