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.

  • Under PDPM, Group/Concurrent Therapy Will Need NAC Case Management

    By Caralyn Davis, Staff Writer - August 13, 2019

    When the Patient-Driven Payment Model (PDPM) implements this October 1 in the fee-for-service Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS), concurrent therapy, group therapy, and even restorative nursing will once again take on a renewed importance as tools for achieving a resident’s clinical goals, says Joel VanEaton, BSN, RN, RAC-MT, vice president of compliance and regulatory affairs for Broad River Rehab in Asheville, NC.

     

    “However, you may run into trouble if SNFs or therapists simply dictate, ‘We will do X amount of concurrent and group therapy,’” suggests VanEaton. “PDPM is intended to be a reimbursement system that elevates the resident’s voice by ensuring that resident care decisions appropriately reflect each resident’s actual care needs.”

    Read more
  • Interrupted Stay Tracker Tool

    By AANAC - August 13, 2019
    Read more
  • TIP: Aug. 13 CMS SNF QRP Training Provides Clarification

    By AANAC - August 13, 2019
    Read more
  • Q&A: For residents admitted during the last week of September, how would we schedule the admission and 5-day assessments?

    By Scott Heichel RN, RAC-MT, DNS-CT, QCP, CIC - August 13, 2019
    Read more
  • 2020 ICD-10-CM Diagnosis Code Files and Coding Guidelines (8/19)

    By CMS - August 12, 2019
    The 2020 ICD-10-CM files  contain information on the ICD-10-CM updates for FY 2020. These 2020 ICD-10-CM codes are to be used for discharges occurring from October 1, 2019 through September 30, 2020 and for patient encounters occurring from October 1, 2019 through September 30, 2020. This also contains the official ICD-10 Coding Guidelines.
    Read more
  • PDPM At-a-Glance Tool

    By AANAC - August 07, 2019
    Read more
  • First Comes PDPM, Then Comes a SNF QRP Tsunami

    By Caralyn Davis, Staff Writer - August 02, 2019

    Nurse assessment coordinators (NACs) won’t be able to take much of a breather following the October 1, 2019, implementation of the new Patient-Driven Payment Model (PDPM) case-mix classification system for the fee-for-service Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS). NACs will have exactly one year to get comfortable with PDPM before their interdisciplinary team has to begin submitting data for 59.5 new Standardized Patient Assessment Data Elements (SPADEs) across the PPS admission and PPS discharge assessments that will be required under the data submission threshold requirement for the Skilled Nursing Facility Quality Reporting Program (SNF QRP). This includes four SPADEs that will be used to calculate and check the logic of two new MDS-based SNF QRP quality measures (QMs) involving the Transfer of Health Information IMPACT Act domain.

    One of the few breaks NACs received in the Fiscal Year (FY) 2020 SNF PPS Final Rule is that CMS has put off plans to expand the SNF QRP to all SNF residents regardless of payer source. Here are the highlights NACs need to know about.

    Read more
  • Spelling Out the Differences Between the IPA and SCSA

    By Jessie McGill, RN, RAC-MT, RAC-MTA - August 01, 2019

    The Significant Change in Status Assessment (SCSA) may be considered an “old dog” in the assessment world, but we will need to learn new tricks under the Patient-Driven Payment Model (PDPM). While the SCSA is an OBRA assessment, historically it could count as a PPS assessment, and could therefore affect payment when completed during a resident’s Medicare stay. Under PDPM, that is no longer the case. The newly-introduced Interim Payment Assessment (IPA) will be the only assessment, beyond the 5-day, that will be able change a resident’s Medicare rate. While this assessment seems to have similarities to the SCSA, nurse assessment coordinators (NACs) must understand the key differences for criteria, scheduling, timing, and payment and survey implications to ensure success under PDPM.  

