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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 –…

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…