PDPM Strategies

Countdown to PDPM








The Patient Driven Payment Model (PDPM) has been approved to go into effect October 1st, 2019. This new case-mix payment model focuses on resident clinical characteristics rather than volume-based services provided to determine the Medicare payment. This new model will replace the current Resource Utilization Group (RUG) system that has been in effect since 1998.

Functional Pathways will take the initiative to assemble your PDPM Transition Dream Team. Your team will have exclusive access to our PDPM Client Portal for training, resources, and updates.
In addition to initial team setup, Functional Pathways will assess and train your ICD-10-CM Expert and ensure their ability to identify active/current diagnoses. An audit of your ICD-10-CM then allows Functional Pathways to determine next steps for training along with an integration of your facility software with Rehab Optima and RightTrack.

Your Functional Pathways’ Director of Rehab will ensure all staff have received training on Section GG via PDPM Academy. They will cover the collaborative process between nursing and therapy, collaborate with staff to determine process for Section GG Scoring, and provide training to nurse aids, nurses and therapy staff.

Functional Pathways will provide ongoing support throughout the PDPM transition. We will collaborate and discuss therapy data, outcomes, and clinical pathways with your Director of Rehab and your Director of Operations. Training will also be provided as needed after a review of your restorative program to ensure patient-centered care coordination.
To ensure clear and accurate communication between key departments, Functional Pathways will implement a pre- and post- admission meeting to identify plans of care. Your Director of Rehab will coordinate a review of your current communication process and maximize the effectiveness of Medicare and Rehab meetings.
We will assess the historic length of stay for your residents under clinical PDPM categories, identify goals, and offer a Transitional Care Coordinator to decrease rehospitalizations.

Value-Based Purchasing (VBP)

To improve your knowledge of this program, your Director of Rehab will help to identify current performance, identify contributing factors to hospital readmissions, and develop best practices to improve hospital readmission measures under VBP.

SNF Quality Reporting Program (QRP)

Similar to the auditing process under VBP, your facility will be assessed for current performance with engagement from the Director of Nursing, MDS Coordinator, and Directors of Rehab to identify and improve your QRP metrics.

Data Analytics

Functional Pathways will evaluate data for your market, identify data-driven decision-making techniques, and work with the facility marketing department to position you for admissions to your center. Using these strategies, we can establish a preferred partner status with referring hospitals, case managers, and discharge planners.



Beginning October 1, 2019 providers will need to begin coding a new set of Health Insurance Prospective Payment System (HIPPS) codes in Section Z0100A of the MDS as well as on the Part A claim. This coding of HIPPS codes will identify the resident’s SNF PDPM...

Positioning Your Team for Change

Change is the name of the game as we move through 2019 and toward the Patient Driven Payment Model (PDPM), one of the largest realignments of service delivery the rehabilitative care industry has experienced in 20 years.  Functional Pathways has been preparing staff...

MDS Section J is no “J”oke!

PDPM!  I am sure you have heard about this new payment system by now, right? As you prepare and position yourself for this major change, we have to not only understand all of the moving parts, but more importantly, how all of those moving parts affect resident...

Proposed Rule for FY 2020

The Centers for Medicare & Medicaid Services (CMS) publicly posted the fiscal year (FY) 2020 Skilled Nursing Facility Prospective Payment System (SNF PPS) Proposed Rule. The rule updates Medicare Part A per-diem payment rates as well as proposing other key policy...

Revitalizing Restorative Nursing

Restorative nursing is important to your facility now and will be under the new Patient Driven Payment Model (PDPM) payment system. Ensuring that our residents have services to improve or maintain their functional abilities is imperative for resident outcomes and to...

Caseload Management

Your PDPM Transition team lead will meet with hospital staff to establish importance of medical record documentation needs and analyze the pre- and post- admission meeting effectiveness.


Therapy Contracts

Contract agreements and pricing will be confirmed by June 30th, 2019 after discussion with Regional Vice President or Area Director of Operations.

Begin Classifying New Admissions Under PDPM

All necessary software updates will be implemented by May 31st 2019 concurrent with pre-admission meetings and IDT Review Tools.

Review Resident Assessment Instrument (RAI) Manual Updates

Once the updated RAI manual is available, Functional Pathways will ensure that the MDS Coordinator has a copy and educated staff on all changes.

Complete interim Payment Assessment (IPA) on all Current Medicare Part A Residents by October 7th, 2019

During this time all residents who will be active on Medicare Part A are to be identified by September 30th 2019.  The MDS Coordinator will be reviewed on their preparation for PDPM assessment coordination, and PDPM billing begin October 1st.

Monitor the effectiveness of training and collaboration of Functional Pathways PDPM Strategy


Want to Know More About Our Strategy?

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