October 1st has come and gone and PDPM is now officially in place. While there have been challenges with the transition, PDPM brings an exciting opportunity for Skilled Nursing Facility owners, administrators, and interdisciplinary team members. There are 10 things your organization should be doing now to continue to succeed under PDPM:
- Interim Payment Assessments: This is something new under PDPM. Does your team know each of their roles and responsibilities in sharing information with the MDS coordinator that might trigger an IPA? Every organization should develop a policy of when to use the optional IPA.
- Interrupted Stay Window: If the patient is gone for less than 3 days, what constitutes a continuing stay versus a new stay? It is important to make sure your admissions team, your clinical team and your billing team all understand this window.
- Physician Role in PDPM: Upfront, there are no changes to their clarification for skilled services. There is no change in requirements. There is no change in their number of visits or their orders. However, it is important for physicians to understand that we are going to have to be working in a timely fashion to determine the primary diagnosis.
- MDS Coordinator Role and Interdisciplinary Team: Make sure your MDS Coordinator has all the tools they need to be successful and that you have a backup plan in place if the MDS Coordinator is unavailable. How often is your IDT meeting? What is everyone’s roles (Nurses, Therapists, Dieticians, etc.) in those meetings and what information should they be providing?
- Software and Primary Diagnosis: Is your software helping you to identify the correct primary diagnosis code? Does your therapy software integrate with your facility software? Do you have worksheets available within your software to assist with coding?
- Forms and Processes/Triple-Check: It is critical to make sure that your IDT team has a checklist and other tools to help them make decisions and that give direction for gathering the patient information and then disseminating it over to the MDS coordinator.
- Medicare Advantage and Managed Care: How are they going to pay? What information is going to be required? How often do they require that information? When do you have to authorize continued care? Have you contacted the Medicare Advantage payers you are contracted with now to determine if there will be any necessary addendum for PDPM after October 1 and going forward?
- Billing: What were your days in AR under RUGS? Are you seeing that creep up in November, December, January? Keep a close eye on that and reconcile with what you were expecting to get paid.
- Therapy Contracts: If you use contract therapy, have you reviewed the pricing in the contract? It certainly needs to be updated for PDPM. Have you had discussions if anything has changed with utilization of services? Have you noticed massive declines?
- Section GG: It is important that the functional scores are reviewed by PT, OT and nursing together. It is also important to remember that under PDPM, a higher score means higher independence, which is just the opposite of the scoring under the RUGS payment model.
Are you interested in learning more about these Top 10 ways to succeed?