Caryn Adams

PDPM is fast arriving. What should my timeline be before October 1?

The Patient-Driven Payment Model will have six areas that comprise our reimbursement, and we will be able to impact five.

The physical therapy and occupational therapy case-mix are driven by clinical factors, or the primary diagnosis. Diagnoses also impact nursing, speech and non-therapy ancillary case mixes.  I cannot stress enough how important it is to have a competent ICD-10 coder. While there are more than 70,000 ICD-10 codes, more than 23,000 of them will not drive reimbursement but are classified as “return to provider.” 

The primary diagnosis assigns clinical categories and the clinical categories drive reimbursement. MDS coding also will impact reimbursement. Section I will be instrumental in setting PT, OT, SLP and NTA case mixes. 

Cognitive and functional scores will impact PT, OT, SLP and Nursing Case-mix. Depression and restorative scoring remain important in the nursing category.

To begin preparing, the facility needs to do an assessment as to where they are today. Include ICD-10, MDS coding, and review of documentation to support diagnoses as well as skill. 

Reviewing and revising therapy contracts also is critical to the facility’s financial wellbeing. This month would be the time to complete baseline assessment. I recommend this be part of the QAPI program and process.  

Once your baseline is established, a plan should be developed and implemented to achieve goals. ICD-10 coding for PDPM should be implemented on the MDS by July 1. 

Reviewing and revising therapy contracts as well as Medicare and resident assessment policies and procedures should be completed by August 1. 

Please send your payment-related questions to Caryn Adams at [email protected]