Worried about PDPM? Reduce the stress by easing into a successful transition. Focus on these areas now:
- Stay current with the information on the CMS PDPM webpage. This site has discussions regarding patient classifications, calculation of functional and cognitive scores, MDS changes, interrupted stay policy and more as well as a FAQ document which CMS is updating as needed.
- Review your facility’s impact analysis to gain an understanding of how this change in reimbursement models could affect you financially. CMS has a tool for most facilities that is based upon data from 2017. RehabVisions can also give you a facility-specific impact estimation based upon your 2018 MDS data. Please follow up with us to get this customized analysis.
- Obtain the updated version of the RAI Manual when it is available (anticipated to be released in May) to begin learning about the changes to the assessment instrument as well as to assessment scheduling. The assessment schedule will vary greatly under PDPM. There will only be three SNF PPS assessments under PDPM: 5-day Assessment, Interim Payment Assessment (IPA), and the PPS Discharge Assessment versus the multiple assessments required under RUG IV.
- Take time to review your current tool utilized for pre-admission assessments. Under PDPM, correct coding and documentation of diagnoses are essential. Plan now to ensure that your pre-admission tool captures all of the information you will need as your facility moves into this new reimbursement structure.
- Begin training staff, as needed. Frequent small bits of information can be less overwhelming. Considered your audience and evaluate which staff need to know what information. For example, Dietary Staff may not benefit from detailed training regarding how patients are classified for PDPM, but it may be helpful for them to understand that it is important to capture mechanically altered diets, when appropriate, to ensure that the SLP component is correctly calculated.
- Consider additional training for key staff on ICD-10 coding. CMS has a Clinical Category Crosswalk available, which may be a resource for understanding which diagnoses fall under each of the 10 particular categories.
- Evaluate MDS accuracy. Coding of GG will be utilized to determine functional scoring for PT, OT and Nursing components of PDPM. Cognitive scores will impact the SLP component and determine placement into BA and BB Nursing Case Mix group.
- Think through how documentation needed may vary under PDPM. Will your current flow sheets and forms need to be updated to better reflect the care that you are giving? Evaluate whether your facility’s current documentation is addressing all of the areas you will need to record to obtain the reimbursement your facility is entitled to.
- Formulate a plan regarding how you will handle the transition period. RUGS IV ends on 9/30/19 and PDPM begins on 10/1/19. There is no overlap or phase-in. Your facility will need to complete an Interim Payment Assessment for all Medicare A residents whose stay goes beyond 9/30/19. This assessment must have an ARD date by 10/7/19. If not completed timely, the resident will receive a default rate for the days that are out of compliance.
- Assess the need to provide your medical director and other physicians with education regarding the new categories and importance of diagnostic coding under the Patient Driven Payment Model.
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