Patient Driven Payment Model
70th AHCA/NCAL Convention and Expo
The new Medicare skilled nursing facility prospective payment system (SNF PPS) patient-driven payment model (PDPM) is based on resident characteristics reported on SNF PPS minimum data set (MDS) assessments. At present there are 188 minimum data set (MDS) items describing resident clinical characteristics that impact payment rates under the new skilled nursing facility prospective payment system (SNF PPS) called the patient-driven payment model (PDPM). Under the prior resource utilization groups (RUGs) payment model, SNF compliance programs focused on therapy utilization and activities of daily living supporting documentation. Triple-check compliance processes primarily focused on these areas. Due to the significant increase in MDS items potentially subject to Medicare audits, compliance programs will need to be retooled to better assure success under the PDPM. This session will provide an overview of the new compliance environment under the PDPM and will offer recommendations for enhancing your clinical documentation and billing triple-check compliance processes.