August 2, 2023

Understanding PDPM and the Nursing Component

There has been much talk about the upcoming proposed switch to the Patient Driven Payment Model or PDPM for reimbursement of Medicare Part A patient stays in Skilled Nursing Facilities (SNFs). The proposed change is effective on October 1, 2019. The model includes the per diem payment as the sum of five case-mix adjusted clinical components based on the patient characteristics and a non-case-mix adjusted rate for every patient. The case-mix adjusted components include: Physical Therapy…

Understanding PDPM and the Medicare Benefit Policy Manual Chapter 8

With the focus on changes in reimbursement requirements related to the Patient Driven Payment Model (PDPM) that has taken effect October 1, 2019, one might not be thinking about the Medicare requirements that remain unchanged.  The Medicare Benefit Policy Manual (MBPM) Chapter 8, provides fundamental rules and regulations that are the foundation of Medicare Part A for the Skilled Nursing Facility (SNF). It is important to remember that these rules are NOT changing.  One might…

F-Tags in Review: F-Tag 600-610 Abuse, Neglect and Exploitation

Working through compliance requirements with Skilled Nursing regulations often takes some “out of the box” thinking.  As we are now two years into the changes in regulations, there remain regulatory tags that continue to show deficient practices that will require providers to “think outside the box.”  In our continuing F-Tag Series we will offer suggestions on how to avoid, or correct existing deficiencies in these areas. Freedom from Abuse, Neglect and Exploitation (F-Tags 600 –…