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The Billers’ Association for Long-Term Care is a membership community created specifically for long-term care billing professionals. This national association provides members with a resource of continuously updated tools, billing-specific education, and reimbursement and regulatory guidance. Become a member today and join your long-term care billing colleagues as you navigate the evolving world of post-acute care billing.

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Submit your PDPM questions to CMS for December 11 call

Nov 30, 2018
The Bottom Line

CMS will hold an informational call on December 11 at 3:00pm, ET, to help providers prepare for the new RUG-IV replacement, the Patient Driven Payment Model (PDPM), to be implemented October 1, 2019. Participants can submit questions prior to the call by sending an email to PDPM@cms.hhs.gov with the subject line “December 11 Call.” Click here to register.

A new PDPM webpage has also been added to the CMS website and includes a variety of preparation tools, such as fact sheets, frequently asked questions, training presentations, and resources. During an Open Door Forum yesterday, CMS encouraged providers to review the webpage prior to the December 11 call.

Under PDPM, SNF patients will be classified in a covered Part A stay based on their conditions and care needs (value) as opposed to the amount of care provided (volume). The new case-mix model will separately identify and adjust five case-mix rate components (PT, OT, SLP, nursing, and non-therapy ancillary), then combine these together with the non-case mix component to form the full SNF PPS per diem rate for each resident. Providers will also need to perfect their ICD-10 coding skills, as reimbursement will hinge on the primary diagnosis under PDPM and will be used to capture additional diagnoses and comorbidities, which can factor into the SLP and NTA component.

 

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