PDPM Resource Center

On October 1, 2019, skilled nursing facility (SNF) providers will submit claims for Medicare Part A services under an entirely new per-diem SNF prospective payment system (PPS) model called the Patient Driven Payment Model (PDPM).  Payments under the RUG-IV SNF PPS model will end on September 30, 2019. 

The PDPM case-mix payment model relies on resident clinical characteristics reported on the minimum data set resident assessment instrument (MDS-RAI) and claim form and includes significant changes in the assessment process and schedules, clinical information used to determine case-mix payment rates, and how therapy services are reported.  These changes will impact all aspects of SNF operations including front office, billing, resident assessment, and care planning and delivery processes.  These changes will also interact with other SNF policies that are not changing including:

  • Need for Daily Skilled Care
  • Requirements of Participation and Related Survey & Certification
  • SNF Quality Programs (SNF QRP and SNF VBP)
  • Annual Payment Rate Update
  • Consolidated Billing

The PDPM payment model may also interact with other payers that rely on RUG-based payment methodologies including; Medicaid, Medicare Advantage, and the VA, as well as other alternative payment models and demonstrations including ACOs and bundled payments.

The AHCA Patient Driven Payment Model (PDPM) Academy provides AHCA provider members with a suite of original content, tools, and training options and resources to assist providers in how to be successful in preparing for and implementing the new Medicare Part A PDPM SNF PPS in October 2019. 

Basic versions of many AHCA PDPM Academy copyrighted document resources and webinars will be available to all AHCA provider members at no additional cost at the AHCA PDPM Resources page (see below).  AHCA will also be providing PDPM educational resources customized to the needs of ABM partners at no additional cost (see link at left side of this page).    

For a reasonable fee, AHCA provider members may enroll in the AHCA PDPM Academy to obtain access to more extensive educational opportunities and resources (see link at left side of this page) including:

  • AHCA PDPM Academy 1-day Hands-on Workshop (most states and online)
  • Monthly AHCA PDPM Academy Update Webinars
  • “How-to” Webinars, Instructions, and Case-Examples for AHCA developed PDPM tools

  Additionally, AHCA will be offering two online customized SNF PDPM ICD-10-CM diagnosis coding training programs for a separate reasonable fee, including one where registrants can earn coding certification in a 16-hour program (see link at left side of this page).    

 

  • PDPM Readiness Toolkit

    Contains 4 Component(s) Recorded On: 10/02/2018

    The AHCA PDPM Readiness Toolkit was designed to facilitate discussions among Skilled Nursing Facility (SNF) management and front-line clinical and support personnel as you begin your journey in preparing your administrative and clinical operations to be successful in the change of the per-diem SNF prospective payment system (PPS) from the current Resource Utilization Groups, Version 4 (RUG-IV) case-mix model to the Patient-Driven Payment Model (PDPM) starting on October 1, 2019. These files should be shared and reviewed by SNF administrative and clinical staff as part of training efforts. Additionally, these tools should be used in identifying your baseline readiness status, and conducting gap-analysis as part of planning to implement those changes necessary to be successful under PDPM.

    image

    How to Register in ahcancalED 

    Easy as 1, 2, 3 !

     

    Step 1

    image

    Go to the ahcancalED site at https://educate.ahcancal.org/and log in using the orange button in the upper left hand corner.

    Use your usual user name and password that you would use for LTC Trend Tracker or the AHCA NCAL website.  


    Don’t have one or can’t remember?

    Click the log in button and follow the directions found under the search button that reads-“If you need help retrieving your Username or Password, click here”.

    *Please note* you must add your member facility name to your login


    Once you are in and can see your name in the upper left hand corner, you are ready to go.

    Step 2

    image

    From the home page click on a category (Resources, Training, Webinars or Trending Now) For this demonstration, let’s try hovering over Webinars until upcoming webinars displays. 

    Under “upcoming webinars” go to a product in which you are interested. Click on the title.

    You’ll be redirected to the site where you can register for the product. This allows you to view the overview, handouts or resources associated with that product.

    Step 3

    image

    Almost there!

