APRIL 2019


PDPM-OVERVIEW Schedule training sessions attend webinars

April 1 – 6

PDPM OVERVIEW – Understand concept for conversion from RUG-IV
  • Schedule training sessions, attend webinars/courses, attend state/national conferences
  • Review resources on CMS’s PDPM webpage

April 7 – 13

SNF COVERAGE REQUIREMENTS – Review regulations that are not changing with PDPM

April 14 – 20

DISCUSS PDPM KEY CONCEPTS – Payment based on patient characteristics, therapy service delivery to be outcome-driven, MDS assessment schedule changes
  • Five (5) variable case-mix group components (vs. 2 under RUG-IV): nursing, non-therapy ancillary (NTA), PT, OT and ST
  • Simplification of MDS assessment schedule: 5-day, PPS Discharge, Interim Payment Assessment (IPA)
  • Variable per diem payment adjustment for PT, OT and NTA
  • Transition from Section G to Section GG for function scoring
  • Download the PDPM Summary Document
  • Review the PDPM Per Diem Rates for FY2020

April 21 – 27

FOCUS ON ICD-10 CODING – Review current ICD-10 coding practices on both MDS and the claim and prepare for identifying primary diagnosis for new MDS item I0020B beginning October 1, 2019
  • Leverage EMR/billing software to determine ICD-10 codes currently utilized
  • Look for unspecified and symptom-based ICD-10 codes as these will likely not map to a PDPM Clinical Category for PT, OT and ST
  • To access PDPM ICD-10 Mappings click here and then scroll to the bottom of the page to the last link, PDPM ICD-10 Mappings
  • Schedule ICD-10 training for key personnel (e.g., MDS Coordinator, Director of Nursing, Therapy Director)
PDPM education and staff training

April 28 – May 4

EVALUATE WHAT YOU HAVE LEARNED – Identify areas of opportunity, focus areas for education and staff training.

MAY 2019



May 5 – 11

OBTAIN PDPM VS. RUG-IV COMPARISON DATA – Determine if current patient population and current practices project better or worse financial performance with PDPM
  • Run current, completed MDS assessments through PDPM analytics software, if available, to compare current performance under RUG-IV to PDPM
  • Review CMS’s SNF PDPM Provider-Specific Impact File – results listed by CCN (CMS Certification Number)
    • Recommend reviewing the Enhanced Provider Specific File spreadsheet
    • Note that the information in this Provider File represents FY 2017 data (not current data)

May 12 – 18

ANALYZE DATA FROM A FINANCIAL PERSPECTIVE – Does current RUG category utilization translate to PDPM?
  • If PDPM analytics software is available for current data, start with an overall picture
    • Financial results of current assessments under RUG-IV and PDPM
    • Financial performance of rehab stays under PDPM, particularly Rehab Ultra High and Rehab Very High
    • Current ADL score (end split) vs. PDPM function score
  • If using CMS’s Provider-Specific Impact File, review overall performance
    • Facility financial performance under RUG-IV vs. PDPM
    • Comparison of therapy and nursing financial performance under RUG-IV vs. PDPM

May 19 – 25

ANALYZE DATA FROM A CLINICAL PERSPECTIVE – Does RUG-IV clinical data accurately reflect the clinical needs of your patients under PDPM?
  • Percentage of rehab vs. non-rehab RUG under RUG-IV
  • Distribution (percentage) of nursing and therapy PDPM case-mix groups (CMGs)
    • What percentage of current patients are in Medical Management for PT and OT (TI – TL)?
    • What percentage of current patients are in SA and SD (2 lowest CMGs) for SLP?
    • What percentage of current patients are in Reduced Physical Function for nursing?
    • Of the patients in Reduced Physical Function for nursing, how many are currently in a rehab RUG?
    • What percentage of current patients are in NF (zero points) for NTA?
    • Learn more here Casamba’s PDPM Data Analysis: What clinical picture does your data paint?

