Let’s continue with “Ready for Your PDPM Checkup. Six Steps for Success.” If you have not read part one yet, click here to go to part one!

3. Inspect the most challenging PDPM nuances. Section GG, Capture of Non-Therapy Ancillaries, ICD-10 coding capture, and Interim Payment Assessments are at the top of the list and require a great deal of expertise. Make sure your team is communicating well on these complicated topics.

4. Length of Stay. If your average length of stay has changed since October 1st, do you understand why? PDPM itself should not be causing any decreases in your average length of stay. If it is going down, what is causing it? Yes, some of the PDPM component reimbursement rates decrease over time. Medicare skilled coverage criteria is to return the patient to their prior level of function or highest state of well-being.

5. Budget Neutrality. PDPM was intended to be “budget neutral” from Day 1. However, rates are up around the country? Will there be an adjustment? Some say it is inevitable some say not so fast. We all remember the massive 11% adjustment in FY 2012 after the implementation of MDS 3.0. I’m not sure the industry is in a position for such a sweeping change this time, so it is important to manage cash wisely.

6. Medicare Advantage. Although Medicare Advantage plans are not required to adopt PDPM, it is important to stay in touch with the plans that make up a significant share of your payor mix. Have conversations with them about PDPM and their intentions & time frames. Medicare Advantage is challenging enough with reduced payments and administrative headaches. There’s no need for any surprises.

Do you have questions about how to turn some of these concepts into actions? Give us a call and we will point you in the right direction.

About the Author: Matt McGarvey is VP of Business Development for Language Fundamentals. Matt holds a BS in Marketing from Le Moyne College and an MBA in Health Systems Administration from Union Graduate College.