This is the seventh posting in the Countdown to PDPM. The series continues to build on prior postings on Patient Driven Payment Model (PDPM). If you missed any of those, or need to review, you can access them here, on the Resource site. Just scroll down the Archive menu on the right side of the Resources home page to view all prior editions.
This month, we will take an overview of how the Nursing Component of the PDPM is calculated. The first step is to calculate the resident’s Function Score for nursing payment. This is not the same as the functional scoring which we used for Physical and Occupational Therapy, however it is also based upon indicators found in GG of the MDS. The nursing functional score has a maximum of 16 possible points with an increasing score signifying increased independence.
Use the following table to determine the score for Admission Performance on Eating (GG0130A1), Toileting Hygiene (GG0130C1), Sit to Lying (GG0170B1), Lying to Sitting on Side of Bed (GG0170C1), Sit to Stand (GG0170D1), Chair/Bed-to-Chair Transfer (GG0170E1), and Toilet Transfer (GG0170F1).
Once the Nursing Functional Score is obtained for the resident, the second step is to refer to the Nursing Case‐Mix Classification Groups table to determine the Case‐Mix Group and indexes for the nursing component.
In our next posting in this series, we will put information from the prior seven to calculate the PDPM. At RehabVisions, we are dedicated to assisting you to prepare and thrive regardless of the reimbursement system. Our traditional values, innovative care and experience are resources that our partners can depend upon.
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This post is based upon details currently available from CMS at the time of publication. Please refer to the CMS PDPM Page for more information.