Frequently Asked Questions

General Questions

Q: Does Signet help with existing psych or rehab programs or just provide startup services for inpatient mental health or acute rehabilitation programs?
A: Signet provides management services for both existing acute rehab and inpatient mental health programs as well as consulting or turnkey management services for developing new psych or rehab programs.

Q: What is the charge for Signet to evaluate my hospital psych or rehab program or discuss strategic planning with hospital leadership?
A: Signet will do an initial evaluation and analysis without charge for prospective hospital clients.

Q: What if I want some limited assistance instead of complete management services for my rehab or psych program?
A: Signet provides a very flexible array of assistance contracts and consulting services to hospital clients.

Q: Do you offer an industry standard 5-year contract only or can you help me with different terms?
A: Yes, we are very flexible with the terms of our psych and rehab management contracts and will customize the terms as needed.

Q: Does Signet offer specialized consulting services in behavioral health or acute rehabilitation programs?
A: Yes, Signet does provide rehab and psych consulting services to hospital clients.


Behavioral Health Questions

Q: Is it realistic to operate a financially viable behavioral health program and meet our community’s needs in today’s healthcare climate?
A: Yes. This is one of two healthcare niches in which Signet Health specializes.  Our hospital clients have clinically excellent psych programs that contribute significantly to the hospital’s overall financial health. Contact us today for a no cost financial, market and competitive analysis.

Q: What impact has the implementation of IPF-PPS for inpatient psychiatric programs had on the financial outcomes in inpatient behavioral health at our hospital?
A: The Prospective Payment System for Inpatient Psychiatric Programs (IPF-PPS) changed reimbursement from a cost based system to a per-diem rate system for distinct part units (DPU) in hospitals. Since it was designed to be budget neutral, reimbursement for psychiatric services for some hospitals have improved while other hospitals will receive less reimbursement than they would have under the former cost-based system.   Signet Health assists client hospitals with strategy adjustments to benefit from IPF-PPS reimbursement as compared to the out-dated strategies utilized with the old cost-based revenue system. Contact us today for a complimentary analysis of the full revenue potential your psychiatric program could be providing for your hospital facility.

Q: What impact will we have on our disproportionate share revenue if we change our behavioral health strategy?
A: Disproportionate share revenue (DSHPRO) is an important revenue stream for many hospitals. When developing a new strategic direction for mental health services, Signet Health provides expert DSHPRO estimates while coordinating bed-space strategy recommendations. While opening a distinct part psychiatric program that is exempt from acute PPS will generally have no impact on disproportionate share revenue, there are instances where opening a DPU would have an adverse impact. Conversely, if beds are de-exempted from an existing psychiatric program (deducted from the distinct part unit exemption), patients treated in these non-exempt psych beds could have a positive impact on your disproportionate share revenue. Let Signet provide the complimentary analysis necessary to develop a strategy that may maximize disproportionate share revenue for your hospital.

Q: Can you help us determine whether we should have an “exempt DPU” or “non-exempt unit” for inpatient behavioral health at our hospital?
A: Yes, in addition to complimentary market and competitive analysis, Signet Health will assist hospital management with developing a specific strategy for inpatient behavioral health that utilizes theoretical bed-demand analysis with real-life financial pro-formas to determine the best financial outcome for the hospital.

Q: We may or may not need help with recruiting psychiatrists? What are Signet’s capabilities in recruiting physicians?
A: Signet is very flexible with our client hospital’s physician needs. We will assist you or fully recruit psychiatrists or other professional positions as the needs of your hospital dictate.

Q: Our hospital is seeing more psych patients through our emergency department. Can you help us develop a strategy to benefit the patient and the hospital?
A: Yes.  Treating psych patients in a med/surgical bed is generally not the best treatment for the patient neither is it the best utilization of the hospital’s resources. Establishing, developing and effectively managing a sound behavioral health strategy to admit and provide quality treatment for psych patients who present in the ER will improve your hospital’s efficiency and financial outcomes.  If you would like to find out more about how we can assist you with the management of psychiatric patients in your ER contact us today.

Q: When can we open a new psych distinct part unit? And how long does it take to develop a new psych program?
A: New DPU’s can only be opened on the first day of your Medicare cost reporting year IF you wish to be exempt from acute PPS reimbursement and eligible for IPF-PPS reimbursement. Regulatory hurdles, construction issues, CON requirements, and staffing needs are just a few of the many variables that affect the amount of times it takes to develop a program. Two of the most critical time elements are CON and construction related. While Signet has successfully worked with hospitals to open programs in extremely short time-frames, in general the process should begin 6 to 9 months prior to the projected opening date. If a CON or major construction is required, the timeline for program development could be even longer. We would be happy to analyze your specific circumstances and promptly provide you with an estimate of the time and tasks necessary to properly develop a program.

Q: What about the timeline for opening a non exempt psych unit?
A: A non-exempt psychiatric program can be opened at anytime during the year. However, it can only be exempted from acute PPS reimbursement at the beginning of a fiscal year. Therefore, if the unit is opened at anytime other than the beginning of the fiscal year it will be reimbursed under DRG’s from the date of opening through the end of the fiscal year.  There can be a significant impact on disproportionate share revenue from a non-exempt psych program. For more information and a timeline estimate contact us today.

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Acute Rehabilitation Questions

Q: What is the “75% Rule” and why does it matter?
A: The “75% Rule” is a hotly debated CMS regulation that requires a defined percentage of all discharges from the physical rehabilitation unit to fall into one of 13 diagnostic categories. The “75% Rule” was being phased in over time and is currently frozen at 60% (12/29/07). Currently, 60% of all patients admitted to an acute rehab unit must fall into one of the 13 CMS categories. For more information on the “60% Rule” click here. The reimbursement for acute rehab patients from CMS can change dramatically should a unit fail to meet the requirements. If a unit fails to meet the “60% Rule” CMS can retroactively pay by DRG in lieu of CMG’s for the existing cost report year. The following year would also be paid under DRG until qualification can be re-established and the unit could lose its DRG exemption.

