The Patient Driven Payment System (PDPM) methodology is centered on the unique needs and characteristics of each patient, and accurate categorization and documentation of patient information is crucial to accurately assess outcomes and drive reimbursement. Ensuring accuracy in the PDPM assessment process can lead to rewarding financial, clinical, and quality outcomes, but even a single mistake can have negative consequences. Errors in the PDPM assessment process, including submission delays and failure to adhere to rules and regulations, can lead to serious problems for the facility. Therefore, it is essential for staff to prioritize accuracy and adhere to best practices in order to achieve positive outcomes and optimize reimbursement under the Patient Driven Payment System. Register, https://conferencepanel.com/conference/the-patient-driven-payment-system-pdpm-the-mds-v3-0-assessment-skills-necessary-for-success

1. The Patient-Driven
Payment System, the MDS
v3.0 Assessment Skills
Necessary for Success

2. Meet your presenter
Reta A. Underwood, RAC-CT, QCP, CPC
President
Reta has over 34 years of professional work experience in the long-term care industry. Reta’s experience has included management and
director positions with nursing facilities and health care companies. She has also provided corporate-wide MDS support services,
numerous mock surveys, regulatory compliance correction, educational programs, clinical documentation, quality assurance
programming, and most recently implemented PDPM in facilities nationwide.
Reta has supplied input to CMS and has been included on projects and discussions pertaining to post-acute care. She holds national
certifications through the American Association of Nurse Assessment Coordination (AANAC) as a Resident Assessment Coordinator
(RAC-CT); Quality (QAPI) Professional and Nurse Manager and as a certified ICD-10-CM coder.
Reta has had numerous articles published in the long-term care industry trade publications and has been used as an expert resource
professional for media interviews including McKnight’s News; HCPro MDS and PPS Advisor and Provider AHCA magazine.
Reta has also copyrighted several clinical documentation forms and tools, such as for Medicare Triple Check Process, nutritional
assessment, skilled clinical and MDS documentation, and restorative nursing programming.

3. Legislation
• Balanced Budget Act (BBA) 1997
• Balanced Budget Refinement Act (BBRA) 1999
• Benefit Improvement & Protection Act (BIPA) 2000
• Medicare ModernizationAct (MMA) 2003
• Affordable Care Act (ACA) 2010
• Post AcuteTransformationAct (IMPACT) 2014

4. Part A SNF
Services
Include
NURSING CARE (RN) ROOM AND BOARD PT, OT, AND/OR SLP MEDICAL SOCIAL
SERVICES
DRUGS, BIOLOGICALS,
SUPPLIES, APPLIANCES
AND EQUIPMENT
MEDICAL AND OTHER
DIAGNOSTIC OR
THERAPEUTIC
SERVICES PROVIDED
BY A HOSPITAL
(AGREEMENT)
OTHER SERVICES
NECESSARY TO THE
HEALTH OF THE
PATIENTS GENERALLY
PROVIDED BY SNFS
<IOM 100-2, CH 8, SEC
10>

5. CHAPTER 6: Medicare Skilled
Nursing Facility Prospective
Payment System (SNF PPS)
The MDS assessment data is used to calculate the
resident’s Patient Driven Payment Model (PDPM)
classification necessary for payment.The MDS contains
extensive information on the resident’s nursing and
therapy needs, ADL status, cognitive status, behavioral
problems, and medical diagnoses.This information is
used to define PDPM case-mix adjusted groups, within
which a hierarchy exists that assigns case-mix weights
that capture differences in the relative resources used for
treating different types of residents.

6. The Patient Driven Payment Model
(PDPM)
PDPM separately identifies and adjusts for the
varied needs and characteristics of a resident’s
care and combine this information together to
determine payment using 6 separate
calculations
Data sources for methodology include Medicare
enrollment data, Medicare claims data, MDS
assessment data and facility data
Base rates = average cost of treating a typical
SNF patient

7. PDPM
PDPM adjusts payment for each major element
of a resident’s SNF care, specifically for physical
therapy (PT), occupational therapy (OT),
speech-language pathology (SLP), nursing, and
non-therapy ancillaries (NTA). In section 6.6
below, we provide a PDPM calculation
worksheet.This calculation worksheet was
developed in order to provide clinical staff with a
better understanding of how PDPM works.The
worksheet translates the standard software
code into plain language to assist staff in
understanding the logic behind the classification
system.

8. HIPPS Code
First Character: PT/OT Component

9. HIPPS Code
Second Character: SLP Component

10. HIPPS Code
Third Character: Nursing Component

11. HIPPS Code
Third Character: Nursing Component

12. HIPPS Code
Third Character: Nursing Component

13. HIPPS Code
Fourth Character: NTA Component

14. 30 - Billing SNF PPS Services
(page 33/104)
SNFs and hospital swing bed providers are required to
report inpatient Part A PPS billing data as follows. Refer to
the Medicare Claims Processing Manual, Chapter 25,
“Completing and Processing the Form CMS-1450 Data Set,”
for a description of claim data elements.

16. Register Now