We all know what happens on October 1, 2019, and each facility continues to prepare for that day. The Patient Drive Payment Model will go into effect and whether you are prepared or not on that day your reimbursement for Medicare Part A patients will be derived from your data and the CMS formula. If those two sentences sound foreign to you it is time for you to prepare.

For those facilities prepared and ready with their multi-disciplinary team approach to PDPM, and not to dampen your spirits, one other area to be mindful of revolves around the area of “compliance” with both the letter and the spirit of PDPM. Reimbursement will be driven by acuity, not therapy minutes, and there may be a tendency to boost patient acuity by submitting inaccurate MDS data. A word to the wise on this topic: “The Centers for Medicare & Medicaid Services (CMS) is poised to root out any major shifts in care plans that it can directly tie back to a financial incentive and not patient need.” Accurate, precise, and comprehensive documentation will support any legitimate diagnosis and must be present to avoid penalties from non-compliance.

For more information on this important aspect of PDPM click on to:

How Skilled Nursing Operators Can Survive the New PDPM Compliance Landscape

Alex Spanko, Sept 3, 2019