PDPM utilizes a different methodology for how payment will be calculated. Instead of determining the payment based on the days and amount of therapy provided in combination with the ADL score, payment will be generated based on the clinical complexities of a patient. The big factor will be a SNF provider’s ability to accurately capture the care provided and clinical complexities present so they can be reimbursed for the care delivered.
The biggest challenge to that is nursing documentation; or lack thereof. The rule of thumb has always been, “if it isn’t documented, it didn’t happen”. That will stay true with PDPM. The clinical record will need to justify key items indicated on the MDS assessment that will impact payment. Historically, over time providers have gotten really good at documenting section G, ADL delivery and substantiating therapy records. Under PDPM, multiple aspects of the MDS that will control payment will begin to be scrutinized. Many of the key areas are highlighted below and are summarized on our webinar - Nursing Documentation Considerations.
Brief Interview for Mental Status (BIMS) The presence of cognitive impairment in section C of the MDS impacts the ST component of PDPM. Specifically, if a score of 12 or less is generated, this will positively impact reimbursement. A facility should consider the following: