PDPM Every Penny Counts

Trends, challenges and solutions in Texas skilled nursing

SEP 15-16, 2020

SESSION 9

PDPM ? Every Penny Counts

Don't Leave Them On the Ground

SUSAN KRALL , PT, RAC-CT CSO, QRM (QUALITY REHAB MANAGEMENT)

Texas LTC Virtual Symposium: CEU Disclosure to Participants

Conflicts of Interest: The planning committee members and presenters/authors/content reviewers of this CNE activity have disclosed no relevant financial relationships related to the planning or implementation of this CNE activity.

Explanation: A conflict of interest occurs when an individual has an opportunity to affect or impact educational content with which he or she may have a commercial interest or a potentially biasing relationship of a financial nature. All planners and presenters/authors/content reviewers must disclose the presence or absence of a conflict of interest relative to this activity. All potential conflicts are resolved prior to the planning, implementation, or evaluation of the continuing nursing education activity. All activity planning committee members and presenters/authors/content reviewers have submitted Conflict of Interest Disclosure forms.

Selman-Holman & Associates, A Briggs Healthcare Company, is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

Penny for your thoughts...

Do you know your trending PDPM revenue by Component (PT/OT, ST,

Nursing, NTA)?

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Agenda

PDPM Reimbursement Model - Refresher PDPM Calculator with FY 2021 Updates Impacting Reimbursement Drivers by Component Revealing Data Trends Key Component Drivers Top 5 Opportunities Risk Mitigation

Are you ready to start finding pennies?

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PDPM Reimbursement Model - Refresher

Intent: Focus care delivery on, and reimburse providers for patient-specific active conditions, co-morbidities and level of care needs. Desired Result: Patient-specific knowledge and individualized care delivery driving improved overall outcomes.

MDS

Initial Medicare Assessment 7-Day lookback window Optional Interim Payment Assessment (IPA) Interrupted Stay 161 Questions on MDS Determine Case Mix Group by Component Case Mix Group (CMG)> Case Mix Index (CMI) (No PDPM MDS item changes for 2021)

Reimbursement

CMI is Multiplied by CMS' Component Base Rate Base rates are Average Wage Index (AWI) Adjusted Components : PT/OT, ST, Nursing, NTA & Non-Case Mix Daily rate = sum of all components impacted by variable per diem (day of stay)

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