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How Will PDPM Change the Role of the NAC?

By Jessica Kunkler, MA, Staff Writer - February 20, 2019

If you are a nurse assessment coordinator (NAC), you’ve probably heard that there will be fewer assessments for Original Medicare residents under the Patient-Driven Payment Model (PDPM). But what does this mean for you, your role, and your job security? Here is what you need to know.

1)      The role of the NAC is here to stay.

According to Jessie McGill, RN, RAC-MT, RAC-MTA, and curriculum development specialist with AANAC, “With PDPM, it is true that there will be a significant reduction in the number of the assessments required during a Medicare stay. However, the 5-Day PPS assessment will become extremely important, with the potential to set the rate for a resident’s entire PPS/Medicare stay. This will make the accuracy of the 5-Day more important than ever.”

McGill stresses that because the role of the NAC is to correctly connect the information in each resident’s clinical documentation to the MDS, and because the MDS will increasingly drive each resident’s care plan and reimbursement, NACs will remain a critical part of facility operations. “Under this new payment model, particularly because reimbursement will be based on resident characteristics instead of therapy volume, properly translating nursing documentation onto the MDS correctly will be critical to accurate payment,” she shares. In other words, the need for NACs is here to stay.

2)      Your duties may shift.

“Because of the change to the assessments, the NAC’s role and job tasks will shift to become more focused on accuracy in the 5-Day, rather than volumes of assessments,” says McGill. She also stresses that the need for accuracy and specificity in ICD-10 coding will increase. This is because proper coding will determine the primary reason for the SNF PPS stay as well as capture comorbidities for the speech-language pathology and non-therapy ancillary components of PDPM and nursing case-mix qualifiers. ICD-10 coding and accuracy will likely fall to the NAC. So, just because there will be fewer assessments doesn’t mean there will be less work.

3)      Your role may grow.

Under the new payment system, the NAC’s understanding of factors that affect reimbursement will need to broaden. “Under PDPM, the NAC will need to thoroughly understand case management, clinical assessment, Medicare reimbursement, and multiple Quality Measures (QMs). Because reimbursement is going to become dependent on resident characteristics and then be adjusted by QMs from the QRP and VBP programs, Medicare reimbursement will become more complex than ever,” says McGill. While an understanding of these programs was helpful under the RUG-IV payment model, it will become necessary for success under PDPM. NACs will need to understand how all of these factors work together to set final payment rates.

4)      You will need to work more effectively with your DON than ever before.

Under the new payment model, facility leaders will look to NACs as their in-house MDS experts. But NACs won’t be able to code the MDS appropriately without proper clinical documentation. A strong working relationship with the director of nursing (DON) will become more important than ever before, as DONs will be responsible for putting systems in place to ensure accurate and consistent documentation.

To learn more about the changing role of the NAC, join Jessie McGill and Jane Belt, MS, RN, RAC-MT, QCP, and AANAC curriculum development specialist, at the Annual AANAC and AADNS Conference, April 3–5, 2019, in Orlando, Florida, for their session “Clearly Seeing the Role of the Nurse Assessment Coordinator.”

At the session, you will learn how to:

  • Delineate the various nurse assessment coordinator functions that are expected under the Patient-Driven Payment Model

  • Compare MDS hours needed under PDPM using a case study

  • Consider key changes in the NAC role with case management and clinical assessment

  • Identify new Medicare reimbursement strategies and application of QM data

Even more important, by attending the conference, you will be in a room with NACs and nurse leaders from across the country facing the same giants together. Your team, your residents, and your facility will need you, the NAC, more than ever before. Come to the conference and get ready.




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