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PDPM is an essential part of long term care, as it helps providers meet their residents’ needs, while also maintaining compliance with federal rules that govern how certain types of payment are calculated. 

While PDPM holds great importance in the long term care industry, we understand that it can be difficult for many facilities to navigate. From the confusing calculations to changing laws that are constantly altering your PDPM process, staying on top of PDPM can undoubtedly present a challenge for even the best facilities.

To make things easier for you, Experience Care has compiled a list of useful resources that can be used to help maintain or improve your compliance. We have included PDPM calculators, FAQs, recent related legislation, and more to help ensure that your facility stays on top of your reimbursements and compliance. For more information on PDPM read our blog on how to achieve a high PDPM functional score.

1. FY 2021 ICD-10 Mapping Codes (Effective 1/1/2021) – Zip File

This is a spreadsheet of all the updated codes of ICD-10-CM for the PDPM. It is very important for staff to understand as it affects reimbursements and patient care. This was last updated in 2021.

2. Find and Compare Nursing Homes Near You (Updates Quarterly) – Website

A tool from Medicare.gov that lets you compare nursing homes, hospitals, and other providers. Seniors use it to determine their choices, so SNFs should take maximum effort to update this and rank better.

3. A Proposed Rule by the Centers for Medicare & Medicaid Services (Updated 4/15/21) – PDF

This document contains the Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities and updates to the quality reporting program and value based purchasing program for FY 2022.

4. PDPM Calculation Worksheet for SNFs (Updated 01/01/21) – PDF

This worksheet illustrates how a resident is classified for payment purposes and how per diem payment is calculated under PDPM.

5. PDPM Calculator (Effective for Fiscal Year 2022) – Zip File of Excel Workbooks

This is an excel worksheet that helps you calculate PDPM for new parity adjustment.

6. Calculating PDPM Rates (9/22/2020) – Blog Post

Experience care blog on how to calculate PDPM, after reading this article you’ll have at least the basics down and you’ll know how much you should be getting paid!

7. PDPM FAQs (Updated 8/30/19) – Zip File of PDFs

From the CMS website, over 100 frequently asked questions and answers related to PDPM. If an LTC leader or employee has a specific question, they could refer to this. It can also act as a guide to understand what PDPM actually is because it also includes basic questions.

8. Measures Management System (Updated 3/31/21) – Website

This CMS webpage explains what a Measures Management System (MMS) is and also lists its primary goals.The page talks in detail about how MMS accomplishes these goals.

9. SNF/LTC Open Door Forum (Updated 8/2/21) – Website

The SNF/LTC Open Door Forum (ODF) addresses the concerns and issues of both the Medicare SNF, the Medicaid NF, and the nursing home industry generally. The types of issues that come up during this forum are often related to the Minimum Data Set, SNF Consolidated Billing, the roles and responsibilities of different SNF, NF or LTC professional staff under CMS regulations, etc.

10. Skilled Nursing Facility Market Basket (Updated 7/29/21) – CMS Website

This includes Quarterly Index Levels in the CMS Prospective Payment System SNF Input Price Index using IHS Global Insight Inc. (IGI) Forecast Assumptions, by Expense Category.

11. Evaluation of PDPM ResDAC Data (Updated 6/3/21) – Website

This is the link to national data trends related to the Patient Driven Payment Model. It talks about OT, PT, SLP and Nursing CMI trends.

12. Basics of Payment Standardization (Created June 2021) – PDF

This document from the CMS explains in detail the process of standardized calculation and different standardization approaches.

13. FY 2022 SNF Prospective Payment System Proposed Rule (Created 4/8/21) – PDF

This document contains FY 2022 Proposed Updates to the SNF Payment Rates, Methodology for Recalibrating the PDPM Parity Adjustment, Proposed changes in PDPM ICD-10 Code Mappings, SNF Quality Reporting Program (SNF QRP) update, etc.

14. Medicare Modernization of Payment Software (Created April 2021) – PDF

This fact sheet is for providers submitting institutional claims to Medicare Administrative Contractors (MACs). It is primarily for the software vendors and others who support SNFs with claims processing systems. It’s important that the vendor is aware of this modernization.

15. Web-based Training on using ICD-10-CM Diagnosis Codes – Online Course

This is a link to a CMS web based training course for LTC employees. It teaches diagnosis coding using the ICD-10-CM. It offers information on the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), as well as the ICD-10-CM classification system and coding examples.