APRIL 2019



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)

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?
  • 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


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