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Understanding PDPM and the PT/OT Components

As you may know, issues with the current Resource Utilization Groups, Version IV (RUG-IV) Prospective Payment System (PPS), were identified by The Centers for Medicare & Medicaid Services (CMS), Office of Inspector General (OIG), MedPAC, and others. Therapy payments under the current SNF PPS Case Mix System is based primarily on the amount of therapy provided to a patient, without consideration for the patient’s individualized characteristics, needs or goals. The Patient Driven Payment Model (PDPM),…

Understanding PDPM and the Interim Payment Assessment

In our “Understanding PDPM” blog series, we have discussed the specific components for Physical Therapy (PT), Occupational Therapy (OT), Speech Language Pathology (SLP), Nursing, and Non-Therapy Ancillary (NTA). The Centers for Medicare & Medicaid Services (CMS), in an effort to simplify the assessment process, has identified that the 5-day MDS can support the reimbursement for the patient’s entire length of stay under the Patient-Driven Payment Model (PDPM). This would significantly decrease the administrative burden for completion…

Skilled Nursing Billing: Understanding Which Diagnosis Code to Use

Selecting codes for your Skilled Nursing Facility (SNF) claims can often be mind-boggling. Residents are admitted to SNFs with varying length of stays and the admission reason is often different from the reason for continued stay. Diagnosis codes can be assigned at the time of admission, concurrently as diagnosis arises, and at the time of discharge. In any of these situations, a principal diagnosis may represent the admission diagnosis, the reason for continued stay, or discharge…