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Effective Oct. 1, 2019, the Patient-Driven Payment Model (PDPM) in the skilled nursing facility prospective payment system (SNF PPS) will revamp how SNFs are paid to care for traditional fee-for-service Medicare Part A residents. “PDPM will look almost entirely different from the RUG models that SNFs have been working with for roughly 20 years,” says Scott Heichel, RN, RAC-MT, DNS-CT, QCP, CIC, director of clinical reimbursement for LeaderStat in Powell, Ohio.
When the Centers for Medicare & Medicaid Services (CMS) released the draft of the PDPM predecessor RCS-I, rumors immediately popped up that the reduction in administrative burden from the streamlined PPS assessment schedule would encourage providers to reduce their nurse assessment coordinator (NAC) staffing. However, aside from how that hot take ignored OBRA and Medicare Advantage assessments, “PDPM actually offers you the chance to make the NAC role even more important than it is under RUG-IV,” says Heichel.
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