PDPM Overview

Background

Patient Driven Payment Model, or PDPM, is a Medicare Reimbursement Plan for a short stay (100 days or less) of post-hospital rehab care. Currently, Medicare rates are tied to the amount of therapy minutes a patient receives. Since facilities are paid less for patients not receiving therapy, it is often provided without clinical need or benefit.

How is PDPM Different?

Medicare Daily rate is now tied to the total amount of care provided by all professionals, meaning facilities will be paid more to care for clinically complex patients. Rates are based on Primary Diagnosis, Function, Cognition, and extensive nursing care.

Process

PDPM daily rate is calculated from the 5-day admission MDS data, where the reason for stay is identified as a Primary Diagnosis (ICD-10). This determines their category for reimbursement.

PDPM Preparation

Engage all management to educate all professionals and appoint PDPM champions. Evaluate all facility resources and align as needed. Enhance all documentation and communication, and be a champion for continued education.

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