DETAILS

Are you READY? Strategies for a Successful Transition to PDPM ~

Effective October 1, 2019, CMS will be replacing the Skilled Nursing Facility (SNF) Resource Utilization Group (RUG) payment system with a new model for Medicare Part A payment. This new payment methodology is called the Patient Driven Payment Model (PDPM). PDPM will have its opportunities, as well as its challenges for SNF providers. Successful implementation will rely on accurate coding of the MDS (i.e., ICD-10 diagnosis codes, functional assessment scores in section GG, cognitive status, evidence of swallowing dysfunction, etc.) and effectively managing length of stay and the types/amounts of therapy services.

As CMS moves toward systems that focus heavily on quality, the industry will move away from a reimbursement system that incentivizes the allocation of therapy minutes to a system that reimburses SNF’s based on patient characteristics. Understanding how selecting and coding proper ICD-10 diagnosis will be a key factor in success with PDPM. This program will provide attendees with the knowledge and tools to prepare for successful transition to PDPM in your SNF.

Attendees will:

1. Describe the components of the PDPM, including differences between RUG IV and PDPM methodology.
2. Recognize the significance of ICD-10 coding related to the PDPM.
3. Understand how to prioritize and sequence ICD-10 codes in the MDS, in the clinical record and on the SNF claim.
4. Discuss the impact on nursing, MDS and therapy providers.
5. Understand the evolving role of the MDS coordinator in an environment focused on quality.
6. Understand how a per-diem rate is created using PDPM: a case study walk-through.
7. Develop an action plan to successfully transition your facility to PDPM.