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Patient-Driven Payment Model (PDPM) Readiness Services
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Patient-Driven Payment Model (PDPM) Training - How it works  

Agenda:

  • Overview - PDPM compared to RUGs
  • Review proposed rates for each category
  • Discuss, in detail all 6 Classifications assigned all residents
    • Nursing
    • PT
    • OT
    • SLT
    • Non – Therapy Ancillary
    • Non-Case Mix
  • Understand CMI and Case Mix group qualifiers for each category
  • Relation of ICD-10 coding to assigned classification
  • Mapping Clinical Category and Section J
  • Mapping NTA qualifiers
  • How to calculate Function Scores for PT/OT and Nursing Categories
  • Explain how Variable Rates apply to PT, OT category and Non-Therapy Ancillary Classification
  • Interim Payment Assessment – Methods to ensure accurate revenue
  • Interrupted Stay Policies with detailed scenarios on how it works
  • New Optional State Assessment
  • GG Coding Tips
  • How to calculate Entire Stay Minutes on End of Stay MDS
  • Financial impact & therapy
  • Claims process and HIPPS Modifier with example claims
  • Coding Section I best practices 
  • How to pick primary reason for admission and mapping for PDPM
  • Practice Mapping Skill Building
  • Changing Roles for MDSC, Admissions, & Social Services
  • Role of physician
  • System impact and Preparation
    • Admissions process
    • PDPM Huddle
    • Weekly Medicare meeting
    • Monthly Triple Check
  • Transition Process for Transition Interim Payment Assessments
  • PDPM Practicums: Practice determining PDPM Case Mix Groups from an MDS to learn how to calculate CMGs, CMI, and HIPPS modifier

Learning Objectives:

  • Be able to explain how the PDPM system will work.
  • Be able to understand qualifiers for each classification.
  • Be able to understand impact on systems.

Audience:

  • Administrator, DON, MDSC, Therapy, Billing, Nurse Managers


  Full PDPM MDS Audit
  PDPM Right Start - Comprehensive Services
  Focused ICD-10 Coding Accuracy Audit and Training
  MDS Coding Accuracy for PDPM Training
   Focused GG Audit and Training
  PDPM to RUGs Financial Impact Analysis
  Transition Services
Other PDPM Support Services:
   Medicare and PDPM Compliance Audits
  Key Indicator Trend Reports - Claim data trending services
  PDPM Manual with policies and procedures
  Billing Manual with policies and procedures
  Solution Center Hotline
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