The Latest on PDPM

5/10/2019 - By Claudia Reingruber, CPA

Have you heard the latest on PDPM from CMS? 

CMS Spoke to SNFs in St. Louis on May 7-8, 2019 on MDS 3.0, QRP and PDPM

CMS covered a lot of material in the two days - here are some highlights on PDPM: 

  • Claim reviews - Audits will focus on documentation supporting
    • Patient primary diagnosis
    • Other diagnosis codes
    • Assessment coding, especially support for each PDPM component
    • Other "clearly defined" aspects of payment
  • Therapy services - SNFs will be monitored for changes
    • Therapy services under RUG-IV vs. under PDPM
    • Changes in volume (did the intensity of therapy decrease?)
    • Changes in delivery  (is there more group and concurrent?)
    • Changes that are significant or sudden (in stays that overlap 10/1)
    • Changes that correlate to changes in Quality Measures
  • Shifts in care provision
    • Increased utilization of mechanically altered diets
    • Anomalies in comorbidity coding

To access materials used in the training, click here

Questions?
If you have questions about the information in this ALERT, please don't hesitate to reach out to a member of our Healthcare team.

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