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If your Skilled Nursing Facility (SNF) is not prepared when October 1, 2019, rolls around, it may seem as though the RUG has been pulled out from under you.
That’s the date when RUG-IV (Resource Utilization Group) codes for SNFs will cease to exist, replaced by the Patient-Driven Payment Model (PDPM). As a result, the way you calculate and receive reimbursements will change dramatically.
According to the Centers for Medicare and Medicaid Services (CMS), the goal of the new payment model for Medicare Part A is to:
PDPM is the biggest change for the SNF industry in 20 years. With this new payment model, a patient’s conditions will drive reimbursement instead of therapy hours. Under PDPM, therapists won’t determine a resident’s overall care plan as they have in the past. PDPM will require SNFs to carefully manage how they deliver services in order to provide just the right level of service for each patient. SNFs will need to think about payments in a different way because ICD-10 codes will form the basis for reimbursements under the new payment model. This means accurate coding is a must for SNFs, and staff responsible for coding and billing may feel a bit more pressure as a result.
So get ready – PDPM will require you to reassess and readjust your SNF care models and operations. When RUG disappears, don’t be caught unprepared. Start taking steps today to prepare for PDPM. Don’t know where to start? Call on eSolutions to help with your transition to PDPM. We have the data intelligence you need to help you prepare and identify what strengths, weaknesses and challenges your SNF faces in preparing for PDPM. We will not only help prepare you for the new payment model, but also will help set you up for success in the new PDPM world.