CMS’s FY2027 final rule identifies no new PDPM ICD-10 mapping changes — but its fact sheet flags “observed case-mix upcoding” as a policy signal for post-acute providers. Here’s what that means for documentation practices, and why last year’s 34 mapping changes still aren’t fully absorbed.
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Written with passion.
A federal review of 19 Medicare Advantage organizations found they collectively denied 12% of skilled nursing facility admission requests — a rate that ranged from 0.4% to 23% depending on the organization. But averages hide the more useful finding here: one contractor processed half of every SNF request in that review, and denied them at […]