August 2, 2023

PDPM ICD-10 Code Mappings Fiscal Year 2022: What’s New?

The Patient-Driven Payment Model (PDPM) is the reimbursement methodology for Medicare Part A for Skilled Nursing Facilities (SNFs) since October 1, 2019. Information in the PDPM International Classification of Diseases, Tenth Edition (ICD-10) Mappings continues to present challenges to MDS Coordinators coding PDPM requirements. Not all ICD-10 codes, when used as the primary diagnosis in the Minimum Data Set (MDS) item I0020B, would automatically be categorized into the PDPM Clinical Categories as one part of the reimbursement…

Understanding the Form 990, Schedule J, for Executive Compensation Analysis

The Internal Revenue Service (IRS) required form 990 is an incredible tool for understanding the financial picture of a not-for-profit organization of any type. The reporting burden, of course, is dependent on the size and financial worth of the organization. Small organizations, earning less than $50,000 per year in gross receipts, only need to file a 990 “postcard.” This short-form could be described as a pro-forma exercise to let the government know that the entity…

PDPM Skilled, Reasonable and Necessary Care

According to the Centers for Medicare & Medicaid Services (CMS), the transition to the Patient Driven Payment Model (PDPM) relates to reimbursement only. Clinical care delivery is expected to remain the same. Although there has been a multitude of new information related to calculating the Health Insurance Prospective Payment System (HIPPS) code, which supports reimbursement, there have not been any changes to the Medicare Benefit Policy Manual (MBPM) Chapter 8: Coverage of Extended Care (SNF) Services Under…