    Read more
  • Finetune Section GG Coding to Prevent Inaccurate Payments

    By Caralyn Davis, Staff Writer - August 01, 2019

    In the current RUG-IV case-mix classification system used in the Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS), the activities-of-daily living (ADL) score derived from MDS section G (Functional Status) factors into the calculation of every case-mix group. Effective October 1, that all changes. While section G will still be important for care planning and some quality measures (QMs), section GG (Functional Abilities and Goals) will take over on the payment front, providing functional scores that will be used in case-mix classification for three of the five case-mix-adjusted payment components under the new Patient-Driven Payment Model (PDPM): physical therapy (PT), occupational therapy (OT), and nursing.

    Read more
  • PDPM FY2020: MDS Nurse FTE Calculator Tool

    By AANAC - August 01, 2019
    Read more
  • Q&A: For the transitional IPA, if we use an ARD of 10/7 and the payment starts on the ARD for an IPA, how will we be paid for the first 6 days?

    By Mark McDavid, OTR, RAC-CT, CHC - August 01, 2019
    Read more
  • Seven Ways to Disseminate Important Information for PDPM Considering a Fixed Timeline

    By Sierra J. Drevline, RN, BSN, RAC-CT, QCP, Performance Improvement Manager - July 31, 2019

    AANAC member, Sierra Drevline, RN, BSN, RAC-CT, QCP, tells how taking a systematic approach to spreading information can help you, as it helped her team, prepare for the new Patient-Driven Payment Model (PDPM).

    Read more
  • FY 2020 SNF PPS Final Rule Link and Fact Sheet (7/19)

    By CMS - July 30, 2019

    The Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1718-F] for Fiscal Year (FY) 2020 Medicare payment rates and quality programs for skilled nursing facilities (SNFs). This final rule is part of the agency’s continuing efforts to strengthen the Medicare program by better aligning payment rates for these facilities with the costs of providing care and increasing transparency so that patients are able to make informed choices. The final rule [CMS-1718-F] can be downloaded from the Federal Register at: https://www.federalregister.gov/documents/2019/08/07/2019-16485/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities.

    OVERVIEW

    This fact sheet discusses three major provisions of the final rule:

    ·        SNF payment policy under the SNF Prospective Payment System (PPS)

    ·        SNF Value-Based Purchasing Program (VBP)

    ·        SNF Quality Reporting Program (QRP). 

    This final rule includes policies that continue to move forward agency commitments to shift Medicare payments from volume to value, with the continued implementation of the SNF VBP and SNF QRP to improve program interoperability, operational quality and safety.

    Read more
  • CMS May 7 and 8, 2019, SNF QRP Post-Training Videos and Slide Sets Available (7/19)

    By CMS - July 29, 2019

    Videos and post-training materials (includes answers to knowledge checks and interactive sessions) from the May 2019 Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Provider Training held in Kansas City, MO, on May 7 and 8, 2019, are now available.

    Please note: Post-training materials include answers to knowledge checks and interactive sessions. Additionally, Section GG presentation has been updated to include links to videos shown during the training.

    Read more
  • Use the ICD-10 Mappings Tool Now to Train for PDPM

    By Caralyn Davis, Staff Writer - July 22, 2019

    Nurse assessment coordinators (NACs) and other members of the interdisciplinary team (IDT) who work with ICD-10-CM diagnosis codes should be using the PDPM ICD-10 Mappings tool provided by the Centers for Medicare & Medicaid Services (CMS) to prepare for the October 1 implementation of the Patient-Driven Payment Model (PDPM) in the Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS), says Tracy Montag, BSN, RN, RAC-MT, clinical consultant with the Senior Living Services Consulting Group at RKL LLP in York, PA.

     

    “In various ways, ICD-10 diagnosis codes can drive case-mix classification for all five case-mix-adjusted PDPM components, and the mapping tool impacts four of the five,” says Montag. “Consequently, it’s important to have a firm grasp of how the ICD-10 codes you commonly use now will play out under PDPM—not only to educate your IDT about documentation requirements but also to educate physicians about the need to narrow down diagnoses.”

    Read more
1 of 6 Next
ثبت شرکت ثبت برند وکيل ثبت شرکت سهامي خاص ثبت شرکت با مسئوليت محدود طلاق توافقي ثبت طرح صنعتي کد اقتصادي
خرید بازی ps4 خرید بازی دست دوم ps4 خرید بازی Xbox One