    Click the green register button.

    Fill out the registration details and voila! The products are yours to use indefinitely and can be found in your dashboard.

    FYI: after registering, you will be automatically notified when the recording of the webinar is ready.


    Need further help? Email us at educate@ahca.org

    We’ll walk you through it.

     

    The AHCA PDPM Readiness Toolkit was designed to facilitate discussions among Skilled Nursing Facility (SNF) management and front-line clinical and support personnel as you begin your journey in preparing your administrative and clinical operations to be successful in the change of the per-diem SNF prospective payment system (PPS) from the current Resource Utilization Groups, Version 4 (RUG-IV) case-mix model to the Patient-Driven Payment Model (PDPM) starting on October 1, 2019.  These files should be shared and reviewed by SNF administrative and clinical staff as part of training efforts.  Additionally, these tools should be used in identifying your baseline readiness status, and conducting gap-analysis as part of planning to implement those changes necessary to be successful under PDPM.   The first file is a 31 slide packet with a cover slide title of “Patient Driven Payment Model (PDPM) Readiness Planning: Background and Methodology”.  This file provides an overview of PDPM and what it means for SNFs, and why and how AHCA identified the need for and developed a PDPM training approach revolving around four Core Competencies for success.  The second file is a more comprehensive 49 slide packet with a cover slide title of “Patient Driven Payment Model (PDPM) Readiness Planning: Core Competencies for Success”.   This file provides more detailed information related to each of the four identified Core Competencies.  The third file is an eight page PDPM readiness considerations checklist document with the title “Core Competencies for Success under PDPM”.  This file identifies very specific questions your administrative and clinical staff should ask and answer within each of the four Core Competencies so that you can identify items where your organization may need to focus efforts prior to October 1, 2019, so that you are best prepared to be successful under PDPM.  

    Learning Objectives:

    1. The document users will understand the importance of beginning the process of a formal Readiness Review in preparation for the October 1, 2019 implementation of the per-diem SNF PPS PDPM payment model to replace RUG-IV.
    2. The document users will be able to describe the four PDPM Core Components for success identified by AHCA through interviews with a diverse array of large and small and for-profit and non-profit member organizations.
    3. The document users will be able to successfully use the “Core Competencies for Success under PDPM” checklists within their organizations to perform gap-analyses to identify operational and clinical areas that will need to be addressed to be successful under PDPM.    

    Who is this for?

    These materials were designed to be useful to all AHCA members that furnish Medicare Part A services under the SNF PPS per-diem payment model, regardless of size or business structure. They were designed to facilitate discussions between administrative and front-line clinical personnel as part of staff education as well as strategic baseline readiness assessment and strategic planning meetings. 

  • PDPM 101 - Introduction to the SNF PPS Patient-Driven Payment Model (PDPM)

    Contains 2 Component(s) Recorded On: 10/02/2018

    This presentation provides an introductory overview of the new Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS) payment model that will be implemented on October, 1, 2019 (Fiscal Year 2020). Specifically, the current Resource Utilization Groups, version IV (RUG-IV) per-diem case-mix payment model, which is based on resident characteristics and therapy utilization, will be replaced by a Patient Driven Payment Model (PDPM), which is based solely on resident characteristics. This represents the most significant change in how SNFs are paid since the SNF PPS was first implemented in October 1998. This presentation describes the motivations for the Centers for Medicare and Medicaid Services (CMS) to change the SNF PPS payment model, the basic design of the PDPM payment model, the specific patient assessment payment drivers and their impacts on payment rates, and the AHCA member support activities to help members prepare for PDPM implementation.

    image

    How to Register in ahcancalED 

    Easy as 1, 2, 3 !

     

    Step 1

    image

    Go to the ahcancalED site at https://educate.ahcancal.org/and log in using the orange button in the upper left hand corner.

    Use your usual user name and password that you would use for LTC Trend Tracker or the AHCA NCAL website.  


    Don’t have one or can’t remember?

    Click the log in button and follow the directions found under the search button that reads-“If you need help retrieving your Username or Password, click here”.

