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Terms in this set (5)Case-Mix Group (CGM) Classification system used in Medicare Skilled Nursing Facility Services Payment System's patient-driven payment model to group residents into groups based on clinical reason for stay and function level Patient-Driven Payment Model (PDPM) Reimbursement model that assigns residents to payment categories based on individual patient characteristics Skilled Nursing Facility (SNF) Facility that is certified by Medicare to provide 24-hours skilled inpatient nursing care and rehabilitation services in addition to other medical services for short-term care Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP) Medicare value-based purchasing program that ties facility performance for established quality measures into the Skilled Nursing Facility Services Payment System Variable Day Adjustment Adjustment in the Skilled Nursing Facility Services Payment System that adjusts the case-mix index value on specified days of the resident's stay for physical therapy, occupational therapy, and non-ancillary therapy components Sets found in the same folderChapter 1 - HEALTHCARE REIMBURSEMENT17 terms BrookeHollandsworth Chapter 4 - HEALTHCARE REIMBURSEMENT19 terms BrookeHollandsworth Chapter 5 - HEALTHCARE REIMBURSEMENT42 terms BrookeHollandsworth LTCH - HEALTHCARE REIMBURSEMENT10 terms BrookeHollandsworth Other sets by this creatorChapter 13 - HEALTHCARE REIMBURSEMENT26 terms BrookeHollandsworth Chapter 12 - HEALTHCARE REIMBURSEMENT14 terms BrookeHollandsworth Chapter 11 - HEALTHCARE REIMBURSEMENT11 terms BrookeHollandsworth Chapter 10 - HEALTHCARE REIMBURSEMENT31 terms BrookeHollandsworth Other Quizlet setsOdysseyware study81 terms dove177 sales promo final36 terms haruna_matsui5 AP Psych Unit 1 Review (Research Methods)20 terms rofl_waffl Real estate sh*t Unit 21 <331 terms Claire_Hollansworth3 •UB92 not matching MDS and/or Rehab billing logs •MD signatures on Certifications •Inaccurate ICD-10 coding •Improper tracking/reporting of therapy time on MDS •Lack of skilled documentation or justification of services in daily or weekly notes •Repetitive Gait Training, Exercises, Activities, or ADL's •Evaluations only- (Should be Screens or have follow up treatment) •Downgrading of Diets •Reevaluations for Falls •Lack of therapy functional progress •Carryover and Justification for Rehab missing from Nursing notes Recommended textbook solutions
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Principles and Foundations of Health Promotion and Education7th EditionDenise Seabert, James McKenzie 133 solutions What is PDPM payment model?What is PDPM? Patient-Driven Payment Model. The Patient-Driven Payment Model (PDPM) is the proposed new Medicare payment rule for skilled nursing facilities. It is intended to replace the current RUG-IV system with a completely new way of calculating reimbursement.
What are the caseIn the PDPM, there are five case-mix adjusted components: Physical Therapy (PT), Occupational Therapy (OT), Speech-Language Pathology (SLP), Non-Therapy Ancillary (NTA), and Nursing. Each resident is to be classified into one and only one group for each of the five case-mix adjusted components.
What are the six components utilized in the PDPM model?The payment rate for each day of the stay, in the SNF, is obtained by adding the six Patient-Driven Payment Model (PDPM) components: Nursing, Non-Therapy Ancillary (NTA), Physical Therapy (PT), Occupational Therapy (OT), and Speech Language Pathology (SLP), plus the Non-Case-Mix component.
What are PDPM codes?The HIPPS code under PDPM represents the sum of the lowest per diem rate under each PDPM component, plus the non-case-mix component. In cases where the default code is used, the variable per diem schedule must still be followed.
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What are the three therapy components used in the PDPM model for SNF payment quizlet?
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