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CMS Posts PDPM Resources

The Centers for Medicare and Medicaid Services (CMS) has just posted a series of resources for those seeking to gain a better understanding of the Patient-Driven Payment Model (PDPM) that is scheduled to replace RUG-IV as the basis for Skilled Nursing Facility (SNF) Medicare Part A reimbursement on Oct. 1, 2019. The new PDPM page with links to materials is available here.

In addition, the Medicare Learning Network has scheduled a call on Tues., Dec. 11th from 1:30 to 3 p.m. to provide an overview of the new methodology and discuss the changeover from RUG-IV to PDPM. The call is free, but registration is required and can be accessed here. A question and answer session will follow the presentation, and attendees are invited to email questions in advance to PDPM@cms.hhs.gov with “December 11 Call” in the subject line.

Members will recall that PDPM represents a significant departure in how Medicare fee-for-service rates are calculated. It divorces the rate from therapy minutes that are provided and focuses on the characteristics of the resident. Rather than using a single RUG with a specified reimbursement amount, the methodology relies on separate components, each with its own discrete case mix adjustment, which are summed to arrive at the payment amount. The new site offers a number of fact sheets, each focusing on a separate feature of the new methodology. The page also provides access to a set of slides that gives a comprehensive overview of the methodology as well as links to the walkthrough of how resident characteristics are used to assign payment groups and a crosswalk that matches clinical categories used in PDPM to ICD-10 diagnosis codes.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841