May 26 – June 1

DRILL DOWN INTO THE MDS ITSELF – Are the items that impact payment under PDPM completed accurately?
  • Review current 5-day vs. 14-day PPS assessments
    • Does the RUG category change from the 5-day to the 14-day? If so, why?
    • Are there items coded on the 14-day that should be on the 5-day? What are the barriers to coding this information on the 5-day?
  • EVALUATE WHAT YOU HAVE LEARNED – Identify areas of opportunity, focus areas for education and staff training
  • ICD-10 coding accuracy
    • Do you know your return to provider (RTP) rate?
    • Have key personnel received ICD-10 coding training?
    • Begin identifying primary diagnosis with each new admission via IDT collaboration in 72-hour meeting, weekly meetings, patient care conferences, etc. (“Why is the patient in our facility?”)
  • Section GG
    • Do nursing staff and CNAs need training on coding Section GG vs. Section G?
    • Does therapy staff assist with coding Section GG?
  • For help with coding Section GG, check out our Therapy MDS Crosswalk
  • Nursing
    • Are nursing needs documented in the medical record and captured on the MDS for all patients, even those receiving therapy (i.e., those in a rehab RUG)?
    • Are there opportunities to improve Restorative Nursing Programming?
  • NTA
    • Ensure accurate coding of comorbidities and complexities such as diabetes, COPD, obesity, wounds, etc.
  • PT, OT, SLP
    • Do PDPM CMGs accurately reflect patient population being treated?
    • Are patients with dysphagia and/or a mechanically altered diet on SLP caseload?
    • Is group and/or concurrent therapy utilized? If not, why not?

JUNE 2019



June 2 – 8

ASSESS YOUR PEOPLE – Do you have the right people in the right places? Are your people informed? Access the Role-Based Assessment tool.
  • Who is involved in the admissions process? Are they effective?
  • Is your MDS Coordinator a strong, clinical evaluator?
  • Does your staff understand PDPM and the shift in reimbursement?
  • Do your doctors and referring providers understand PDPM and their role?
  • Are your therapists involved in a collaborative team effort to ensure accurate diagnosis and MDS coding?

June 9 – 15

ASSESS YOUR PROCESSES – Admissions, MDS coding and completion, standing meetings/patient care conferences, triple check, therapy scheduling, etc.
  • Are your processes clearly defined? Are they consistently followed?
  • Do your processes need to be improved or is it a “person problem”?
  • Do you have the right person in the right role?

June 16 – 22

DEFINE NEW ROLES AND PROCESSES – Identify your desired state with respect to workflow, task/process ownership, communication, timeliness and output
  • What and/or who needs to change?
  • What skills and characteristics are needed for each role?
  • Clearly communicate expectations

June 23 – 29

INITIATE ROLE AND PROCESS CHANGES – Continue education and training with a role-based focus, document processes
  • Socialize changes in roles and processes
  • Support staff who are changing roles – consider assigning staff mentor
  • Establish expectations of collaboration and accountability
  • Casamba customers can schedule time for staff to complete the Section GG competency training on your Computer-based Training (CBT) site and use the Casamba Competency Quiz report to track staff performance

June 30 – July 6

EVALUATE WHAT YOU HAVE LEARNED – Identify areas of opportunity, focus areas for education and staff training

JULY 2019



July 7 – 13

REVIEW CUSTOMER CONTRACTS – Assess current contract structure with SNF providers from volume and performance perspective
  • What types of contracts do you currently have in place?
  • How do you perform under each contract?
  • Assess customer/partner relationship – strong (true partner) vs. weak (vendor only)
  • Review the PDPM Pricing Model white paper.

July 14 – 20

  • Percentage of therapy CMGs, percentage of all CMGs
  • Risk-sharing, performance adjustments
  • Time in facility, management

July 21 – 27

SCHEDULE CONTRACT NEGOTIATION MEETINGS – Jointly define the metrics that communicate success with PDPM
  • Readmission rates
  • DC to community
  • Other metrics?

