PDPM Part Four: What we can do now to begin preparing for change

This full version of this article addresses 4 components of PDPM: 1A brief overview of the PDPM payment model; 2New challenges impacting nursing, 3Therapy: Debunking myths and therapy’s role in PDPM; and finally 4– What we can do now to begin preparing for change. This article focuses on Part 4.


How We Can Prepare Now

Although PDPM is a year away, there are definite items that we can work on today to prepare for October, 2019. Establishing processes and investment in education today will pay huge dividends when PDPM is implemented. Where to start?

ICD 10 Coding Accuracy: [Importance- CRITICAL] Coding accuracy can determine success or failure in PDPM.  Unlike PPS where more care equaled more reimbursement, PDPM starts with the patient being categorized into a Medical Classification based on ICD 10 coding.  Missing key ICD 10 codes can result in a patient being incorrectly categorized resulting in decreased payment.  Certain comorbidities also give financial benefits if present so it is essential that these are captured on ADMISSION.  Remember that the number of required assessments will decrease and CMS has stated that IPA’s or Interim Patient Assessments should not be used to correct mistakes.  Collecting accurate and complete data on admission is essential when managing the bottom line on Part A patients.

One of the major challenges that a SNF Provider faces is information on admission. It is highly recommended that education begins now.  Having dialog with hospitals, discharge planners and most importantly physicians and educating on the importance of detailed and accurate coding will not only save countless headaches but will position you to be highly successful under the PDPM payment model.

Physician Education: [Importance- CRITICAL] Even though this was just mentioned, physicians will be essential to your success under PDPM and their importance cannot be stated enough.  Incomplete, vague, or incorrect coding will cost you valuable reimbursement dollars.  Success under PDPM starts with proper classification into one of the 10 Clinical Categories.  Having physicians onboard, educated and fully understanding the value of correct coding will position you to best succeed under the new payment model.

Care Team Education: [Importance- VITAL] Building systems in preparation of PDPM will ensure a smooth and easy transition.  In order for this to happen however, all members of the Care Team must know their new roles and educate themselves to expectations.  Your MDS Coordinator as relayed earlier holds a very important role to facilitate accurate information to the MDS.  The information transmitted on the MDS will be vital in ensuring that you are paid for the services provided but also ensuring that you stay paid.  Communication between Therapists, Nursing, Social Services, Dietary and CNA’s needs to be cultivated.  Missed information can lead to missed items on the MDS translating into missed revenue.  Section GG is another vital area of importance.  It is recommended that education be provided on how to properly code GG.  The MDS Coordinator will need to be well versed in Section GG as they will be the person to make the final determination as to what is the patient’s “Usual”.  Good communication between all members of the care team will help insure that the MDS is accurate on submission.

Print out our PDPM checklist to ensure you are prepared for what is to come in 2019.

This concludes our PDPM series.

Have questions about PDPM? We are here to help! Email our EVP of SNF Operations with your questions as it relates to PDPM changes for 2019.

For a hard copy of this article, view here PDPM Content 2018 Full Article.


Article Written by:

Lance Hill, OTR/L, RAC-CT®

Executive Vice President of SNF Operations

Dir. of Regulatory and Clinical Compliance



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