Patient Driven Payment Model

Patient Driven Payment Model 

CMS implemented a new payment model for SNF providers, the Payment Driven Payment Model (PDPM). This payment model, effective October 1, 2019, focuses SNF payments based on resident specific clinical characteristics and needs. MDS, therapy, business office staff, managers and administrators must have a solid understanding of the PDPM system to be successful. In this course, we will provide an in-depth look at the various rate components, the variable rate adjustments, the assessment schedule and other new policies related to this payment system.

$30.00

Hours: 2.00
REL-PAC-0-PDPM

Certificates

Certificates provided by accrediting body (14 Match)

California Board of Registered Nursing

2.0 HOURS


Provider approved by the California Board of Registered Nursing, CEP# 13791

Nurses will receive 2.00 contact hours for participating in this course.

District of Columbia Board of Nursing

2.0 HOURS


District of Columbia Board of Nursing Approved Continuing Education program (CEBroker Provider #50-290).


Nurses will receive 2.00 contact hours for participating in this course.

Florida Board of Nursing

2.0 HOURS


Florida Board of Nursing (CEBroker Provider #50-290).


Nurses will receive 2.00 contact hours for participating in this course.

American Nurses Credentialing Center

2.0 HOURS


In support of improving patient care, Relias LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.



Georgia Board of Nursing

2.0 HOURS


Georgia Board of Nursing (CEBroker Provider #50-290).


Nurses will receive 2.00 contact hours for participating in this course.

South Carolina Board of Nursing

2.0 HOURS


This program was approved by the South Carolina Board of Nursing Approved Continuing Education Program (CEBroker Provider #50-290).


Nurses will receive 2.00 contact hours for participating in this course.

West Virginia Board of Registered Nursing

2.0 HOURS


West Virginia Board of Registered Nursing (CEBroker Provider #50-290).


Nurses will receive 2.00 contact hours for participating in this course.

New Mexico Board of Nursing

2.0 HOURS


New Mexico Board of Nursing (CEBroker Provider #50-290).


Nurses will receive 2.00 contact hours for participating in this course.

Arkansas State Board of Nursing

2.0 HOURS


Arkansas State Board Of Nursing Approved Continuing Education program (CEBroker Provider #50-290).


Nurses will receive 2.00 contact hours for participating in this course.

Florida Board of Nursing Home Administrators

2.0 HOURS


Course approved by the Florida Board of Nursing Home Administrators.
Provider # 50-290
NHA/RCAL
This activity is approved for 2.00 contact hours.

Georgia Nursing Home Administrators Board

2.0 HOURS


Course approved by the Georgia Nursing Home Administrators Board.
Provider # 50-290
This activity is approved for 2.00 contact hours.

Texas Health and Human Services Commission

2.0 HOURS


Texas HHSC has determined that Relias Learning’s submitted training meets or exceeds the minimum standards for HCSSA administrator training in the following categories: Licensed and Certified Home Health. Texas HHSC also recognizes Relias Learning provides continuing education for administrators and alternate administrators. This activity is approved for 2.00 contact hours.

National Association of Long Term Care Administrator Boards (RCAL)

2.0 HOURS


This educational offering has been reviewed by the National Continuing Education Review Service (NCERS) of the National Association of Long Term Care Administrator Boards (NAB) and approved for 2.00 clock hours. If you have any feedback regarding the NAB approved continuing education programs, send your email to the following address: [email protected]

National Association of Long Term Care Administrator Boards (NHA)

2.0 HOURS


This educational offering has been reviewed by the National Continuing Education Review Service (NCERS) of the National Association of Long Term Care Administrator Boards (NAB) and approved for 2.00 clock hours. If you have any feedback regarding the NAB approved continuing education programs, send your email to the following address: [email protected]

Course Details

Course Code: REL-PAC-0-PDPM
Hours: 2
Type: Online Course
Content Expiration Date: 8/31/2021
Learning Objectives:
Describe each of the case mix components of the PDPM.
Describe the impact of select MDS items in relationship to the PDPM case mix groups.
State at least two conditions that will impact PDPM SLP reimbursement.
Describe how the PDPM HIPPS code is obtained and when to use the default code on the Medicare claim.
State the PDPM assessment schedule and item sets.
Describe the interrupted stay policy.

