Patient Driven Payment Model

70th AHCA/NCAL Convention and Expo

PDPM-3 - Back to the Basics: SNF Coverage Requirements and Documenting for Skilled Nursing and Skilled Rehabilitation Services

Speaker(s)

• 

  Judy Wilhide Brandt, RN, BA, CPC, QCP, RAC-MT, DNS-CT

  Principal
  Wilhide Consulting Inc.

  Disclosure: ABILITY NETWORK: Consultant (Status: Ongoing)

The new Medicare SNF PPS patient driven payment model (PDPM) is based on resident characteristics reported on SNF PPS minimum data set assessments. While the payment model itself has changed, CMS has emphasized that many SNF PPS policies remain unchanged, including SNF coverage criteria and documentation requirements to support skilled level of care as described in Chapter 8 of the Medicare Benefit Policy Manual. This session will detail the key components of the SNF level of care policies and documentation requirements associated with the administrative level of care presumption, daily skilled nursing requirements, daily skilled rehabilitation requirements, and other coverage policies.

Learning Objectives:

• Describe the SNF level of care criteria.
• Define what daily skilled nursing services means and the documentation requirements for supporting medical necessity.
• Define what daily skilled therapy services means and the documentation requirements for supporting medical necessity.
• Identify whether a resident qualifies for the PDPM administrative level of care presumption through the 5-day assessment reference date.