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CMS is Dedicated to Making Payment Reform Happen

If you are not convinced that the Patient-Driven Payment Model (PDPM) is coming, then you have not been paying attention to everything CMS is doing surrounding payment reform. CMS is all over PDPM, by not only releasing the provider specific impact file back in April and expanding it from the original RCS-1 provider specific impact file produced in 2017, by including case mix and other imperative data points around each of its components, but by already updating some minor items in the tools released in April. A version two of the following documents have been released and are attached in this blog for your convenience. The Centers for Medicare and Medicaid Services (CMS) highlighted those changes nicely:

SNF PDPM Classification Walkthrough, Version 2

  • Corrected typo on page 23 in definition of Extensive Services category “ES2”

SNF PDPM Grouper Tool, Version 2

  • Corrected typo in ES1 and ES3 labels on the nursing tab
  • Added D0600 logic to depression flag
  • Added support item "did not occur" logic to ADL construction
  • Improved clinical category logic so that the tool assigns the default clinical category for patients who have procedure info that will not impact category assignment
  • Corrected GG-based function score rounding
  • Updates final payment calculation to include proposed 18% nursing add-on for patients with HIV/AIDS

SNF PDPM NTA Comorbidity Mapping, Version 2

  • Added ICD-10 code mapping for category “Major Organ Transplant Status, Except Lung”

It is clear that CMS is dedicated to making a change from our current skilled nursing payment system to something more value based to align with all of the current incentive based programs out there today.

HealthPRO® Heritage also conducted a webinar on June 13, 2018  for our partners titled, Specialized Care Today for Tomorrow's Patient-Driven Payment Model: Time to Make Your Move – click HERE to view the recorded webinar!

Resources provided by: CMS

Information based on Proposed Rule released by CMS on April 27, 2018.

Written by: Kristy Yoskey, MOT, OTR/L, RAC-CT, Senior Vice President 
Kristy's #HigherCalling: "Everyone has a significant purpose in life, mine is to help others become aware of that purpose - every nurse, CNA, rehab professional, on person at a time." 

Tags: PDPM, Patient-Driven Payment Model, CMS Update 2018