Patient-Driven Payment Model (PDPM)

The Patient-Drive Payment Model (PDPM) is scheduled to begin Oct. 1, 2019, and AANAC is here to help!

The Centers for Medicare & Medicaid Services released the Fiscal Year (FY) 2019 Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule, which solidified their plans to implement PDPM.  PDPM is set to replace the RUG-IV case-mix classification model that has been the hallmark of SNF PPS for years. This new payment system will be unlike anything SNFs have seen before! You and your staff have a lot to do to get ready for PDPM, and AANAC will be with you the entire way.  Visit this page frequently to get tools, education, and resources to help you lead your team readiness.

PDPM Lessons Learned From the Nursing RUGs

Posted By: Caralyn Davis, Staff Writer
Post Date: 07/10/2019

On October 1 2019, the nursing case-mix groups used in the RUG-IV case-mix classification system will be streamlined and consolidated to form the nursing component of the Patient-Driven Payment Model (PDPM). By decreasing distinctions based on function for certain groups, the PDPM nursing component will use only 25 case-mix groups (ES3 – PA1) compared to the 43 RUG-IV nursing case-mix groups. For example, the RUG-IV groups HE2 and HD2 will be collapsed into the modified PDPM nursing case-mix group HDE2.

 

However, the core process for assigning residents to a nursing case-mix group will remain basically the same, taking into account the use of extensive services, the presence of certain clinical conditions, the presence of depression, the provision of restorative nursing services, and the resident’s functional score (using section GG instead of section G). Consequently, nurse assessment coordinators (NACs) and other interdisciplinary team (IDT) members can learn some lessons about historically undercoded MDS items that could impact their ability to achieve the most accurate case-mix group for the PDPM nursing component, says Robin Hillier, CPA, STNA, LNHA, RAC-MT, president of RLH Consulting in Westerville, OH.

 

Here are four items or sections worth revisiting:

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