PDPM Article 9: Game Day Plan

November 10, 2020

Get ready for the October implementation date of the Patient Driven Payment Model (PDPM) with our informative series of articles authored by Leah Klusch, RN, BSN, FACHCA, founder and director of The Alliance Training Center. We’ll prepare you for the new reimbursement model with detailed insights in a step-by-step guide to PDPM success. You’ll learn about everything from building staff competencies and improving your coding practices to the value of partners and how to enhance efficiencies. The series will conclude with a checklist to help you gauge your readiness.

With just weeks to go before the overnight transition to the Patient Driven Payment Model (PDPM), the list of tasks to be completed in order to be prepared is significant. Chances are you’re worrying whether you forgot anything, or wondering what you should you be doing now. We’ve identified 10 action steps that should be on any facility’s to-do checklist.

1. Evaluate and review the MDS 3.0 data formulation process in the facility today, pre-transition.

2. Update the MDS 3.0 data formulation process with the October 1, 2019, changes to the Resident Assessment Instrument (RAI) Manual and the three new assessments: the five day comprehensive, interim payment assessment, and new Medicare discharge assessment.

3. Establish a case management approach for admissions that places a significant focus on the correct diagnostic documentation correlating the hospital and SNF Stay.

4. Define or update the competencies of the IDT with an emphasis on the new coding instructions and MDS data using the coding instructions in the RAI Manual.

5. Preschedule the OBRA assessments (the regularly scheduled quarterly and annual assessments for long-term stay elders) that are scheduled for late September and early October to earlier in September to relieve the congestion in the schedule during the transition process.

6. Run sample PDPM rate calculations for at least two to three Part A Medicare admissions prior to the October 1 transition using the current 5 Day MDS Admission Assessment.

7. Develop a schedule for the transitional IPA assessments that will be created for elders on Part A Medicare on September 30, 2019, and October 1, 2019.

8. Have operations, clinical leadership and the MDS staff develop a staff work schedule from September 25, 2019, through October 14, 2019, to manage the increase in assessments and assessment documents that will be required.

9. Review the coding instructions for MDS section GG with nursing and therapy staff to ensure accurate data formulation during the first three days of the Medicare Part A stay and the last three days of the IPA assessment reference period.

10. Establish a process with the attending physicians, physician extenders and Medical Director for the documentation of diagnostic data in the record during the open assessment reference period on the Transitional IPA Assessments.

Key Takeaway
The transition period will be busy, but a step by step approach and a good checklist will help you through it.

Quick Links

  1. RAI Manual
  2. CMS PDPM website
  3. PDPM ICD 10 Mapping
  4. Updated CMS PDPM FAQ

Leah Klusch, RN, BSN, FACHCA,
founder and director of The
Alliance Training Center

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