July 28 – August 3

EVALUATE WHAT YOU HAVE LEARNED – Identify areas of opportunity, focus areas for education and staff training




August 4 – 10

  • Complete Market Strategy Framework
  • Record averages from trailing 12-month period to show the percentage of referrals by:
    • Payer mix (Managed Care, Medicare, Medicaid, Hospice)
    • Percentage of readmissions – focus on strategies to reduce avoidable readmissions
    • Percentage from each hospital referral source
    • Percentage by specific insurance contract
    • Percentage by hospital networks, ACOs, and bundles
    • Percentage by primary patient diagnosis
  • Analyze the behavior, decision process and characteristics of each segment. Know who pays for what, for how long and what the documentation requirements are

August 11 – 17

  • Download JOC Sample Letter
  • Aligning behaviors with mutual goals and objectives
    • Discuss strategies to standardized care. Download Facility Assessment Tool
    • Discuss readmissions and how to improve outcomes with complex patients. Casamba customers can refer to the May 8th Casamba Skilled Lunch & Learn on Screening Tools by logging in to the Community.
    • Define new processes and expectations. Access Discharge Readiness Checklist and Next Site Of Care questionairre
    • Introduce PDPM Pre-admission Screening Tool – Educate the hospital team on PDPM
  • Identify who is responsible for intake and whom they notify with all details communicated
    • Evaluate forms/systems
    • Consider MD/APN documentation forms – Are they inclusive of ICD-10 codes?
    • Identify who is responsible for intake in the gaps (Friday-Sunday and holidays)
  • Ultimately, these strategies should reduce avoidable hospital readmissions, reduce cost, and improve outcomes and patient/family satisfaction
  • Download Evaluate Admissions Process

August 18 – 24

EVALUATE CURRENT PAYER CONTRACTS – Must know all payer contract requirements on admission or could be a financial liability
  • How are we performing? Are we ready?
  • Are current contracts financially positive for the facility?
    • If not, which areas are causing loss?
    • How can we improve performance?
    • Can contracts be renegotiated?

August 25 – 31

EVALUATE WHAT YOU HAVE LEARNED – Take time to review changes made thus far and assess overall progress
  • Are employees gaining competence and confidence in new roles?
  • Is additional staff training on PDPM necessary? ICD-10 coding, Section GG
  • Have you completed contract negotiations?





September 1 – 7

ASSESS MARKET DEFINITION – Determine where you fit in the market and where you want to be
  • Analyze strength of clinical programs offered
  • Identify opportunities to strengthen your position in the market and/or services offered
  • Develop a clinical grid to assist admission coordinators to more readily accept referrals
  • Create messaging/branding campaigns
  • Identify collateral and equipment needs
  • Identify training and educational initiatives
  • Consider specialties/competencies to assist in reducing variation in clinical care (e.g., Memory Care, Disease Management, Behavioral Health, Vent/Trach Units, Post-acute Rehab)

September 9 – 14

OPTIMIZE THERAPY PROCESSES – Discharge readiness, group therapy, clinical pathways
  • Shift paradigm from complete resolution of all problems/deficits to readiness for next level of care. Start to evaluate the planned and actual discharge location
    • Hand off to next level of care professionals is successful (e.g., home health, outpatient)
    • Transition to restorative should be seamless
    • Assure efficacy of caregiver training
  • Begin peer review of therapy goals set vs. goals met
    • Provide objective feedback on functionality and appropriateness of goals
    • Standardized tests used routinely
  • Plan successful group therapy sessions with appropriate cohorts
    • Identify therapists who have skills to deliver group effectively
    • Identify 2-3 groups to meet the functional needs of your patient population
    • Anchor these functional groups on the schedule
    • Socialize the group schedule throughout the therapy department and the facility
  • Ensure adoption of clinical pathways and evidence-based interventions
  • Learn more about Skilled Groups

September 15 – 21

OPTIMIZE NURSING PROCESSES – Restorative nursing, interdisciplinary meetings, MDS coding
  • Restorative nursing and therapy becoming more efficient with integration – For example, therapy in the morning, restorative in the afternoon (skilled treatment in the morning, strengthening in the afternoon)
    • Restorative documentation to support daily program delivery
    • Emphasize importance of restorative programming and consistent RNA staffing
  • Evaluate effectiveness of interdisciplinary meetings – Is IDT collaboration evident?
    • Assess your Daily Stand-Up Meeting
      • Do you have pertinent information about new admissions – are you performing pre-admission screening?
      • Does the team conduct a clinical review of skilled patients and new admissions?
      • Do you review MDS items that impact reimbursement?
      • Is documentation in place?
      • Who leads this meeting? Should leadership change under PDPM?
  • Assure new admissions are being viewed as a PDPM case?
    • Does the team use PDPM terminology (e.g., primary diagnosis, comorbidities, non-therapy ancillaries)?
    • Are ICD-10 codes being determined and utilized efficiently?

