PDPM Issues - Do You Really Believe?
Long-term care organizations “sort of believe” that their PDPM processes are fully intact for efficiencies and optimization. What I mean by that is that leaders in long-term care organizations often offer some form of the mantra “we are getting reimbursed for PDPM, so we believe things are okay." Not exactly a strong validation of certainty for a reimbursement process that for many organizations is so vital to their overall revenue and success. Certainly, all organizations would do well to adopt a practice of routine assessment of all processes that impact revenue and compliance. A great place to start may be with a commitment to assessing your PDPM reimbursement and compliance processes with a professional, comprehensive review.
Based on our PDPM Reviews, we have observed recurring issues that are preventing organizations from truly optimizing PDPM reimbursement and compliance. The following presents a sample of recurring issues we identified:
- Portions of the MDS should not be blank when submitted to CMS. The Admission Record (face sheet) should contain the appropriate entries. Not doing so increases the risk for invalid assessments and therefore, missed potential Case Mix Index opportunities.
- Resident assessments identified with missing weights leaving potential opportunities to increase revenue.
- Vaccination coding documentation contains inconsistencies between resident charts. Inaccuracy and increased inattention to consistent coding could have negative effects on quality measures.
- Swallow disorder documentation lacking on resident charts. There is a significant opportunity to increase PDPM scores with charts that have more detailed documentation related to swallow disorder.
- Coding that is not congruent with the documentation requires the MDS nurse to investigate and write a progress note. The most frequent findings are related to ADL coding.
- Pertinent therapy documentation not found coded on MDS with ARD. Examples include:
- Coughing with food and fluids noted in SLP note. This would also re-categorize ST component.
- SOB while lying flat noted by PT. This would place a resident in special care high category re-categorizing nursing component.
- MDS with ARD observed to have incongruent documentation related to resident falls.
- Assessments not recalculated as appropriate negatively impact average in CMI scores.
As you can see believing is seeing. The point? Don’t assume everything is well with your PDPM reimbursement. Prove it to yourself for your organization’s sake.
Consider utilizing Microscope, a trusted outside source to help guide you towards identifying and implementing efficient PDPM processes inclusive of appropriate, beneficial technologies as appropriate to help your organization improve and optimize PDPM reimbursement and compliance.
For more information, reach out to: Michael F. Masse, OTR/L, Senior Director