Time To Run Up the [Function!] Score to Win at PDPM!

by Blue Sky Therapy
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shutterstock_748617433You may be standing on the sideline, but it is time to get in the Section GG game if you want your reimbursement to win under PDPM! A major part of your team’s strategy will be how you prepare for the GG Function Score which impacts the PT, OT, and Nursing components of the per diem rate calculation.

Section GG of the MDS will be used to determine the Function Score but Section GG also has the most recent changes! These changes include the addition of 36 new items, modifying existing text, and clarification about when the inactivity codes should be used. All new item additions focus on patient function and are coded on the admission and discharge assessments.

 

Calculation of the resident’s Function Score for PT/OT payment uses the following items from Section GG:

  • Eating Admission Performance (GG0130A1)
  • Oral Hygiene Admission Performance (GG0130B1)
  • Toileting Hygiene Admission Performance (GG0130C1)
  • Sit to Lying Admission Performance (GG0170B1)
  • Lying to Sitting on Side of Bed Admission Performance (GG0170C1)
  • Sit to Stand Admission Performance (GG0170D1)
  • Chair/Bed-to-Chair Transfer Admission Performance (GG0170E1)
  • Toilet Transfer Admission Performance (GG0170F1).
  • Walk 50 Feet with Two Turns (GG0170J1)
  • Walk 150 Feet (GG0170K1)

Calculation of the resident’s Function Score for the Nursing payment uses the following items from Section GG:

  • Eating Admission Performance (GG0130A1)
  • Toileting Hygiene Admission Performance (GG0130C1)
  • Sit to Lying Admission Performance (GG0170B1)
  • Lying to Sitting on Side of Bed Admission Performance (GG0170C1)
  • Sit to Stand Admission Performance (GG0170D1)
  • Chair/Bed-to-Chair Transfer Admission Performance (GG0170E1)
  • Toilet Transfer Admission Performance (GG0170F1)

 

We realize these are a lot of changes when it comes to calculation of the Function Score, but providers need to be proactive in preparing for the shift to focus on Section GG. It is very likely that the Office of the Inspector General (OIG) will be auditing Section GG for accuracy and clinical documentation that supports the coding. Reimbursement levels are directly dependent on the GG Function Score under PDPM. Providers with inaccurate Section GG coding could see denials, recoupment and fines. Providers should also consider standardized training during the orientation process and at annual retraining for all staff who could potentially contribute to Section GG data under PDPM.

 

Let Blue Sky Therapy help get your team prepped and ready to win!

  • Blue Sky Therapy was one of the first in the industry to educate and certify our therapists in the CARE Tool as part of the inception of the Impact Act in 2014.
  • The CARE Tool items mirror Section GG items, so our therapists are well trained in reporting function to appropriately reflect the resident’s usual performance.
  • Section GG is embedded into our EMR software and is where our functional status outcomes are generated. Our therapists contribute Section GG information and supporting documentation to the interdisciplinary team to ensure accurate coding of the resident’s usual performance.
  • In response to new items being added to Section GG effective October 1, 2018 and with the new emphasis on Section GG as part of the PDPM Function Score, Blue Sky has provided extensive Section GG training to our therapists and will continue to collaborate with our partners to provide joint education to the interdisciplinary care team.
  • Blue Sky focuses on the patient and the patient’s functional outcome - our outcome-driven care delivery model = PDPM SUCCESS!

Section GG PDPM Care Tool Function Score MDS

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