Right the Ship and Set Sail for FY23 PDPM Parity Adjustments

The Patient-Driven Payment Model (PDPM) transformed how SNFs provide, track, and code patient care. Then the pandemic required facilities to batten down the hatches and change course, creating additional obstacles and sinking PDPM’s intended budget neutrality. Navigating the waters in FY23 may prove challenging – the three-day stay waiver will likely end, Medicare rates will decrease, and additional documentation requests for payment determinations will increase. While PDPM parity adjustments are deferred until FY23, operators should take the helm now to ensure SNFs are on board to meet new CMS rules.

Smooth sailing ahead! To be successful under PDPM, SNFs must tie care, quality, and reimbursement to outcomes, much like a pay-for-performance model. Key to this approach is knowing and understanding current trends on both a patient and facility basis – and appropriately coding them for assessment and reimbursement purposes. SNFs will need to go beyond just MDS data to assess detailed clinical and financial analytics to improve patient care and ROI.

Learning Objectives

• Understand the impact of key clinical drivers on PDPM, including diagnoses, therapies, and PDPM item categories
• Identify and correct missed coding errors, particularly ICD-10 and Section GG scoring and determine how and when facilities should document or complete IPAs
• Ensure appropriate, comprehensive documentation to avoid common denials and prepare for medical reviews and potential audits

Speaker

• Jim Shearon, RN, BSN, MHSA, Vice President, Clinical Solutions, Real Time Medical Systems

This session will be presented at the Arizona Health Care Association 2022 Annual Convention & Expo.