HWCo PDPM HIPPS Code Calculator

HW&CO. PATIENT DRIVEN PAYMENT MODEL (PDPM) HIPPS CODE CALCULATOR RATES EFFECTIVE OCTOBER 1, 2019 THROUGH SEPTEMBER 30, 2020

KEGD Resident Tier 1 Category: PT and OT Medical Management

SLP

Any one SLP Condition*

Nursing

Special Care High

Select State and County in drop down box:

NTA

3-5 Comorbidity points

2062

Entry Required

PDPM HIPPS Billing Group Wage Index Adjustment for CBSA #2062 - which includes OH-Cuyahoga County Value-Based Purchasing (VBP) Incentive Payment Multiplier from Casper Report Quality Reporting Penalty (QRP), if applicable.

KEGD

(1st digit = PT and OT; 1st digit = SLP; 3rd digit = Nursing and 4th digit = NTA) 0.8819 Urban

1.0000 (Facility Specific; FY2019 ranged from .9802 to 1.0165) 0.00% (Will be zero for most facilities; enter 2 if you are subject to the penalty)

HIV/AIDS Resident?

A

No

(Change to YES if HIV/AIDS resident for calculation of 18% add-on)

Length of Stay

(Discharge day not calculated. Enter 1 extra day if want a specific number of days calculated)

25 days.

Estimated Medicare Revenue before Coinsurance and Sequestration for the Length of Stay

$

14,439 (assuming no IPA or interrupted stay)

Estimated Average Medicare Rate for the Length of Stay (LOS)

$ 601.63

Estimated Therapy Expense:

Estimated Therapy

Can just enter your contracted method or multiple to evaluate differences

Expense Per Diem Percent

Based upon Percent of Total PDPM Rate

Enter Percent

30% $ 4,332

180.49

30.0%

Based upon Percent of Therapy PDPM Rate

Enter Percent

70% $ 3,570

148.74

24.7%

Per Diem Rate

Enter Rate $ 150.00 $ 3,600

150.00

24.9%

Days

Physical Therapy

(PT)

Occupational Therapy (OT)

Speech Language Pathology

(SLP)

Nursing

Non- Therapy Ancillary

(NTA)

Total Base

Non-Case Federal

Mix

Rate

Total Wage Adjusted PDPM Rate before VBP and QRP

Value-Based Purchasing

(VBP)

Quality Reporting Penalty

(QRP)

Total PDPM Payment Rate

Cumulative Decrease Therapy in Rate Decrease

1 to 3

92.34

87.09

53.07

197.01

318.84

94.84

843.19

772.59

-

-

772.59

4 to 20

92.34

87.09

53.07

197.01

106.28

94.84

630.63

577.83

-

-

577.83 (194.76)

21 to 27

90.49

85.35

53.07

197.01

106.28

94.84

627.04

574.54

-

-

574.54

(3.29)

28 to 34

88.65

83.61

53.07

197.01

106.28

94.84

623.45

571.25

-

-

571.25

(3.29)

35 to 41

86.80

81.86

53.07

197.01

106.28

94.84

619.86

567.96

-

-

567.96

(3.29)

42 to 48

84.95

80.12

53.07

197.01

106.28

94.84

616.28

564.68

-

-

564.68

(3.29)

49 to 55

83.11

78.38

53.07

197.01

106.28

94.84

612.69

561.39

-

-

561.39

(3.29)

56 to 62

81.26

76.64

53.07

197.01

106.28

94.84

609.10

558.10

-

-

558.10

(3.29)

63 to 69

79.41

74.90

53.07

197.01

106.28

94.84

605.51

554.81

-

-

554.81

(3.29)

70 to 76

77.57

73.16

53.07

197.01

106.28

94.84

601.92

551.52

-

-

551.52

(3.29)

77 to 83

75.72

71.41

53.07

197.01

106.28

94.84

598.33

548.23

-

-

548.23

(3.29)

84 to 90

73.87

69.67

53.07

197.01

106.28

94.84

594.74

544.94

-

-

544.94

(3.29)

91 to 97

72.03

67.93

53.07

197.01

106.28

94.84

591.16

541.66

-

-

541.66

(3.29)

98 to 100

70.18

66.19

53.07

197.01

106.28

94.84

587.57

538.37

-

-

538.37

(3.29)

Non-therapy ancillaries (NTA) will be paid at 300% for the first three days of a resident's stay. PT and OT will be paid at 100% for the first 20 days of a resident's stay. From days 21 through 100, these rates will be reduced by 2% for each additional seven days of a resident's stay. HIV/AIDS: Residents with a diagnosis of HIV/AIDS will receive an 18% add-on to the nursing component of the PDPM payment. The Federal rates are based upon the final rule published in the August 7, 2019 federal register. Rates subject to change if subsequent Correction Notice is issued. Rates may be off for pennies rounding * SLP Conditions: Presence of Acute Neurologic Condition, SLP-Related Comorbidity,or Cognitive Impairment

CONFIDENTIAL - Copyright ? 2019 HW&Co. All Rights Reserved.

(6.58) (9.87) (13.15) (16.44) (19.73) (23.02) (26.31) (29.60) (32.89) (36.17) (39.46)

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