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Traditional Values. Innovative Care.

PDPM Preparations

Posted: 12/3/18
Jennifer Flanagan, SLP

RehabVisions is busy preparing for the new PDPM payment system, the first significant change in the SNF reimbursement model in 20 years. While the current PPS system is based on two case-mix adjusted components; therapy and nursing, the PDPM system is based upon five case-mix adjusted components: PT, OT, SLP, Nursing and Non-Therapy Ancillaries. In addition, there is a non-case mix component.

The proposed clinical categories for PT and OT are all based on the clinical reason for the stay (code in I8000A) and the resident’s functional status. The SLP component is based upon the clinical reason for the stay, presence of a swallowing disorder and/or altered diet and the presence of a SLP-related co-morbidity and/or cognitive impairment. This means that therapy minutes are no longer the driver for the reimbursement category under PDPM.

Our software provider, Casamba, has developed a tool to determine which classifications and what reimbursement will be realized under PDPM as compared to the current PPS reimbursement system. In addition, it will provide valuable information regarding the primary diagnosis entered in section I8000A and determine if the primary clinical diagnosis category that was chosen best describes the patient’s reason for therapeutic services. This detailed information can be obtained by uploading your facility’s MDS files through the program.

RehabVisions can help you determine the impact that the proposed PDPM payment model will have at your facility. RV partners, a member of the RehabVisions team will be reaching out to you soon to initiate the process of downloading your MDS files.

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