PDPM: 1 important thing to begin doing now

Ken BellClient News, Skilled Nursing16 Comments

Beginning Oct. 1, 2019, the new Patient-Driven Payment Model (PDPM) will shift the way your skilled nursing facility is reimbursed for Medicare A services. PDPM will replace the current RUG-IV system, introducing a whole new way to calculate SNF reimbursement.


The current RUG-IV system incentivizes the use of therapy minutes as the basis for payment. Under PDPM, however, every resident will receive a case-mix classification, which will drive the daily reimbursement rate for that resident.

The case-mix classification consists of five components:

  • Physical Therapy (PT)
  • Occupational Therapy (OT)
  • Speech Language Pathology (SLP)
  • Nursing
  • NTA

On Tuesday, Dec. 11, CMS released a SNF PPS: Patient Driven Payment Model presentation, answering frequently asked questions about the transition. The presentation provides a snapshot of the payment model, patient classifications under PDPM, patient classification examples, MDS changes, and much more.

A key takeaway from the CMS presentation: Coding diagnosis information accurately and efficiently is more important than ever, as it will make up a majority of your reimbursement.

1 important thing to begin doing now

Remember: There will not be a transition period between RUG-IV and PDPM. It’s not too early to start preparing for PDPM. You can begin by identifying affected processes and adjust your SNF’s workflow and resources accordingly.

When planning for PDPM, it’s important to use data to support your clinical decisions. Under PDPM, CMS will focus heavily on measuring and rewarding quality outcomes, so it’s crucial to leverage your current data to ensure the right care is provided to meet individual residents’ needs.

To lay the groundwork for proper clinical data under PDPM, you must correctly report clinical conditions for diagnosis and MDS accuracy.

Here’s the critical PDPM practice you should begin doing immediately:

Ensure the primary diagnosis is correctly entered in I8000A. Be sure to do this for every resident and make this a standard practice leading up to the changeover to PDPM.

Completing I8000A accurately will help you proactively prepare for upcoming PDPM reimbursement requirements. At SimpleLTC, we’ve polled many of our largest customers, who have confirmed they are following this practice. Therefore, we recommend that all our customers follow this best practice.

SimpleLTC’s commitment to help

We’re committed to helping you stay current with industry changes, which includes constantly updating our products to help you maintain regulatory compliance and leverage the value of your MDS and clinical data.

One way we’re helping our SNF customers make the difference between success or failure is through predictive, real-time MDS analytics. Sign up for your free demo to learn why over 1,000 facilities trust SimpleAnalyzer™ to improve quality measures, reduce rehospitalizations, maximize QRP compliance, and more.

16 Comments on “PDPM: 1 important thing to begin doing now”

  1. Could you please notify me on the next webinar on PDPM as today’s webinar was full; thanks.

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