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PDPM Update: November 19, 2019

We are now almost 50 days into the transition to the Patient Driven Payment Model (PDPM). Hopefully as each day goes by, providers become more familiar with how to effectively work within this new reimbursement methodology.

As the sister company to Marquis, Consonus has had the opportunity to be involved in conversations with CMS, AHCA, and a few providers to discuss progress in the transition. We are optimistic that CMS / MAC’s have made tangible progress in being able to process/pay the October claims with a single HIPPS code.  While each provider’s % of claims with multiple HIPPS codes can vary, there are examples of it being a very small %.  We also know that CMS projects the technology patch to resolve the challenges around processing multiple HIPPS claims to be completed by sometime this week, and then thereafter MAC’s being able to process/pay these claims.  If all goes as planned, by early December we should have collected on all October claims that were submitted up to 11/15/19, if not earlier.

As we all get more acquainted with PDPM going forward, here are 5 important things to remain focused on:

  1. Establish effective workflows – PD3 Process (PDPM morning meetings) / Principle Diagnosis confirmation in team approach
  2. Ensure accurate and comprehensive process in identification of co-morbidities associated with SLP and NTA points
  3. Consistently review therapy model outcomes post 10/1/19  – Focus on Functional Outcome SNFQRP measures
  4. Establish daily process to recognize IPA opportunities after initial 5 day has been completed.
  5. Ensure accurate and complete clinical documentation from Nursing and Therapy teams, to support the multiple clinical conditions captured under PDPM.

October P/L’s will be generated over the next 10 days and this will be the first time we will see actual Revenue/Expense impacts of the PDPM transition. As providers are doing this review, remember the positive impact the transitional IPA’s will have for Oct 1-3, in that all Medicare episodes at that time will get the three times NTA rate even if not just the first three days of the stay. Our projections suggest that this will be a positive impact of somewhere between $15-$20 / day increase to October average PPD rates.  November month forward will not have this one-time bump.   Once you have your October results, it will be the first look at providing you the results you need to determine how well you are functioning under the PDPM system.

We certainly expect that it will be a process in getting clinical teams functioning at optimal levels in this transition. Due to this, we would expect to see improved PDPM rates PPD as we work thru the winter months.  Consistent review/education on this transition will be vital in being successful.

Consonus is committed to supporting our customers as we all continue forward on this journey! Please reach out if you would like to discuss your PDPM workflows and results.