Proactive Planning Can Result in PDPM Success

OHA Health Care Professionals Meeting

Congratulations! You’ve survived the start of the Patient-Driven Payment Model (PDPM). PDPM is the biggest change in Medicare reimbursement for skilled nursing facilities (SNF) since the late 1990s. Most current skilled nursing employees have never worked under a different payment model. The Resource Utilization Group system has been in place since the late 1990s. Prior to that, SNFs were reimbursed on a cost-based reimbursement system. Now that the most recent transition has passed, it’s a great time to think about current facility processes for collecting patient information prior to SNF admission.

With the increased number of minimum data set (MDS) items affecting payment under PDPM, obtaining timely information from referral sources is critical for accuracy and appropriate reimbursement. These questions should be addressed: What’s your current process for collecting information from referral sources? How strong are your relationships with hospital discharge planners? How quickly do you receive patient information from the hospital?

First, we must address how SNFs request information from referral sources. SNFs should have a standardized list of requested information for each potential admission. This information is critical to a SNF’s ability to not only care for each patient’s immediate needs but develop a plan of care that identifies potential problems throughout the patient’s rehabilitation stay. SNFs admit patients with numerous comorbidities and challenges. When planning care, information is power.

The process of requesting information for patients being admitted for skilled care begins before the admission date. It may be necessary to physically meet with discharge planners at referral sources and explain why the patient information is necessary for continued care once he or she is discharged to a lower level of care. If you’re a provider with electronic access to hospital medical record information, remember you’ll need copies for your medical record to support diagnoses, conditions and services captured on the MDS. The information must be maintained in a hard chart or scanned into your electronic system. During medical review, SNFs are expected to provide a copy of the medical record that includes those items captured by the MDS from the hospital setting.

We’ve developed a “Request for Information to Referral Sources tool that may assist you with obtaining appropriate information from your referral sources. If you have additional questions, please reach out to your BKD trusted advisor or use the Contact Us form below.


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