Outline:

Section 1: Introduction

About This Course

Learning Objectives

Section 2: The PDPM Definitions and Components

Six PDPM Components

Review

Summary

Section 3: The Variable Per Diem Adjustment Schedule

The Variable Per Diem Adjustment Schedule

Review

Summary

Section 4: PDPM and MDS Coding

MDS Item I0020B: PDPM Primary Diagnosis

I0020B Mapping

Additional ICD-10 Diagnosis Coding on the MDS

Review

Summary

Section 5: MDS Items J2100-J5000: Surgical History

MDS Items J2100-J5000: Surgical History

Review

Summary

Section 6: MDS Section GG Function Scoring

MDS Section GG Function Scoring

GG Lookback Period

GG Coding

Review

Summary

Chapter 7: The PDPM Impact of MDS Section C

MDS Section C

BIMS

SLP Case Mix

Review

Summary

Chapter 8: The PDPM Impact of MDS Section D

Review

Summary

Chapter 9: The PDPM Impact of Restorative Nursing Services

The PDPM Impact of Restorative Nursing Services

Behavioral Symptoms and Cognitive Performance

Reduced Physical Function

Review

Summary

Section 10: PDPM Case Mix Groups and Case Mix Indices

PDPM Case Mix Groups and Case Mix Indices

Review

Summary

Section 11: Add-On Payments for HIV/AIDS Condition

Add-On Payments for HIV/AIDS Condition

Review

Summary

Section 12: The PDPM Assessment Schedule

The PDPM Assessment Schedule

Review

Summary

Section 13: The IPA Item Set

The IPA Item Set

Review

Summary

Section 14: The Interrupted Stay Policy

The Interrupted Stay Policy

An “Interrupted Stay”

A “Not an Interrupted Stay”

Discharge Assessment

Interrupted Stay Policy Examples

Review

Summary

Section 15: The PPS Discharge MDS and Coding Therapy Services

The PPS Discharge MDS and Coding Therapy Services

Review

Summary

Section 16: Therapy Concurrent and Group Limits

Therapy Concurrent and Group Limits

Review

Summary

Section 17: The Medicare Part A Administrative Level of Care Presumption

The Medicare Part A Administrative Level of Care Presumption

Presumption of Coverage

Review

Section 18: All About PDPM HIPPS Codes

The Default Code

Review

Summary

Section 19: The PDPM Methodology: Putting It All Together

Case Study Background

Calculating Daily Rate

Section 20: Conclusion

Summary

Course Contributors

Resources

Congratulations!


Instructor: Frosini Rubertino, RN, RAC-CT, C-NE, CDONA/LTC
Ms. Rubertino is a Registered Nurse and Certified Nurse Executive with over 30 years’ experience in the healthcare industry. She has received her certificate in Executive Management from Case Western Reserve's Weatherhead School of Management and her Continuous Process Improvement training in Cleveland, Ohio. As a regulatory consultant, Ms. Rubertino conducts mock surveys and Medicare review. She also teaches Medicare regulatory compliance and survey compliance throughout the United States for a national education company. Disclosure: Frosini Rubertino, RN, RAC-CT, C-NE, CDONA/LTC has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Target Audience:
The target audience for this course is: Administrators; Nurses; in the following settings: Post-Acute Care.
Relias will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Course Delivery Method and Format
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
Relias has a grievance policy in place to facilitate reports of dissatisfaction. Relias will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias.
If you require special accommodations to complete this module, please contact Relias Support by completing the web form (https://www.relias.com/help) or by using the chat functionality.
All courses offered by Relias, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.
All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
Accommodations
If you require special accommodations to complete this module, please contact Relias Customer Support here.