AHCA: Weekly PDPM Update

Lisa Volk in Clinical & Quality

Since the Skilled Nursing Facility (SNF) Prospective Payment System officially migrated to the Patient-Driven Payment Model (PDPM) on Tuesday, October 1, there have been some bumps in the road.  

Before we provide a PDPM implementation update, please mark your calendar for tomorrow's "Week 2 of PDPM Implementation Status Update" all-member webinar from 3-4 PM Eastern Standard Time. You may register for the webinar here

CMS PDPM Software Errors Update 

As an update to last week's emails about the MDS software grouper errors, AHCA is in regular contact with Centers for Medicare and Medicaid Services (CMS) at all levels, as well as with our sister associations. CMS continues to work with SNF providers and information technology (IT) vendors to correct the problems, and progress is being made.   

On Monday, October 7, CMS released an updated PDPM grouper DLL software package to MDS IT vendors. The purpose is to address issues that were creating error messages or rejections to MDS assessments submitted to CMS. Since then, the IT vendors have been updating their software and pushing out the updates to providers.

As of early today, AHCA has learned that some providers are successfully submitting some PDPM assessments, while others are still receiving error messages. Providers still receiving error messages should be in close communication with their IT vendor to make sure they have the most current MDS grouper softwareinstalled in their facility and that providers perform the necessary steps to refresh all MDS assessments entered prior to these software updates before submitting the MDS assessments. If you continue to have problems, please take a couple minutes to complete the survey discussed below or submit a description of the problem to pdpm@ahca.org (no personal beneficiary identifiers please). 

CMS Releases Medicare Manual Updates for PDPM 

This week, CMS issued three important manual updates for PDPM implementation. 

  • The Medicare General Information, Eligibility, and Entitlement Manual PDPM update contains minor updates to certification guidance.  
  • The Medicare Benefit Policy Manual PDPM update contains minor updates to the SNF benefit period and benefit days sections in chapter 3, as well as major changes to the SNF PPS guidance in Chapter 8.
  • The Medicare Claims Processing Manual PDPM update provides substantial updates to the chapter 6 SNF PPS claims processing instructions.

AHCA has conducted a preliminary review of these updates that you can view here

HELP US UNDERSTAND HOW IMPLEMENTATION IS GOING AND YOUR NEEDS 

Each week, AHCA will collect feedback on PDPM implementation. Please help provide valuable, real-time information by completing this survey each week. This will help us address your needs through member education, resources, and advocacy with CMS on regional and national issues. 

AHCA MEMBER SUPPORT

AHCA has worked closely with members over the past year to provide resources to ensure you are prepared for success under the new payment model. These efforts will continue into post-implementation. 

PDPM Updates for Convention Attendees in Orlando

While members are at the AHCA/NCAL Convention & Expo next week in Orlando, we will keep you informed of any PDPM updates via the Convention app. 

Upcoming All-Member PDPM Status Update Webinars

Mark your calendars for the upcoming all-member PDPM Status Update webinars. All webinars will take place from 3-4 PM ET.

  • Oct. 11, 24, & 31
  • Nov. 7, 14, & 21
  • Dec. 5 & 19

PDPM Resource Navigators 

AHCA PDPM Resource Navigators are trained to help you find existing AHCA and CMS resources and guidance. They can be reached by email at pdpm@ahca.org or by calling (202)-842-4444 and asking to speak with an AHCA PDPM Resource Navigator. If you have technical questions, PDPM Resource Navigators will record your information and question(s) and submit them to in-house PDPM technical experts. Members will receive a same day response to questions and requests. You will be notified if additional technical research or clarification from CMS is required and a projected response date will be provided.

Available ahcancalED Resources 

AHCA PDPM Resource Navigators can also help you find existing AHCA resources, such as those offered on ahcancalED. While many of the AHCA PDPM resources are available to all members, some are available only to participants of the PDPM Academy. The PDPM Resource Center for all members is available here, while resources for AHCA PDPM Academy registrants are available here.

Recently updated PDPM resources available on ahcancalED include:

Please contact pdpm@ahca.org with any questions or concerns.

NYSHFA/NYSCAL CONTACT:

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