CMS issued the final rule for Fiscal Year (FY) 2019 SNF Prospective Payment System (PPS) announcing that the Patient-Driven Payment Model (PDPM) will take effect October 1st, 2019, replacing the current PPS RUGs-IV model. How will your facility fare under PDPM?

Reimbursement Under PDPM:

  • PDPM completely replaces RUGs IV and focuses on resident clinical characteristics versus the former focus on therapy service intensity to drive reimbursement.
  • Six components will be used to establish per diem rates: PT, OT, SLP, Nursing, Non-Therapy Ancillary and Non-Case Mix.
  • ICD-10 coding accuracy on the MDS will be essential as MDS item I8000 will be used to determine each resident’s PDPM clinical category.
  • Section GG is finalized for use as the functional measure (replacing Section G) with some modifications.
  • The 5-day and Discharge assessment are the only required PPS assessments. Note: OBRA assessment schedule will remain unchanged. The new Interim Payment Assessment will now be an optional assessment used to reset payment when certain criteria are met.

Prepare for the Transition with Proactive

  • Contact Proactive for a budget friendly analysis on the impact of PDPM on your facility.
  • Schedule a review of current ICD.10 and section GG coding and clinical systems which will significantly impact reimbursement under the new reimbursement model.
  • Schedule PDPM transition focused ICD.10 Training by Proactive’s AHIMA approved ICD.10 Trainer.
  • Plan to attend the webinar series focused on the 2019 Changes including understanding PDPM and implementing an action plan to successfully transition by the October 1, 2019 effective date. Find information on the webinars in our shop.