PDPM Checklist

PDPM is an acronym for Patient-Driven Payment Model. It is a new way of paying for Medicare Part A and Part B services. The PDPM Checklist is important because it helps to ensure that Medicare patients are billed correctly under the new Patient-Driven Payment Model. The checklist includes specific instructions for billing, including which services are covered under PDPM and how to code them. The checklist can help facilities to ensure that they are billing correctly and getting paid for the services they provide.

Details for PDPM Checklist

1. Make sure you are familiar with the Patient-Driven Payment Model.

The Patient-Driven Payment Model (PDPM) is a new way of paying for Medicare Part A and Part B services. It is important to familiarize yourself with the new payment model so that you can bill Medicare correctly.

2. Understand which services are covered under PDP.

Under the PDPM, Medicare will only pay for services that are considered "patient-driven". This includes services that are considered medically necessary and are provided in a skilled nursing facility.

3. Code services correctly according to the new model.

To bill Medicare correctly under PDPM, you must code services correctly. This includes knowing which services are covered and how to code them.

4. Bill Medicare for services provided.

You must bill Medicare for the services you provide to get paid. Make sure you are using the correct billing codes and that your software is updated for PDPM.

5. Make sure your software is updated for PDPM.

To bill Medicare correctly under PDPM, you must make sure your software is updated for the new payment model. If your software is not updated, you may not be able to bill Medicare correctly.

6. Train your staff on the new billing procedures.

To ensure that you are billing Medicare correctly under PDPM, you must train your staff on the new billing procedures. This includes knowing which services are covered and how to code them.

7. Review your claims to make sure they are coded correctly.

It is important to review your claims to make sure they are coded correctly. This will help to ensure that you are getting paid for the services you provide.

8. Stay up to date on changes to the PDPM payment model.

It is important to stay up to date on changes to the PDPM payment model. This will help you to ensure that you are billing Medicare correctly under the new payment model.

FAQ for PDPM Checklist

1. What is the Patient-Driven Payment Model?

The PDPM is a new way of paying for health care that rewards doctors and hospitals for providing quality care that meets the needs of their patients. Under this model, doctors and hospitals are paid based on the quality of care they provide, rather than the number of services they provide.

2. How does the PDPM work?

Under the PDPM, doctors and hospitals are paid based on the quality of care they provide, rather than the number of services they provide. This means that doctors and hospitals are rewarded for providing quality care that meets the needs of their patients.

3. What are the five payment components under the PDPM?

The five payment components under the PDPM are: 1. Service classification: This component will reimburse SNFs for the services that patients receive, such as nursing, therapy, and social work. 2. Payment rate: This component will reimburse SNFs for the services that patients receive, based on the complexity of the services. 3. Case-mix weight: This component will assign a weight to each service that reflects the complexity of the service. 4. Service duration: This component will reimburse SNFs for the time that patients receive a particular service. 5. Payment amount: This component will reimburse SNFs for the services that patients receive, based on the payment rate and the case-mix weight.

4. How will the PDPM affect Medicare reimbursement for SNFs?

The PDPM will affect Medicare reimbursement for SNFs by replacing the current Medicare reimbursement system, which is based on a facility’s average daily census (ADC). The PDPM will reimburse SNFs based on the services that patients receive, rather than on the number of patients in the facility. This will allow SNFs to be paid for the services they provide, rather than for the number of patients they care for.

In Summary

The PDPM Checklist is an effective tool to help facilities transition to the new payment model. However, facilities should be aware of potential issues to avoid during the transition. These issues may include inaccurate coding, inadequate documentation, and improper implementation of the new payment model. Facilities can use the checklist to make sure they are accurately billing and being paid for the services they provide.

ChecklistComplete

PDPM Checklist

Make sure you are familiar with the Patient-Driven Payment Model.

Understand which services are covered under PDPM.

Code services correctly according to the new model.

Bill Medicare for services provided.

Make sure your software is updated for PDPM.

Train your staff on the new billing procedures.

Review your claims to make sure they are coded correctly.

Stay up to date on changes to the PDPM payment model.