Supporting Your Clinical Team For PDPM

Supporting Your Clinical Team For PDPM

Declining revenues, census declines, staffing shortages, COVID-19 response reforms, a planned PDPM re-calibration initiative, resumption of surveys and audits…you know many of the specific issues affecting your facility. Yet, there are other issues at hand that may not be on the radar, but could have a significant impact on compliance and reimbursement.

At the onset of the change from RUGS to PDPM many facilities have instituted what is now likely a “default” process for PDPM that has largely gone unchecked for efficiency that could put your reimbursement potential at critical risk.
Many facilities have appointed the MDS Coordinator as the “gatekeeper”, responsible for all things PDPM and reimbursement in the facility. In addition, many facilities have not implemented a clinical team collaboration process leaving the MDS Coordinator in a silo for PDPM, creating increased workload stress and opening the door for vacated positions, PDPM inaccuracies, poor supporting documentation and ultimately sub- optimal Medicare Part A reimbursement.

Here is our 2 solution approach to ensuring MDS and the rest of the clinical team (including providers) are supported for PDPM compliance, coding accuracy, optimized reimbursement, clinical team efficiency and satisfaction:

1. OPTICS Technologyfor front end, PDPM real time information gathering, coding accuracy and optimized reimbursement:

  • Promotes a collaborative (including providers) best practice approach to PDPM accuracy
  • Provides front end, real time information and reimbursement viewing
  • Provides a built-in PDPM Coach assist to ensure data gathering compliance, case mix scoring accuracy and optimized reimbursement
  • Saves your team valuable time that could be used for more patient effacing activities and relieves added workload stress by halting back end information gathering and MDS re-work.

2.MDS Review and Clinical Documentation Review:

  • Use the review get a true picture of your PDPM health and as needed implement our  proven solutions to safeguard the reimbursement you have worked so hard to obtain

For information on Continuing Care & Long Term Care and how we can help your organization, please reach out to our Senior Director:

Michael F. Masse, OTR/L

mmasse(at) / 607.316.6576

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