Q: How can our hospital best adhere to the 60% Rule?
A: Signet has a proprietary internet based marketing system (SigNetwork) that provides hospital clients with live, real-time data. This live data allows customized tailoring of rehab data to hospital leadership tied to the annual strategic marketing and business plan.  The SigNetwork database allows constant monitoring and instant access (password protected) from any internet connection at any time. Consequently, Signet’s community education efforts will be actively managed and adjusted on a real-time basis to the current patient mix and annual marketing plan.

Q: What is a Recovery Audit Contractor and what do they want from our rehab program?
A: The Medicaid Modernization and Improvement Act mandated a pilot project to utilize Recovery Audit Contractors (RAC’s) in an effort to provide additional oversight for acute rehabilitation programs. For more information, click here. For assistance in preparing for a RAC audit, please contact us today.

Q: We may or may not need help with recruiting physicians? What is Signet’s recruiting capability?
A: Signet is very flexible with our client hospital’s physician needs. We will assist you or fully recruit physiatrists or other professional positions as the needs of your hospital dictate.

Q: If we contract with Signet to manage our physical rehabilitation program, who controls the program?
A: The hospital remains in control of the program at all times. Signet is responsible for executing the goals of the program while the hospital maintains ultimate decision making authority in all instances. The Signet program is transparent as a hospital service and any Signet employed staff function as agents of the hospital.

Q: Do acute rehabilitation programs still make money? Or are they on their way out?
A: Yes, Signet client hospitals have varying positive contribution margins from acute rehab programs. The variability of staffing, overhead, ADC, volume, and patient diagnosis coupled with a complex CMG payment per Medicare discharge payment system (IPF-PPS) make each hospital’s financial outcomes unique.   Under IRF-PPS, since it is a budget neutral payment system, there are hospitals that have prospered and hospitals that are struggling financially. Let Signet help your hospital by providing complimentary financial analysis for your facility, please contact us today.

Q: Assuming there is a positive financial benefit, what other benefits would the professional development of an acute rehabilitation unit (ARU) bring to our hospital?
A: Acute rehab services generally provide a better alignment of patient needs with IPF-PPS reimbursement. Additionally, hospitals can expect better management of ALOS outliers as a result of patients in need of physical rehabilitation being transitioned out of medical/surgical beds more quickly. The appropriate development of hospital based physical medicine services also provides a needed service to the hospital’s service market area while adding an additional revenue source to the hospital’s bottom line. To find out more about the benefits your hospital could receive from offering a physical rehabilitation program contact us today.

Q: How long does it take to develop an ARU program?
A: New DPU’s can only be opened on the first day of your Medicare cost reporting year IF you wish to be exempt from acute PPS reimbursement and eligible for IRF-PPS reimbursement. Regulatory hurdles, construction issues, CON requirements, and staffing needs are just a few of the variables that affect the amount of times it takes to develop a program. Two of the most critical time elements are CON and construction related. While Signet has successfully worked with hospitals to open programs in extremely short time-frames, in general the process should begin 6 to 9 months prior to the projected opening date. If a CON or major construction is required, the timeline for program development could be even longer. We would be happy to analyze your specific circumstances and promptly provide you with an estimate of the time necessary to develop a program.

Q: I have heard that if we open a physical rehabilitation unit we have to go through 12 months of payment under DRGs? Is that right?
A: If developing the unit involves new construction, the re-licensure of skilled beds or a change in ownership it may be possible to exempt the program without operating for a full year under DRG reimbursement. Let Signet provide your hospital a sound strategy for opening a program without operating for 12 months under DRG’s by calling us or completing the form on the “contact us” page today.

Q: Does your company assist with the CON process?
A: Yes. Signet will assist the hospital in completing the CON process by providing market analysis complete with demographics, bed need, and competitor analysis.

Q: We have a busy SNF and are not sure about the necessity of acute rehab.  Why should we look at an ARU?
A: It is possible that a significant number of your patients in the skilled unit could benefit by receiving a higher level of care and the hospital would also benefit financially from a higher level of reimbursement as a result of providing the more intensive treatments prescribed in acute rehab settings. Let Signet analyze and contrast the differences between skilled and acute rehabilitation financial outcomes by contacting us today.

Q: What types of patients are appropriate for inpatient rehabilitation?
A: Individuals appropriate for treatment in an acute physical rehabilitation program include those patients disabled as a result of chronic illness such as post-stroke conditions, congestive heart failure, acute arthritis, multiple sclerosis, Parkinson’s and other degenerative diseases; those disabled as a result of major, multiple trauma including people with complex orthopedic conditions, burns, brain and spinal cord damage and amputation and those disabled by premature birth or congenital defects.

Q: What are the CMS 13 conditions to comply with the current 60% rule for IRF reimbursement?
A: Qualifying conditions for inclusion of patients in the IRF compliance percentage include patients who have one or more of the following conditions as either a principal or secondary diagnosis may be counted toward an IRF’s compliance percentage:

*Stroke
*Spinal cord injury
*Congenital deformity
*Amputation
*Major multiple trauma
*Fracture of femur (hip fracture)
*Brain injury
*Neurological disorders
*Burns
*Arthritis-related medical conditions (three types specified in regulation)
*Knee or hip joint replacement if (1) it was bilateral, (2) the patient’s BMI was greater than 50, or (3) the patient was 85 or older