Tuesday, October 8, 2019

Struggling with PDPM? AHCA’s Online PDPM & ICD-10 Education Can Help

Dave Kyllo
The new payment system known as the Patient Driven Payment Model (PDPM) took effect last week.  PDPM transforms the way skilled nursing facilities are reimbursed for Medicare Part A stays.  Some of the changes that began October 1 include: 
  • The PDPM system relies on more than 180 MDS item fields that completely transforms the previous RUG-based Medicare Part A payment system for skilled nursing facilities. Staff roles and facility processes must be substantially modified to operate effectively under PDPM, including ICD-10 coding which now directly ties to reimbursement.  
  • Simply accepting the hospital’s ICD-10 code or using the ICD-10 code that seem most appropriate does not work under PDPM.  Assuming the admitting physician has the correct diagnosis and code does not work either. MDS Coordinators and billing staff now must be masters at ICD-10 coding and how it maps to PDPM and play an active role in admission process.
  • As a condition of coverage, physicians must certify on admission and then recertify by day 14 and every 30 days thereafter that skilled care is needed.  Physicians and MDS Coordinators must understand and effectively communicate about arriving at the reason for SNF care and define the clinical basis for admission using appropriate ICD-10 codes that map to PDPM. 
  • Primary diagnosis tied to accurate ICD-10 coding matters more than ever under PDPM.  CMS now has a much clearer way to monitor whether SNF care is really needed.  Accurate ICD-10 coding minimizes the risk of payment delays and denials.  
  • SNFs that are not well versed in PDPM and ICD-10 coding are at a much higher risk of seeing their revenue negatively impacted and are at a substantial increased risk for potential audit and recovery. 
AHCA SNF members who did not attend an in-person PDPM Academy training hosted by an AHCA state affiliate earlier this year are encouraged to take AHCA’s Virtual PDPM Training.  Included with the virtual training is access to all materials on AHCA’s PDPM Academy. The PDPM Academy is where updates, tools, webinars and other supporting materials are housed. AHCA SNF members who attend the Virtual PDPM Training will also be able to join in free monthly PDPM Academy webinars hosted by AHCA.
This training is available to AHCA SNF provider members only. The cost for the training – whether first time or repeated - is $350. The training has been approved for 8 NAB CE credits. 
Virtual ICD-10 Coding training is also available through AHCA and is equally important to PDPM success and bulk purchases are available.  There are two online trainings offered, including: 
  • AHCA/AHIMA ICD-10 Training for PDPM – Coder is an in-depth course designed for SNF billing staff, MDS staff, Nursing and Therapy staff, and Admissions and Discharge staff.  The course contains seven modules and comes with 16 CNEs for nurses and 16 AHIMA CEs upon successful completion.  The cost is $499 for AHCA members and $599 for non-members. AHCA/AHIMA ICD-10 Training for PDPM – Coder:        ahcancal.org/icd10pdpmcoder
  • AHCA/AHIMA ICD-10 Training for PDPM – Non-Coder is a four-hour course developed for individuals who need to lead a successful PDPM transition and is intended for Administrators, DONs, and other management staff.  The course for non-coders comes with 4 CNEs for nurses, 4 AHHIMA CEs or 4.5 NAB approved CEs upon successful completion.  The cost is $199 for AHCA members and $249 for non-members. AHCA/AHIMA ICD-10 Training for PDPM – Non-Coder: ahcancal.org/icd10pdpmnoncoder
Members will need to login with their AHCA/NCAL usernames and passwords to register for any of these courses.  For assistance obtaining AHCA/NCAL usernames and passwords, please e-mail educate@ahca.org with your name and facility contact information. 
 AHCA members can also access their facility's personal Top-Line PDPM report here. This report is a snapshot of previous coding practices for ICD-Coding on MDS assessments. Use this step-by-step guide to access your reports.

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