Preparing for PDPM

Counting Down to PDPM


PDPM has Begun!

PDPM is Here: Is Your SNF Prepared for the New Payment Model?

If your Skilled Nursing Facility (SNF) is struggling with the launch of PDPM, it may seem as though the RUG has been pulled out from under you.

We are now past the date when RUG-IV (Resource Utilization Group) codes for SNFs cease to exist, replaced by the Patient-Driven Payment Model (PDPM). As a result, the way you calculate and receive reimbursements has changed dramatically.

According to the Centers for Medicare and Medicaid Services (CMS), the goal of the new payment model for Medicare Part A is to:

  • More accurately reimburse SNFs for the clinical care provided to patients
  • Lessen the incentive for SNFs to over-deliver therapy services
  • Simplify the payment process for SNFs

PDPM has totally transformed the way SNFs do business. Are you adapting to the shift?

PDPM is the biggest change for the SNF industry in 20 years. With this new payment model, a patient’s conditions drive reimbursement instead of therapy hours. Under PDPM, therapists don’t determine a resident’s overall care plan as they have in the past. PDPM requires SNFs to carefully manage how they deliver services in order to provide just the right level of service for each patient. SNFs need to think about payments in a different way because ICD-10 codes form the basis for reimbursements under this 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 be ready – PDPM requires you to reassess and readjust your SNF care models and operations. Struggling with the changes PDPM has brought? 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 adjust and identify what strengths, weaknesses and challenges your SNF faces with the changes brought by PDPM. We will not only help you deal with the new payment model, but also will help set you up for success in the new PDPM world.

More PDPM Resources

The eSolutions PDPM Webinar Series with Maureen McCarthy

PDPM is here and your billing processes and revenue cycle are undergoing a huge transformation. eSolutions has several resources to help you during this time of change. View our webinar series, featuring PDPM expert Maureen McCarthy, to learn more details about PDPM and how to manage all the new changes.

The SNF Guide to PDPM: What Every SNF Needs to Know

The Medicare experts at eSolutions lead you step by step through understanding PDPM coding and case mixes, new reimbursement rules, therapy payments, adjustment factors, changes to MDS and stay policies, and other tips to help you manage PDPM and its impact on your bottom line.

PDPM Q&A with Maureen McCarthy

Now that PDPM is in full effect, we’re sure you have questions. The Medicare experts at eSolutions are bringing you answers. Download this special PDPM question-and-answer PDF with SNF expert and President of Celtic Consulting, Maureen McCarthy.

Struggling with PDPM? Contact eSolutions for your PDPM analysis.