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CMS PDPM Program Manual UpdatesContains 4 Component(s)
The Centers for Medicare and Medicaid Services (CMS) has issued sub-regulatory guidance related to the Skilled Nursing Facility Medicare Part A Prospective Payment System (SNF PPS) Patient Driven Payment Model (PDPM) in recent Progrram Manual update transmittals. The most current updates and related resources are provided in this folder.
TRICARE SNF Payment Policies Impacted by PDPMContains 3 Component(s)
TRICARE provides health care benefits to active military personnel and their families. TRICARE has three regions: East, West, and Overseas. Each TRICARE region has its own managed care support contractor (MCSC) who is responsible for administering the TRICARE program in each region. The MCSCs establish the provider networks and conduct provider education. At a minimum, all TRICARE providers must be authorized/certified under TRICARE Regulation and must have their authorization/certification status verified by the managed care support contractors (MCSCs) in each region. There are two types of TRICARE-authorized providers: Network and Non-Network Providers
Veterans Administration (VA) SNF Payment Policies Impacted by PDPMContains 9 Component(s)
The Veterans Health Administration is America’s largest integrated health care system, providing care at 1,255 health care facilities, including 170 medical centers and 1,074 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year. Community providers are a vital part of VA’s high-performing health care network; making sure Veterans who have served our country and their families get the timely, high-quality health care they need. With community care, Veterans and their family members (dependents) can receive care from a local provider in their community depending on specific eligibility requirements, their medical needs and circumstances, care available at VA, and other factors.
CMS PDPM HIPPS Coding Web Page Resources (posted 9/20/19)Contains 1 Component(s)
This web page contains information related to the use and maintenance of the Health Insurance Prospective Payment System (HIPPS) codeset. The Centers for Medicare and Medicaid Services (CMS) are named in the ASC X12 837 Institutional Claim Implementation Guide as the code source for HIPPS codes. The following files contain specific details regarding the SNF PPS PDPM HIPPS code construction as well as a master list of all valid HIPPS codes applicable to PDPM. • Definition and Uses of HIPPS Codes (see file below) • HIPPS Code Master List (see file below) - an Excel spreadsheet that provides a complete list of all valid HIPPS codes, with their effective dates, payment settings and code definitions.