PDPM Strategies

Functional Pathways began preparing for an outcome-based reimbursement payment model in 2011 with the development of our proprietary software system, RightTrack™


PDPM Strategies

Functional Pathways began preparing for an outcome-based reimbursement payment model in 2011 with the development of our proprietary software system, RightTrack™.


Functional Pathways has established effective workflows and strategies to ensure our partner communities maximize their reimbursement by accurately capturing the most appropriate ICD-10-CM codes and Minimum Data Set (MDS) clinical characteristics reflecting the patients’ medical status and care needs. Using our processes, we have helped many of our partner communities achieve CMIs at or above national average. Using RightTrack™, via an integration with our electronic medical record, our Directors of Rehab and partner communities can, in real-time, review patient-level active diagnoses, Section GG scoring, and Speech-Language Pathology components, improving the accuracy of MDS coding using a collaborative Interprofessional Team approach.

Our PDPM Processes Include:

  • Pre-Admission Screening Tool
  • PDPM Component Cue Cards
  • Thorough reconciliation process between partner communities’ EMR, therapy EMR, and RightTrack™
  • Standardized Triple Check and Weekly Medicare Meeting Checklists
  • Section GG and ICD-10-CM education for our partner communities and Therapy Teams by our Resident Assessment Coordinator – Certified Program (RAC-CT) Specialists

During the first two quarters of PDPM, Functional Pathways’ patients meet over 86% of their therapy goals in an average of 22 days. These results show Functional Pathways was successful in improving outcomes and reducing hospitalizations. These are important achievements as CMS continues to increase focus on quality measures related to patient outcomes and safe transitions home. Our success is contributed to the fact we utilize RightTrack’s™ predictive analytics to ensure patients receive the right dose of treatment at the right time based on their specific clinical characteristics.

Clinical decision making is the key to ensuring  functional outcomes that exceed expectations. This includes identifying treatment frequency and intensity necessary to meet or exceed the patient’s goals. Data analytics have shown there is an optimal range of treatment minutes and that too little or too much therapy can negatively impact patient outcomes. What is your Therapy Team’s process for determining how much therapeutic intervention each patient needs to attain the best possible outcome? This is an important, yet often overlooked detail that has implications on functional outcomes and efficient care delivery.


In 2011, Functional Pathways began developing a systematic approach to ensure the patients we care for receive truly individualized treatment plans with a focus on functional outcomes. In combination with clinical decision making, RightTrack™ uses predictive analytics and evidence-based protocols to help develop these individualized plans. The analytics and protocols are based on a complex algorithm using data points from thousands of patient records. These protocols yield optimal outcomes and guide therapy professionals in providing the right amount of care.


Utilizing the data captured, we gain a greater insight into the following areas of real-time care management:

  • Length of Stay
  • Treatment Utilization
  • Anticipated Functional Gains (Section GG Items and Function Score)
  • Anticipated Discharge Outcomes
  • Reimbursement Categories
  • Average Case-Mix Index (CMI) by Discipline
  • Evaluation Lag Time
  • Actual Treatment Intensity and Outcomes Compared to the Anticipated Ranges and Scores


Functional Pathways has a robust Restorative Nursing Auditing Program. The Introductory Restorative Nursing Audit is a snapshot review of current Restorative Nursing Programs, documentation of minutes, time mapping, and other Restorative Nursing metrics to identify strengths, weaknesses, and opportunities with current Restorative Programming. Functional Pathways also offers a fee-based expanded review as well as Restorative consulting services. The Restorative consulting services are tailored to your needs and range from auditing to developing, hiring, and running your Restorative Nursing Program. 

ICD-10 Audits

Functional Pathways has an ICD-10 auditing process. The ICD-10 Coding Audit is a review that targets primary and secondary diagnoses along with the appropriate ICD-10 codes for skilled residents. This audit will assist in supporting the community in preventing billing for inaccurate or unspecified codes that do not support skilled services. Insufficient coding will lead to claim delays, ADR’s, and denials. 

PDPM Audit

This is an in-depth look at your diagnosis and coding process: HIPPS Codes, Therapy Case-Mix Groups, Nursing Case-Mix Groups, Non-Therapy Ancillary (NTA) Case-Mix Group, and select sections of the MDS. This audit is a current glance of your diagnosis and coding process strengths and weaknesses in nine different areas and how Functional Pathways can partner to assist in a more successful diagnosis and coding process to ensure accurate reimbursment. 

PDPM Academy

Functional Pathways has a Client Portal with a comprehensive library of resources available to our partner communities to assist with the ongoing PDPM care management and regulatory updates. These include webinars, tools, and presentations on all things PDPM:

      • CMS Regulatory Updates
      • Nursing and NTA Reimbursement and Coding
      • Section GG Training
      • SLP Component Training: BIMS and Section K
      • ICD-10-CM: Understanding Diagnosis Selection and CMI
      • Measuring Patient Outcomes
      • Nursing and Therapy Documentation Training

For more information please contact pdpm@fprehab.com and our RN Clinical Reimbursement Specialist will contact you