The calculation for the nursing component of the Patient-Driven Payment Model (PDPM) can look deceptively simple. The two steps entail calculating a section GG nursing function score and then placing the resident into one of six nursing categories. But completing these two steps correctly requires understanding a number of coding …
Since the implementation of the Patient-Driven Payment Model (PDPM), nursing facilities have had to take a more nuanced approach to how a resident’s needs are assessed and documented. As discussed in part 1 of this series, Medicare payment, as well as Medicaid payment in many states, is determined using PDPM …
In skilled nursing facilities (SNFs), staff members often find the Patient-Driven Payment Model (PDPM) process complex and unfamiliar, especially when determining how Medicare (and, in many states, Medicaid) payment is calculated. PDPM is based on five separate case-mix adjusted components: Physical Therapy (PT), Occupational Therapy (OT), Speech Language Pathology (SLP), …
Navigating Medicare Part A coverage in skilled nursing facilities (SNFs) is a matter of regulatory compliance. But it’s also a daily ethical test for facility staff and administrators. In many ways it depends on the honor system, and those responsible for billing and care case management must understand and apply …
The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code assignment continues to be a bit of an enigma in the long-term care setting. Members regularly ask questions about ICD-10-CM coding in AAPACN’s online communities, as well as in post-education surveys, often confused about how to order the codes. …
In long-term care, the Minimum Data Set (MDS) ensures appropriate care planning, accurate reimbursement, and quality measurement while maintaining compliance with federal and state regulations. However, MDS coding may pose some ethical challenges. Completing the MDS accurately and according to the Long-term Care Facility Resident Assessment Instrument 3.0 User’s Manual …
For skilled nursing facilities (SNFs), diagnosis selection and accurate ICD-10-CM coding are essential for both quality resident care and compliance with regulations. For therapists providing skilled rehabilitation services, the ability to choose the correct diagnosis code is not only crucial for resident outcomes but also ensures proper reimbursement and avoids …
The Centers for Medicare & Medicaid Services (CMS) implemented the Patient-Driven Payment Model (PDPM) in October 2019 for residents receiving Medicare Part A coverage in the skilled nursing facility (SNF). PDPM replaced the previous legacy payment model, the Resource Utilization Group (RUG-IV) system, still used by some state Medicaid agencies …
Accurate diagnosis coding is critical in nursing facilities (NFs) for care planning, reimbursement, and quality measurement. NF coders must understand ICD-10-CM conventions, general coding guidelines, and chapter-specific coding guidelines that affect how diagnoses are assigned. Coding guidance can be found in the ICD-10-CM Official Guidelines for Coding and Reporting for FY …
Backdating, or placing an earlier date than the actual date on a document, is only permissible in limited Minimum Data Set (MDS) scenarios. Has anyone asked the nurse assessment coordinator (NAC) to change the assessment reference date (ARD) of a 5-Day prospective payment system (PPS) assessment after day 8? Is …
