What Is PDPM?

The Centers for Medicare and Medicaid Services (CMS) will soon be replacing the Resource Utilization Group (RUG) Version IV payment model with the new Patient Driven Payment Model (PDPM).

The current RUG-IV system focused on payments based on how much therapy services were received. However, PDPM places patients into case-mix groups based on certain clinical characteristics.

This article from @SIAResearch does a fantastic job detailing out what this new model will look like and what Skilled Nursing Facilities (SNF’s) should expect.

CMS Requested To Simplify Three-Day Stay Rule

Currently, Medicare beneficiaries must have a three-day hospital stay to receive subsequent fully covered skilled nursing services. Hospitals admitting on an observation basis rather than inpatient has lead to very costly Medicare denials.

The American Health Care Association (AHCA) CEO has asked Centers for Medicare & Medicaid Services (CMS) to eliminate uncertainty on the Medicare three-day stay rule stating, “three days is three days”.

For more on this, see this article from @skilled_nursing.