Patient Driven Payment Model
Hours: 2.00
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.
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.
California Board of Registered Nursing
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
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
Florida Board of Nursing (CEBroker Provider #50-290).
Nurses will receive 2.00 contact hours for participating in this course.
American Nurses Credentialing Center
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.
Nurses will receive 2.00 Nursing Contact Hours after successfully completing this course.
Georgia Board of Nursing
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
South Carolina Board of Nursing (CEBroker Provider #50-290)
Nurses will receive 2.00 contact hours for participating in this course.
West Virginia Board of Registered Nursing
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
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
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
Florida Board of Nursing Home Administrators (CEBroker Provider # 50-290)
This activity is approved for 2.00 contact hours.
Georgia Nursing Home Administrators Board
Georgia Nursing Home Administrators Board (CEBroker Provider # 50-290)
This activity is approved for 2.00 contact hours.
Texas Health and Human Services Commission
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
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]
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.
The target audience for this course is: Administrators; Nurses; in the following settings: Post-Acute Care.
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.
If you require special accommodations to complete this module, please contact Relias Customer Support here.
