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continuing to Exceed Expectations

PDPM Strategies

The Patient Driven Payment Model (PDPM) went 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.


Time to Act: 2020 Physician’s Fee Schedule (PFS)

Now that the dust is starting to settle post October 1st Patient-Driven Payment Model transition, it is time take heed to provisions in the 2020 Physician’s Fee Schedule (PFS) final rule released in November. There are items of high importance to therapy professionals...

Medical Review Under PDPM

CMS issued their updated their guidance to Medicare Administrator Contractors (MACs) on November 15, 2019 regarding Medical Review Instructions related to Skilled Nursing Facilities in Publication 100-08 Medicare Program Integrity, Transmittal 924. The effective date...

The One Thing You Can Count on in Healthcare is CHANGE

In less than two short weeks the Post Acute Care world will see the biggest change in reimbursement in over 20 years. PDPM here we come.  How daunting is this, most of your employees have never practiced outside of the RUG world.  But remember, the healthcare...

What is Your PDPM Transition Strategy?

Well my friends, it is time to seriously review your Patient-Driven Payment Model (PDPM) transition strategy.  October 1st  is just around the corner.  Over the past nine months, at Functional Pathways, we have had a robust educational campaign to prepare and position...

Embracing Change: Our New Work Environment

  “The oldest and strongest emotion of mankind is fear, and the oldest and strongest kind of fear is fear of the unknown. Howard Phillips Lovecraft As we approach the implementation of the Patient-Driven Payment Model (PDPM) on October 1, 2019, most of us are...

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?

We have the resources you need; just fill out the form and one of Functional Pathways’ PDPM Experts will be in touch!