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

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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