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As you’ve probably heard, big changes are coming to Medicare Part A reimbursements starting on October 1, 2019. The new Patient Driven Payment Model (PDPM) will shift the Medicare reimbursement structure to focus on complete patient needs, rather than therapy minutes. Not only will this result in better, more individualized care for patients, but it will make it easier for SNF providers to accurately track patient progress.

One key change coming from PDPM will concern the Minimum Data Set (MDS) Assessment in terms of cadence and requirements. Previously, under RUG-IV, facilities had to assess patients on or around days 5, 14, 30, 60, and 90 – depending on the length of their stay. PDPM will shrink this sequence down to three assessments – initial Medicare assessment, Interim, and PPS Discharge Assessments. The Initial Patient Assessment and PPS Discharge Assessments are both necessary; the Interim Payment Assessment (IPA) is optional and would only occur if a resident experiences a clinical change. Of these three assessments, the initial one is the most critical for ensuring accurate reimbursement rates. It can truly make or break the financial health of your facility.

If the initial Medicare assessment doesn’t depict a resident’s full range of health concerns – from previous surgeries to comorbidities – the facility may end up losing money. SNFs will have an easier time ensuring the initial Medicare assessment accuracy if they gather complete resident profiles during, not after, the pre-admission process. We recommend using an integrated referral portal which allows clinical liaisons to accurately represent a resident’s needs from the start.

With that said, let’s dive into some key details about the MDS. There are more than 20 sections to evaluate and record factors like:

  • Identification Information
  • Hearing, Speech, and Vision
  • Cognitive Patterns
  • Mood
  • Behavior
  • Preferences for Customary Routine and Activities
  • Functional Status
  • Functional Abilities and Goals
  • Bladder and Bowel
  • Active Diagnoses
  • Health Conditions
  • Swallowing/Nutritional Status
  • Oral/Dental Status
  • Skin Conditions
  • Medications
  • Special Treatments, Procedures and Programs
  • Restraints
  • Participation in Assessment and Goal Setting
  • Care Area Assessment (CAA) Summary
  • Correction Request
  • Assessment Administration

Under PDPM, several of these categories were updated and adjusted to fit modern patient needs. Some of the changes include updated language, the removal of certain indications, and the addition of new coding categories. Although it may seem like less data will be gathered due to the reduced schedule, the data gathered at each assessment will need to be more thorough. This might seem overwhelming at first, but these changes and adjustments will help providers better track patient data and care – ultimately yielding better clinical outcomes.

Making the Switch

While any abrupt change in care can be difficult for a direct care team, reviewing handouts, literature, and online resources provided by the Centers for Medicare and Medicaid Services (CMS) can help a team transition to PDPM smoothly – as can our PDPM resource center. Being aware of the most important changes to the assessment schedule, new coding options and categories, and adjustments to various sections of the MDS. Here are some bottom-line tips to keep you and your team on track:

5 things to remember about the Initial Medicare Assessment

  1. It’s the first of three patient assessments, and it’s required. Timeliness and a thorough evaluation during the initial Medicare assessment will lead to better clinical care for your residents and appropriate reimbursement for Medicare Part A SNF stays.
  2. Several changes have been made to MDS sections. Review each section of the MDS, as changes have been made to sections A, D, GG, I, J, K, O V, X, and Z – and it’s possible that more changes are on the way prior to PDPM implementation.
  3. It helps to paint a complete picture, and Non-Therapy Ancillary Services can greatly impact reimbursement rates. The new MDS is a more comprehensive clinical assessment and includes factors that impact everyday life. Coordinators will now have to understand many aspects of their residents’ clinical needs to receive reimbursements. For example, NTA factors can significantly bolster payments, but only if your facility successfully captures all of them on the initial Medicare assessment. For the first three days of the resident’s reimbursable care episode, the variable per diem adjustment for NTA factors will run at 300%.
  4. The initial Medicare assessment now covers all applicable standard Medicare payment days. Unless an IPA is completed due to a clinical change, the initial Medicare Assessment will pay for all covered Part A days until discharge.
  5. Reviewing CMS resources ahead of time will help your team transition smoothly to PDPM. Webinars, presentations, and literature are all available to help ensure SNF are well prepared for the change in MDS coding and timing. Ensure your whole staff has time for training – from nurses and physicians to administrators and beyond.

For many Skilled Nursing Facilities, the next few months will be spent preparing for the switch from RUG-IV to PDPM. Adapting to modern technology is one way to make a facility run smoother and more efficiently – starting with Cantata’s Referral Portal during the pre-admission process. With a more complete resident profile and by paying close attention to the changes coming to the initial Medicare Assessment, SNFs can be sure that they receive proper reimbursement for patient care.