Important PDPM Update

Jackie Pappalardi and Lisa Volk in Clinical & Quality

It has come to our attention through ACHA that on Friday (9/27/19), the Centers for Medicare and Medicaid Services (CMS) issued updates to the PDPM DLL Package (V 1.0002 FINAL). This is the software code that SNF software vendors need to use as part of the PDPM classification Grouper programs within the MDS software packages to generate the PDPM billing case mix codes (physical therapy, occupational therapy, speech-language pathology, non-therapy ancillary, and nursing). The CMS PDPM grouper logic has an error involving calculating the case mix groups. CMS is working to repair the issue. The date for the corrected software code fix is still to be determined.

Per the recommendation of NYSHFA Business Affiliates, Celtic Consulting, we recommend setting the ARD for transitional IPA as planned but do not complete any of the assessments until CMS has provided a program patch for the software grouper. We also advise using your Celtic Case Mix Group cheat sheets to ensure accuracy in calculations.

AHCA is in communication with CMS to seek further guidance for providers.

We will share updates as they become available. In the meantime, please do not hesitate to contact pdpm@ahca.org with any questions.

NYSHFA/NYSCAL CONACTS:

Jackie Pappalardi, RN, BSN
Director, Educational Development & Grant Mgmt.
518-462-4800 x16

Lisa Volk, RN, B.P.S., LNHA
Director, Clinical & Quality Services
518-462-4800 x15