Find your copy of our exclusive AMBR Journal here. This quarter's issue contains in-depth features on:
MDS coordinators to take on quality
The onset of the PDPM marks another evolution for the MDS and MDS coordinators.
Experts uncover little-known risks and opportunities in PDPM
AMBR asked five long-term care experts to share key PDPM opportunities and risks that SNF providers may not have considered leading up to the transition.
Limit financial risk by enlisting billersto forecast profitability prior to admission
Determining and tracking the profitability of each potential new patient will be key to protecting the SNF’s bottom line in PDPM.
Consolidated billing made simple: Manage relationships
Proactively manage relationships with outside patients and external service providers to avoid costly consolidated billing mistakes
The new version of the MDS 3.0 RAI Manual, v1.17.1 are effective October 1, 2019 and incorporates clarifications to existing coding and transmission policy; it also addresses clarifications and scenarios concerning complex areas.
Download the first issue of AMBR Journal! In this issue we discuss how to focus on new incentives under PDPM without scrapping therapy; how to get your compliance and ethics program into shape before November 1; ICD-10 training for your staff; a breakdown of consolidated billing, category I; and what billers can do to properly handle long-term care insurance policies.
Once you come to understand how reimbursement will be calculated under the new skilled nursing facility (SNF) prospective payment system (PPS) model, Patient Driven Payment Model (PDPM), you may wonder why it wasn’t named the Primary Diagnosis Driven Payment Model, but that’s a conversation for another day. What we should be focusing on is the fact that under PDPM, each resident’s primary diagnosis code entered into line I0020B of the minimum data set (MDS) (a new MDS field that will be added effective 10/1/2019) will be used to place the patient into one of ten PDPM clinical categories. These clinical categories are then used as part of the patient’s classification under the physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) components. A resident’s primary diagnosis code is essentially the hinge for that resident’s clinical documentation and reimbursement path, so getting it right is essential in order to achieve accurate reimbursement under PDPM.
The American Health Information Management Association’s definition of principal/first diagnosis lists the primary reason for the encounter as determined at the end of the encounter. In the LTC setting, it is referred to as the first listed code, described as “that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.” The primary diagnosis, or the first listed code, is assigned after reviewing the resident’s hospital admission and discharge documentation. In some cases, the primary diagnosis code may apply at the hospital as well as the SNF, but this is not always so.