image

BACKGROUND

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.

AHCA EDUCATION AND TRAINING

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 link at left side of this page).  AHCA will also be providing PDPM educational resources customized to the needs of ABM partners at no additional cost (see below).    

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 below) 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 now offers 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.    

PDPM Workshop Pre-Requisite Webinars

  • Patient Driven Payment Model (PDPM) Workshop Pre-Requisite Webinar Modules

    Contains 7 Component(s) Recorded On: 02/01/2019
    image

    How to Register in ahcancalED 

    Easy as 1, 2, 3 !

    click the image button found in the upper right corner of your screen or follow these three easy steps below! 

     

    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. 

    If you cannot remember your login- go here and follow the steps to access your account. 

    If you are new: click CREATE ACCOUNT button and follow the directions on this page.

    Step 2

    image
    image

    New Users: Complete all necessary fields on the "Create an account" screen and; 

    *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 add this product to your cart and checkout. 

    Step 3

    image

    Almost there!

    Click the green register button and voila! The products are yours to use indefinitely and can be found in your dashboard (shown on the left hand side of the web page). 

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

    We’ll walk you through it.

     

    Recorded Pre-Requisite Webinar Modules on:

    a) PDPM Academy Workshop, What to Expect (5 minutes)

    b) PDPM Basics (32 minutes) 

    c) Payment Case Examples (20 minutes) 

    d) SNF Benefit Review & Interaction with Existing SNF Policies/Programs (17 minutes) 

    e) “How-To” Use CMS ICD-10 PDPM Crosswalk Tables (22 minutes)  

    f) Administrator’s Role in PDPM Training (19 minutes)


    Estimate 115 minutes of prep time before workshop to view pre- requisite webinar modules, and additional time to review the documents either included in your registration packet, or that you have been requested to download prior to the workshop. 

    image

AHCA PDPM Academy Resources

Resources are now available, specific to you, and can be found in "My Dashboard". If you have questions please email educate@ahca.org.

COPYRIGHT STATEMENT

AHCA PDPM Academy publications, tools, workshops, webinars or other resources have been developed and paid for as a part of your AHCA provider membership  and/or PDPM Academy registration.  These resources are for your facility use only and copyrighted resources should not be distributed outside your organization without AHCA permission.  Please respect the copyright.

Questions about the contents of AHCA PDPM Academy publications, tools, workshops, webinars or other resources may be directed to pdpm@ahca.org.

For additional information about AHCA visit www.ahcancal.org.

Copyright 2019 American Health Care Association, 1201 L Street NW Washington, DC  20005. All Rights Reserved.  Permission to use, copy and/or distribute any documentation and/or related images from AHCA PDPM Academy publications, tools, workshops, webinars or other resources shall be expressly obtained from AHCA.


Please see additional resources available to AHCA members below:

  • Understanding the critical role of malnutrition in the Patient Driven Payment Model (PDPM) for Success

    Contains 1 Component(s) Recorded On: 02/26/2019

    image

    How to Register in ahcancalED 

    Easy as 1, 2, 3 !

    click the image button found in the upper right corner of your screen or follow these three easy steps below! 

     

    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.

     

    Efficiency and cost-effective positive nutritional outcomes are critical for success in today’s healthcare environment. CMS will be replacing the current SNF PPS Resource Utilization Group (RUGs) payment model with a new per-diem payment system called the Patient-Driven Payment Model (PDPM) beginning on October 1, 2019. It is critical for success that providers understand where key nutrition related diagnoses are included in the PDPM. This session will discuss collaboration with appropriate healthcare professionals to incorporate systems, processes and documentation for successful financial reimbursement of nutrition related services.

    Objectives:

    After attending this session attendees will be able to:

    • Identify key components for sustainable success with the CMS Patient Driven Payment Model (PDPM).
    • Present key Non-Therapy Ancillary (NTA) Components Diagnostic Criteria and SLP   - Component of Presence of swallowing disorder or mechanically altered diet related to Nutrition.
    • Discuss critical collaborative steps for successful integration of nutrition services into PDPM.

    Presented by:

    Brenda Richardson, MA, RDN, LD, CD, FAND

Coming Soon- Continuing Updates & Support on PDPM

  • AHCA PDPM Case-Mix Grouper Simulator Toolkit
  • AHCA PDPM Model Job Descriptions Toolkit 
  • AHCA PDPM Therapy Staffing/Contracting Considerations Toolkit 
  • AHCA Creative Thinking: Innovative Solutions to Complex Challenges Toolkit 
  • AHCA PDPM Toolkit Updates (as needed) based on CMS FY 2020 SNF PPS PDPM Proposed Rule (estimated Jun 2019 release)
  • AHCA PDPM Toolkit Updates (as needed) based on CMS FY 2020 SNF PPS PDPM Final Rule (estimated Sep 2019 release)    
  • AHCA PDPM Academy ABM Partner Resources



    NCAL AHCA