PDPM was finalized by CMS on July 31, 2018 and will go into effect on October 1, 2019, replacing the current PPS RUGs-IV model.
If we can provide consistent practices, we can effectively capture everything needed to optimize PDPM payments and Provide the quality of care
Reimbursement Under PDPM:
- PDPM completely replaces RUGs IV and focuses on resident clinical characteristics to drive reimbursement.
- Six components will be used to establish per diem rates: PT, OT, SLP, Nursing, Non-Therapy Ancillary and Non-Case Mix.
- ICD-10 coding accuracy on the MDS will be essential as MDS will be used to determine each resident’s PDPM clinical category.
- Section GG is being finalized for use as the functional measure (replacing Section G).
- We also need to ensure accuracy of MDS by capturing clinical conditions accurately. We need to improve clinical documentation with timely identification of conditions, skilled documentation, and education.
The 5-day and Discharge assessment are the only required PPS assessments. The new Interim Payment Assessment will now be an optional assessment used to reset payment when certain criteria are met.
Prepare for the Transition with
- Contact Rehabilitation masters for a budget friendly analysis on the impact of PDPM on your facility.
- Schedule a review of current ICD.10 and section GG coding and clinical systems which will significantly impact reimbursement under the new reimbursement model.
- Plan to discuss an individualized PDPM transition plan focused on the 2019 changes including understanding PDPM and implementing an action plan to successfully transition by the October 1, 2019 effective date.
- • PEPPER Reports
- • MDS Updates
- • Interact Tools
- • QM Trends, QRP, PBJ
- • 5-Star Rating
- • EHR, Modifiers Updates
- • VBP, BPCI,
- • Managed Care
- • IMPACT Act, ACO Changes
- • Performance Based Metrics
- • Re-Hospitalization Management
- • LOS Management
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