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PDPM Is Almost Here

After months of preparation, nursing homes are on the brink of the Oct. 1st switch from RUG-IV to the Patient-Driven Payment Model (PDPM) as the basis for Medicare Part A reimbursement. Because RUG-IV will be the basis for payment for all days through the end of September, providers need to make sure that all residents in the home prior to Oct. 1st have an assessment that provides a RUG-IV score, especially for residents admitted at the end of the month. Homes will need to complete a special PDPM assessment on every resident admitted prior to Oct. 1st that remains in the home on Oct. 1st. While the required staff time to complete the assessments for these residents may be significant, they will be treated as new admissions for PDPM reimbursement purposes. This means that the non-therapy ancillary component of the rate will be tripled for the first three days, helping to offset some of the costs of the transition.

The Centers for Medicare and Medicaid Services (CMS) has signaled that they will be monitoring changes in therapy utilization as well as discharge patterns as the new methodology is implemented. With non-therapy dynamics such as nursing and non-therapy ancillaries becoming greater drivers of reimbursement, providers should be certain to carefully and completely document category assignments.

Along with individual fact sheets, one of the most comprehensive resources from CMS on the new methodology is the extensive compilation of Frequently Asked Questions (FAQ). The fact sheets, FAQ document, and other resources are available on the dedicated CMS PDPM site here.

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