Due to finalization of payment reform rules - The Content has been recorded and is available NOW!
A Live Q and A was recorded on December 13th and the recording is available in the resources area.
The Centers for Medicare and Medicaid Services is implementing new Medicare Part A reimbursement methodologies for skilled nursing facilities and home health agencies, termed the Patient-Driven Payment Model (PDPM) and Patient-Driven Groupings Model (PDGM), respectively. While coverage of therapy services is not changing, it is important for PTs and PTAs to understand how these models are designed to better align payment with patient characteristics and needs. Learn how Medicare will reimburse SNFs and HHAs for services delivered to Medicare beneficiaries and practical strategies for PTs and PTAs to demonstrate their value, both in these settings and across the continuum of care.
Meet our Presenters
Kara Gainer joined APTA in 2017 and provides leadership and strategic direction to the regulatory affairs team on key programs, initiatives, and policy development in the federal regulatory space. She has extensive knowledge and experience working on policies related to Medicare, Medicaid, health care reform, and provider billing and reimbursement. Prior to joining APTA, Kara was a health care consultant with Drinker Biddle & Reath, where she developed and executed comprehensive public policy strategies for her clients that integrated legislative, regulatory, and communications efforts. She also served as attorney advisor for the US Department of Health and Human Services Office of Medicare Hearings and Appeals, and clerked with the US Senate Sergeant at Arms. Kara received her bachelor’s degree in psychology from the University of Montana and law degree from the University of Montana, School of Law, and is a member of the District of Columbia Bar.
Toby S. Edelman has been representing older people in long-term care facilities since 1977. As a Senior Policy Attorney with the Center for Medicare Advocacy since January 2000, Ms. Edelman provides training, research, policy analysis, consultation, and litigation support relating to nursing homes and other long-term care facilities. Under two grants from the Commonwealth Fund, she evaluated the federal nursing home survey and enforcement system and its impact on state activities and provided technical assistance to states on effective enforcement practices. In cooperation with the Centers for Medicare & Medicaid Services, she recently completed a Commonwealth Fund project to evaluate seven states' deficiency citations for misuse of antipsychotic drugs. Since September 1999, she has written a monthly newsletter on nursing home enforcement issues. Ms. Edelman was the lead attorney for a statewide class of nursing facility residents who successfully challenged the state of California's refusal to implement the federal Nursing Home Reform Law (Valdivia v. California Department of Health Services, Civ. No. S-90-1226 EJG (E.D. Calif. 1993). As a beneficiary representative, Ms. Edelman has testified before Congress and served on federal task forces, technical expert panels, and working groups on nursing home issues.
Ellen R. Strunk, PT, MS, GCS, CEEAA, CHC has worked in various roles & settings as both clinician & manager/director. Presently, Ellen is owner of Rehab Resources & Consulting, Inc., RRC specializes in helping customers understand the CMS prospective payment systems in the skilled nursing facility and home health setting, as well as outpatient therapy billing for all provider types. Ms. Strunk’s experience includes utilizing medical record reviews and data systems to help both inpatient and outpatient therapy providers meet regulatory guidelines. She has worked with clients on a variety of Medicare/Medicaid payment and certification matters, including substantial overpayment assessments and facilitation of Corporate Integrity Agreements. Services offered include: interdisciplinary medical record review, compliance risk analysis appeals and appeals management, obtaining Medicare certification for a rehabilitation agency, developing clinical programs, and developing operational and clinical processes to support therapy management. In addition to assisting clients meet their operational & clinical goals, Ms. Strunk lectures nationally on the topics of regulatory compliance in the post-acute care space and coding/billing/documentation to meet medical necessity guidelines and payer regulations, as well as pharmacology for rehabilitation professionals, clinically appropriate exercise for older adults, and the importance of functional outcomes to value-based payment.
Matt Sivret, PT Matt Sivret, PT, CLT is the Divisional Vice President, Clinical Operations for Kindred Rehab Services/RehabCare. He has held various positions with the company over the past 21+ years, including Rehab Manager, Area Rehab Director, and Education and Compliance Coordinator. He also has his Certification as a Wound Specialist (CWS) and Lymphedema Therapist (CLT).
Bud Langham, PT, MBA Bud is a Physical Therapist and serves as the CCO for the Home Health and Hospice division of Encompass Health. He has been in leadership roles in acute and post-acute care settings as well as outpatient rehab and cardiac rehab. Bud is responsible for clinical care, quality and innovation at Encompass Health. He has a passion for innovation and clinical excellence in patient care. Bud believes that all clinicians must maintain a commitment to always Learn, Unlearn, and Relearn when it comes to patient care. He graduated from the University of Oklahoma Health Sciences Center with a degree in PT and later from the OU Price College of Business with an MBA.
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