PDPM and Medicare Advantage Toolkit

Because SNF providers contract directly with MA plans, it is essential that both parties understand any changes in resident assessment and claims processing that may be necessary to assure that beneficiary access and provider cash flow are not interrupted. To assist, AHCA has added new resources to the PDPM and Medicare Advantage Toolkit that providers can use to help prepare for discussions with Medicare Advantage (MA) plans prior to October 1 to help assure a seamless transition as the SNF PPS transitions to PDPM. The Toolkit includes:

• For Providers – PDPM Impact on Medicare Advantage - PDPM Impact on Medicare Advantage, containing an overview of the impact that PDPM may have on your existing MA contracts and out of network payments, as well as suggested questions for health plans to ease the transition.
• Sample PDPM Survey for Medicare Advantage Health Plans - with sample questions to ask plans to better understand what operational and billing procedures regarding MA residents you may have to change on 10/1.

• PDPM in Medicare Advantage Contracts Readiness Checklist - to ensure you are fully prepared under your existing MA contracts and for out of network payments.
• PDPM Impact on Medicare Advantage Webinar - which reviews the recommendations and resources above.