PDPM Overview


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.


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.

Patient Pattern will help you start navigating the Patient Driven Payment Model and optimizing reimbursements today.

Enhancing the Admission Process for PDPM

Screening patients for admission for a Part A Medicare stay takes on new meaning under PDPM. Consider this – the per diem…

Enhancing Discharge Planning

The PDPM guidance recommends that discharge planning begin prior to admission for the Medicare A stay in a Post-Acute Care setting. The…

Therapy and PDPM

Since therapy no longer drives Medicare A reimbursement should skilled nursing facilities cut their therapy staff? Almost 93% of all RUGS-IV is…

A Paradigm Shift in Post-Acute Care by Karl Steinberg MD, CMD, HMDC

A Paradigm Shift in Post-Acute Care by Karl Steinberg MD, CMD, HMDC Caring for the Ages. January/February 2019. Vol 20, No 1….