PDPM: MDS Accuracy and QAPI Initiatives

With the implementation of the Medicare Patient Driven Payment Model (PDPM) on October 1st, 2019 comes the need for increased MDS accuracy and supportive documentation. Under PDPM, responses to 188 MDS items will be used to determine a resident’s PT, OT, SLP, Nursing, and NTA case mix groups (CMGs), all of which are part of the per diem rate. While the MDS has always been scrutinized for accuracy, there are important areas under PDPM that may not have been on the radar for RUG-IV payment including:

  • Section GG – Function Score affecting PT, OT, Nursing Components
  • Section K – Swallowing Disorder and Mechanically Altered Diet affecting SLP Component
  • Sections I and J – SNF Admitting Diagnosis and Surgical Procedures affecting PT, OT, and SLP Components

While accuracy of reported therapy utilization has always been closely monitored, it is advisable to continue current data tracking as the days, minutes, and modes of therapy will continue to be reported in Section O of the MDS, but only at the time of Discharge (Part A PPS Discharge Assessment) and for the entire Medicare Part A stay.

Including MDS accuracy and supportive documentation initiatives into your QAPI processes is an ideal way to prepare for the transition to PDPM and avoid costly errors after implementation of the model. QAPI analysis, planning, and monitoring will also be imperative for those providers considering any type of shift in their population or clinical and/or rehabilitative services.

Contact us today for more information on our MDS coding accuracy audits and MDS focused training to prepare your team for PDPM success.

Click here to download the PDPM Action Plan now.

View our PDPM on Demand Training Section GG

The Proactive Section GG webinar provides insight into changes which correlate with new QMs and how section GG will be used in the newly proposed PDPM. Learn more about the Section GG Webinar.

PDPM Transition Success

CMS published the Fiscal Year 2019 SNF Prospective Payment System (SNF PPS) final rule, which announced their plans for implementation of PDPM scheduled for a start date of October 1, 2019. We’ve created a resource to help you understand this major reimbursement change. Learn more here.

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Blog by Eleisha Wilkes, RN, RAC-CT, Clinical Consultant, Proactive Medical Review

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