The Patient-Driven Payment Model (PDPM) has changed how many of us identify cognitive impairments. From a reimbursement standpoint, it has led many to assume that reimbursement for cognition is solely dependent on a patient score <13 on the BIMs. Just because you have a patient who has a WNL BIMs score, does NOT mean that there is nowhere else to maximize reimbursement for cognitive impairment. 

Consider the following example: Patient A is admitted with a diagnosis of metabolic encephalopathy that was medically treated in the hospital. 

Is the facility able to capture an acute diagnosis using metabolic encephalopathy? 

The answer is maybe

We need to answer these 2 questions:

1. Did the metabolic encephalopathy resolve as a result of the treatment in the hospital?
2. Are there any residual deficits that are affecting the patient’s plan of care while a resident in the Sub Acute Rehab? 

We know that diagnoses like metabolic encephalopathy can impact a person’s cognitive function, however, by the time this patient enters the SAR the residual cognitive impairment may not be detected as the BIMs is a screening tool and not as sensitive as many standardized cognitive assessments. 

Let’s say patient A has a diagnosis of dysphagia, is on an altered diet, has a speech-related comorbidity, and scores a 13 on the BIMs. They are no longer receiving treatment for metabolic encephalopathy. Rather than abandoning the reimbursement, you would get for using an acute neurologic diagnosis, you should consider having your Speech Language Pathologist administer a more sensitive and complete standardized assessment to diagnose residual deficits often missed by the BIMs.  

Providing a complete evaluation and treatment plan of care can link the acute neurologic diagnosis with residual impact on the patient’s cognitive function. While you may not be able to get points for cognitive impairment via the BIMs, you have now set yourself up to be able to use an acute neurologic diagnosis you otherwise would not have justification.  In this one example, the difference between an SF and an SI speech component score is $16.13 ppd (in New York City).

About the Author: Originally from Port Jefferson, New York, Jennifer Maher, MA, CCC-SLP of Language Fundamentals earned a Master’s Degree from St. John’s University’s Communication Sciences and Disorders program.   Jennifer and her husband live on Long Island with their 2 children.