70th AHCA/NCAL Convention and Expo
For each Medicare Part A admission the skilled nursing facility should determine the primary reason for skilled care. While the new SNF PDPM payment system due to take effect October 1, 2019 places additional emphasis on the reason for SNF care, this is not a new concept. Like the plotline in a good novel; “why are they here?” is of paramount importance. Skilled nursing facilities should take the first step toward PDPM readiness by assuring key staff are properly trained and systems are refined to assure the Medicare team understands the “why” so that documentation and care is centered on this point because the reason for SNF care, driven by a physician diagnosis must receive and ICD-10 code that is appropriate for their condition and map to PDPM. Additionally, under PDPM certification and recertification requirements have not changed. As a condition of coverage, the physician must certify on admission and then recertify by day 14 and every 30 days thereafter that skilled care is required and; the reason for skilled care, the discharge plan and the estimated duration of inpatient care.