    *Please note* you must add your member facility name to your login


    Once you are in and can see your name in the upper left hand corner, you are ready to go.

    Step 2

    image

    From the home page click on a category (Resources, Training, Webinars or Trending Now) For this demonstration, let’s try hovering over Webinars until upcoming webinars displays. 

    Under “upcoming webinars” go to a product in which you are interested. Click on the title.

    You’ll be redirected to the site where you can register for the product. This allows you to view the overview, handouts or resources associated with that product.

    Step 3

    image

    Almost there!

    Click the green register button.

    Fill out the registration details and voila! The products are yours to use indefinitely and can be found in your dashboard.

    FYI: after registering, you will be automatically notified when the recording of the webinar is ready.


    Need further help? Email us at educate@ahca.org

    We’ll walk you through it.

     

    This presentation provides an introductory overview of the new Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS) payment model that will be implemented on October, 1, 2019 (Fiscal Year 2020).  Specifically, the current Resource Utilization Groups, version IV (RUG-IV) per-diem case-mix payment model, which is based on resident characteristics and therapy utilization, will be replaced by a Patient Driven Payment Model (PDPM), which is based solely on resident characteristics.  This represents the most significant change in how SNFs are paid since the SNF PPS was first implemented in October 1998.  This presentation describes the motivations for the Centers for Medicare and Medicaid Services (CMS) to change the SNF PPS payment model, the basic design of the PDPM payment model, the specific patient assessment payment drivers and their impacts on payment rates, and the AHCA member support activities to help members prepare for PDPM implementation.              

    Learning Outcomes:
    - The participant will be able to explain why PDPM is replacing the RUG-IV SNF PPS payment model on October 1, 2019
    - The participant will be able to describe the key features of the PDPM payment model design including changes in assessments, payment components, per-diem rate tapering, interrupted stays, and concurrent and group therapy .
    - The participant will be able to identify MDS item categories that determine each of the five case-mix-adjusted PDPM payment components.
    - The participant will understand the impact of PDPM on revenues based on differences in resident characteristics and the variable PT, OT, and NTAS component per-diem payments as the length of stay increases.
    - The participant will know the types of PDPM implementation member support activities and resources planned and where to find updates.    

    Speakers:

    Daniel Ciolek, Associate Vice President, Therapy Advocacy, Government Relationsa

    Mike Cheek, Sr. Vice President, Reimbursement Policy, Finance Policy & Legal Affairs

  • FY19 SNF PPS Final Rule

    Contains 1 Component(s) Recorded On: 08/01/2018

    This webinar is on the FY19 SNF PPS Final Rule which includes an overview of changes to the SNF Re-hospitalization Value-Based Purchasing (VBP) Program, IMPACT Act Quality Reporting Program (QRP) as well as the new SNF payment system, the Patient-Driven Payment Model (PDPM).

    image

    How to Register in ahcancalED 

    Easy as 1, 2, 3 !

     

    Step 1

    image

    Go to the ahcancalED site at https://educate.ahcancal.org/and log in using the orange button in the upper left hand corner.

    Use your usual user name and password that you would use for LTC Trend Tracker or the AHCA NCAL website.  


    Don’t have one or can’t remember?

    Click the log in button and follow the directions found under the search button that reads-“If you need help retrieving your Username or Password, click here”.

    *Please note* you must add your member facility name to your login


    Once you are in and can see your name in the upper left hand corner, you are ready to go.

    Step 2

    image

    From the home page click on a category (Resources, Training, Webinars or Trending Now) For this demonstration, let’s try hovering over Webinars until upcoming webinars displays. 

    Under “upcoming webinars” go to a product in which you are interested. Click on the title.

    You’ll be redirected to the site where you can register for the product. This allows you to view the overview, handouts or resources associated with that product.

    Step 3

    image

    Almost there!

    Click the green register button.

    Fill out the registration details and voila! The products are yours to use indefinitely and can be found in your dashboard.

    FYI: after registering, you will be automatically notified when the recording of the webinar is ready.


    Need further help? Email us at educate@ahca.org

    We’ll walk you through it.

     

NCAL AHCA