Patient Driven Payment Model
70th AHCA/NCAL Convention and Expo
The new Medicare 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 MDS items describing resident clinical characteristics that affect payment rates under the PDPM. Previously, SNF compliance programs focused on therapy utilization and activities of daily living supporting documentation, and triple-check compliance processes primarily focused on these areas as well. 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 clinical documentation and billing triple-check compliance processes.