Missed coding will have a significant impact on the bottom line

PDPM considers a vast array of patient characteristics in the reimbursement calculation. Primarily based on MDS coding accuracy to “paint the picture” of each resident’s needs, missed coding will have a significant impact on the bottom line. The graphic below demonstrates the highest potential (urban) per diem reimbursement in contrast to the lowest possible per diem with a startling difference of up to $752.24 per day. How will your facility ensure strong systems of assessment, data collection, documentation and coding across the interdisciplinary team to ensure MDS coding accuracy? It is estimated MDS scrubber software identifies approximately 40% of the possible errors on average.

Prepare for success

To prepare for success, facilities must develop strong auditing and monitoring protocols. Proactive recommends:

  • Analysis of the effectiveness of IDT collaboration and data collection processes beginning with the pre-admission process and continuing through the pre-bill triple check claims assessment process
  • QA systems for assessing the quality of supportive documentation for MDS coding
  • Review of resident interview protocols
  • PDPM updates to Clinical Meetings, Medicare/UR Meeting, Triple Check Meeting, and periodic monitoring of meeting processes
  • 3rd party documentation and coding audits

Contact Proactive for PDPM readiness assistance or to learn more about PDPM audit support solutions on a budget friendly flat rate partner plan.

PDPM Triple Check Billing Accuracy Toolkit

This tool kit is intended to assist facilities in establishing and/or updating existing processes to promote clean claims for accurate billing and preparing Triple Check team members for an effective and compliant process in “clean claims” through pre-bill review. Click here to get all the details and download this resource in our shop.

PDPM Pre-Admission Assessment Tool Kit

Proactive’s Pre-Admission Screen and Pre-Admission Interview tools guide the SNF admissions team in gathering essential information for estimating care needs and identifying critical factors impacting the PDPM per diem rate. Click here to get all the details and download this resource in our shop.

Get more resources in our shop!

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Blog by Amie Martin OTR/L, CHC, RAC-CT, President, Proactive Medical Review

Click here to learn more about Amie and the rest of the Proactive team.