September 22 – 28

OPTIMIZE DISCHARGE PLANNING – Downstream communication, caregiver training, manage readmission risk
  • Referrals to next level of care (HH, OP)
  • Ensure caregiver training is comprehensive and complete – from a therapy (function) and nursing (medical management) perspective
  • Be able to accept calls/questions from patient and/or caregiver after discharge
  • Consider follow-up contact/communication after patient has transitioned home at 24 hours, 72 hours, 1 week and 4 weeks
  • Review CMS’s Care Coordination Toolkit

September 29 – October 5




PDPM Therapy Services Solutions

October 1 – 5

  • Create list of patients under a Medicare Part A payer admitted prior to 10/01/2019 and remaining on therapy caseload after October 1st
  • Check to ensure an ARD is set for the transitional IPA between 10/1 and 10/7/2019 for each patient admitted to the SNF under Medicare Part A prior to October 1, 2019
    • The ARD MUST be set on or before October 7th, 2019
  • For patients admitted on 10/01/2019 or after, initiate care under PDPM and set the ARD for 5-day MDS on days 1 – 8
  • Review all ICD-10 coding, comorbidities, swallowing issues, cognition, and other MDS items impacting payment

October 6 - 12

  • Perform a triple check of ICD-10 coding (on the MDS and the claim), physician orders and certification, and MDS items, including a review of medical record documentation to support each item:
    • Mechanically Altered Diet - Restorative Nursing Programs
    • SLP Comorbidities - Shortness of Breath
    • Cognition - Skin Integrity
    • Depression - Special Treatments, Procedures, and Programs
    • Function - Surgery Prior to Admission
    • Active Diagnoses - Swallowing Disorder
  • Verify that ALL transitional IPAs are completed and submitted within 14 days of the ARD. Verify on CMS site that the assessments were received.
    • Without this step, the SNF will LOSE significant revenue due to billing the default category. Make sure ARDs are set and assessments are COMPLETED and SUBMITTED timely. There are no exceptions for late assessments during the transition.
physician orders and certification

October 13 - 19

  • Do you know how the MDS impacts reimbursement?
    • 161 items in 11 Sections of the MDS impact reimbursement under PDPM:
      • B: Hearing, Speech, Vision
      • C: Cognitive Patterns
      • GG: Functional Abilities
      • H: Bladder and Bowel
      • I: Active Diagnosis
      • J: Health Conditions
      • K: Swallowing/Nutritional Status
      • M: Skin Conditions
      • N: Medications
      • Section O: Special Treatments/Procedures & Programs
  • What is your MDS Practice?
    • Who currently codes MDS Sections GG, C, D, K?
      • Is therapy involved in scoring the BIMS or PHQ-9?
      • Are patient interviews being conducted effectively?
      • How does the MDS coordinator obtain MDS data from therapy or other departments? Can the EMR or other technology be leveraged to gather or provide this data?
    • The ARD for the 5-Day MDS must be set by Day 8. How does the IDT determine the ARD?
    • Does MDS completion include a thorough review of clinical documentation from both the referring hospital/provider and the SNF stay?
      • Is physician documentation present to support the Active Diagnoses in Section I?
      • Is documentation present to support special treatments and procedures impacting nursing and NTA, such as IVs, TPN, ventilator, tracheostomy, treatment of wounds?

October 20 - 26

  • Reassess your Interdisciplinary Processes and meetings
    • Daily Stand-Up
      • Are you receiving timely and accurate information from your referral sources?
      • Are you using a pre-admission screening tool effectively?
      • What information is still lacking?
    • Weekly Medicare Meeting
      • Does the team successfully identify and document changes in the patient’s condition?
      • How are differences or potential contradictions in nursing and therapy documentation addressed?
  • Reinforce accountability for the MDS and IDT process
    • Who leads the process?
    • Are team members working well together?
    • Are there barriers to communication or to care planning?
Interdisciplinary Processes and meetings

October 27 - 31



PDPM Therapy Services Solutions
  • Billing time for first month of residents under Part A payer and under the new PDPM process.
    • Review the HIPPS codes and CMG percentages
  • Do you have contract structures that are financially successful?
  • Which areas need improvement?
  • Identify relevant outcomes to measure success under PDPM.

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