Caryn Adams

With just about six weeks until the PDPM rollout, what should be occurring at our facility?

With the October 1 Patient-Drive Payment Model implementation date fast approaching, there are many tasks that facilities should be completing. If you haven’t completed a baseline readiness assessment, there’s no time now! 

Initiate QAPI to ensure training and compliance. The final rule needs to be reviewed for changes and final information related to PDPM. Although the draft RAI manual was published in May, you should continue to check for updates. 

Also, continue to check the PDPM website for updates. Monitoring should be ongoing. Be especially vigilant with ICD-10 and MDS coding. Ensure that the diagnosis codes being used will be reimbursable as of October 1. 

Under PDPM, nursing documentation is at a higher risk of scrutiny during additional development requests because therapy is no longer driving the reimbursement. Audit nursing documentation to see that it supports the primary diagnosis, medical necessity, and skilled nursing being provided. If there is an issue, initiate training as soon as possible. 

Electronic documentation has simplified charting, but checkboxes alone will not support skilled care. Obtain training for staff — nursing, therapy and caregivers — on section GG, as well as the other sections addressed last month that impact reimbursement. 

If you have not reviewed and updated contracts, this is also critical to complete now. Therapy contracts need to be revised to ensure fair reimbursement to both parties. Managed care companies may or may not be following the PDPM reimbursement model. 

Above all, ensure that your MDS coordinator feels appreciated and is not on vacation until after October 7!