Effective October 1, 2019, the Patient Driven Payment Model will replace the current RUGS-IV PPS system. Organizations are facing major changes, and along with change comes worry. The purpose of this document is to help facilities with the transition to PDPM.
Steps for Success During the First Week of the Transition:
- Ensure that there is an MDS assessment completed for all residents who initiated Medicare Part A prior to October 1, 2019 so that there is a HIPPS code for all billable days through September 30, 2019 under the current RUGS-IV system.
- Complete a “transitional” Interim Payment Assessment (IPA) for residents that initiated Part A prior to October 1, 2019 with an Assessment Reference Date (ARD) of October 1, 2019 through October 7, 2019 so that a billable HIPPS code under PDPM is generated.
- The BIMS and PHQ-9 resident interviews should be completed on the ARD, or anytime within the look-back period. It is preferred to be completed on the ARD or one day prior.
- If neither the BIMS nor the Staff Assessment for cognition is completed, the resident will be classified as “cognitively intact” for the purpose of creating a PDPM HIPPS code.
- Any transitional IPAs after October 7, 2019 will be considered late, and the late assessment penalty will be applied.
- The BIMS and PHQ-9 resident interviews should be completed on the ARD, or anytime within the look-back period. It is preferred to be completed on the ARD or one day prior.
- Obtain all hospital paperwork for every resident to include:
- Medication Administration Records (MARs) with the date(s) and time(s) of medication(s) given,
- Treatment Administration Records (TARs),
- Record of vital signs,
- Surgical reports (if applicable),
- Nursing assessments and notes,
- Therapy assessments and notes, and
- Physician assessments and notes, which include diagnoses.
- Note that some diagnoses may need to be clarified with the physician (e.g. obesity, unspecified vs morbid obesity).
For additional tools to help your center prepare, including payment and billing updates, assessment schedules, MDS items/policies, click here.