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Countdown to PDPM

With only days remaining before Medicare Part A reimbursement switches from RUG-IV to the Patient-Driven Payment Model (PDPM), we remind members to be aware of assessment requirements at the transition to ensure accurate payments. To receive payment for any day prior to Sept. 30th, a resident must have an assessment with an assessment reference date (ARD) prior to Sept. 30th. All Medicare Part A residents admitted prior to Oct. 1st who continue their stay into October must also have a PDPM Transitional Assessment with an ARD between Oct. 1st and 7th. PDPM payment based on the transitional assessment for such residents will begin on Oct. 1st. For purposes of the variable per-diem adjustment, Oct. 1st will be considered day 1 for these residents, meaning that the non-therapy ancillary component will be adjusted by 300 percent for the first three days starting Oct. 1st even if a resident is in a stay that began in a previous month.

The Centers for Medicare and Medicaid Services (CMS) recently posted an informational video outlining in clear, non-clinical terms what is changing and what is not changing when PDPM is implemented. The transitional assessment issue is addressed at minute 52:15. The video is available here. The CMS resources page dedicated to PDPM is here.

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