September is here, which means October 1st is
less than 30 days away. Transitioning the patients receiving care under
Medicare Part A to the PDPM September 30th to October 1st
will require the planning and attention of the interdisciplinary team (IDT).
Here are some IDT considerations for all Medicare A patients admitted prior to October
- Payment for the month of September, regardless of admit date, must be transmitted using the RUGs IV classification system.
- To receive payment for October 1st and beyond, a Transitional Interim Payment Assessment (IPA) must be completed and have an ARD set no later than October 7, 2019.
- The facility has the normal transmission time frame of 14 days to submit the transitional IPA. Use this time and plan appropriately!
- Remember! The patient’s care needs and plans do not change on October 1st. Only payment is changing. A therapy recertification or re-evaluation is not necessary, and the facility care plan is still active.
- Therapy and nursing will need to complete interim Section GG scoring for the 10 Section GG items that produce the PDPM Function Score.
- Discuss current caseload and any new admissions to identify all necessary comorbidities, clinical conditions and services, restorative nursing needs, primary reason for skilled admission, and surgical interventions during the most recent hospital stay.
- Ensure timely communication of admissions for screening and/or completion of a holistic evaluation by therapy.
- Plan for discharge destination and goals upon admission to allow for predictive length of stay and to identify patient specific education and resource needs.
- Continue to coordinate care between therapy, nursing, and facility support staff to foster outstanding functional outcomes and safe transitions to the next level of care!
Your partners at Reliant Rehabilitation are here to help
with the transition to the PDPM. The Director of Rehabilitation at your
facility has been provided extensive training and is equipped to facilitate
therapy and collaborate with the facility through the October 1st
transition. Feel free to reach out to your Reliant partners with any
questions or to help you problem solve. Together, we can make this a
ICD-10 Codes and PDPM Mapping
The Centers for Medicare
and Medicaid Services (CMS) have identified, categorized, and mapped medical
conditions through ICD-10 coding which predict payment for physical therapy,
occupational therapy, speech therapy, nursing, and non-therapy ancillary needs.
occupational therapy, and speech therapy will be categorized based on the
primary diagnosis for the SNF stay as coded in item I0020B. This single primary
diagnosis will then map to 1 of 10 PDPM clinical categories which directly impacts
Are “return to provider” codes
codes entered in I0020B (primary reason for skilled stay) will map to “return
to provider”. If a “return to provider” code is used in I0020B of the MDS, the
claim will be returned for revision of the code entered in I0020B.
“return to provider” codes include symptom codes that may be used by physical,
occupational, and speech therapists as treatment diagnoses on their plans of
include but are not limited to: M25.561 pain in right knee, M62.81 muscle
weakness (generalized), R13.11 dysphagia – oral phase, R27.9 unspecified lack
of coordination, R26.81 unsteadiness on feet, and R41.841 cognitive
Symptom codes do not represent the
primary reason for the SNF stay; therefore, they are not appropriate for
I0020B. However, they do support
the highly specified and individualized treatment provided to the patient by
therapy and must be coded by
therapy as treatment diagnoses and reflected on the UB04 and other areas of the
MDS. This coding ensures a full clinical picture of the patient’s clinical
characteristics is provided and ensures the claim is supported in the event
additional review is requested.
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What to Do If You Suspect You Are a Victim of Phishing:
- Change your password immediately.
- Contact your IT Department.
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