nAVIGATING POST-ACUTE CARE REIMBURSEMENTPDPM 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.
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.
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.
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.
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.
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