The Patient-Driven Payment Model (PDPM): Everything You Need to Know

presented by Ellen R. Strunk, PT, MS, GCS, ACEEAA, CHC, RAC-CT

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Disclosure Statement:

Financial: Ellen R. Strunk receives compensation from MedBridge for this course.

Nonfinancial: Ellen R. Strunk has no competing nonfinancial interests or relationships with regard to the content presented in this course.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

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Video Runtime: 57 Minutes; Learning Assessment Time: 40 Minutes

Clinicians working in skilled nursing facilities (SNFs) need to understand the prospective payment system under which the SNF is paid. Given that staffing in SNFs regularly changes, clinicians may benefit from an overview of the important aspects of the Patient-Driven Payment Model, or PDPM. This course will cover the fundamental concepts that drive the SNF prospective payment model and will server as an introduction for new clinicians and a refresher for others. By the end of the course, clinicians will gain an understanding of the importance of documenting patient characteristics that support the medical necessity of SNF care.

Meet Your Instructor

Ellen R. Strunk, PT, MS, GCS, ACEEAA, CHC, RAC-CT

Ellen R. Strunk has worked in various roles and settings as a clinician, manager/director, and policy expert. Ellen is an expert at helping customers understand the Centers for Medicare & Medicaid Services (CMS) prospective payment systems in the skilled nursing facility and home health settings, as well as outpatient therapy billing for all provider types.…

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1. Components of the Patient-Driven Payment Model (PDPM), Part 1: Clinical Characteristics

This chapter discusses the importance of clinician skills in analyzing residents’ clinical history and presentation to identify active diagnoses and comorbidities in the PDPM. Participants will learn the key conditions and services that contribute to the resident case-mix index under the PDPM.

2. Components of PDPM, Part 2: Functional Characteristics

This chapter examines active functional characteristics that contribute to the coding of the residents’ PT, OT, and ST components. The chapter demonstrates the relationship of these characteristics to the case-mix index under the PDPM.

3. Putting the Pieces Together Under PDPM

This chapter identifies how the six components of PDPM are added up to determine a daily SNF payment rate. The chapter also examines key SNF processes and methods necessary to accurately identify components of resident classification for the PDPM.

4. PDPM Case Study: Joe

This chapter provides an opportunity for participants to apply knowledge of the case-mix methodology to a case study to demonstrate the importance of clinical assessment skills.