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PDPM ICD-10 Code Mappings Fiscal Year 2023: What’s New?

The Patient-Driven Payment Model (PDPM) has been the reimbursement methodology for Medicare Part A in the Skilled Nursing Facility (SNF) since October 1, 2019, with updated regulations effective every October 1st. Each fiscal year, the Centers for Medicare & Medicaid Services (CMS) releases the updated ICD-10 CM guidance for the new fiscal year, the ICD-10-CM Official Guidelines for Coding and Reporting. In addition to these ICD-10 coding changes or updates, SNFs must be aware of the changes in…

10 Factors that Could Trigger an Audit of Your Medical Records

With the ever-increasing litigious environment and mandatory Congressional oversight of commercial and government payers, physician supporting documentation should emphasize and include the type of service(s) provided, the time involved, special technology and equipment used, as well as any other complications encountered.Furthermore, because the government and insurance carriers routinely perform audits as mandated through the Fraud, Waste and Abuse program, it’s important for providers to be aware of problems that could cause them to come under…

Understanding PDPM and the NTA Component

As we prepare for the transition to the Patient-Driven Payment Model (PDPM), which is expected to occur on October 1, 2019, we have been reviewing the primary components that make up the Case Mix Index (CMI) for reimbursement. Previous articles in this series outlined the physical and occupational therapy component and the speech language pathology component. In this article, we discuss the non-therapy ancillary (NTA) component. The NTA component, together with the nursing and non-case mix…