SNF Medicare Part A Training for Therapy Professionals Montero Therapy Services Copyright 1
6 Components ALL COMPONENTS ADDED TOGETHER = DAILY RATE Montero Therapy Services Copyright 2
PDPM Breakdown Summary Day 1-20 = 100% Days 21-100 = Decreases 2% every 7 days Day 1-3 = Rate x 3 Days 4-100 = Rate x 1 Montero Therapy Services Copyright 3
5 Day MDS Data collection and coding of Section GG by PPS Day 3 Decision based on review of multiple data sources Usual Performance Montero Therapy Services Copyright 4
Determine ICD-10 Coding Primary Diagnosis Clinical Category Major Joint Replacement or Spinal Surgery Orthopedic Surgery (Except Major Joint Replacement or Spinal Surgery) Non-Orthopedic Surgery Acute Infections Cardiovascular and Coagulations Pulmonary Non-Surgical Orthopedic/Musculoskeletal Acute Neurologic Cancer Medical Management Clinical Category Major Joint Replacement or Spinal Surgery Other Orthopedic Non-Orthopedic Surgery Medical Management Medical Management Medical Management Other Orthopedic Acute Neurologic Medical Management Medical Management Montero Therapy Services Copyright 5
Nursing Component Extensive: Trach, Vent, Iso Special Care High: COPD/Bed; RT Special Care Low: CP,MS,PD,Tube,Skin Clinical: O2, Hemi, IV Meds, Pneumonia Nursing Function Score Depr essed? Case Mix Group with in each category is determined by GG Function Score, Depression, Restorative Nursing Program.and. In general, more Dependent = Higher CMI PDPM Nursing Classification 0-5 Yes HDE2 0-5 No HDE1 6-14 Yes HBC2 6-14 No HBC1 Montero Therapy Services Copyright 6
Function Score Calculation: Nursing Use the following table to determine the Function Score for: Eating Admission Performance (GG0130A1) Toileting Hygiene Admission Performance (GG0130C1) Average of 2: Sit to Lying Admission Performance (GG0170B1) AND Lying to Sitting on Side of Bed Admission Performance (GG0170C1) Average of 3: Sit to Stand Admission Performance (GG0170D1) AND Chair/Bed-to-Chair Transfer Admission Performance (GG0170E1) AND Toilet Transfer Admission Performance (GG0170F1). TOTAL POSSIBLE: 16 Admission Performance (Column 1) = Function Score = 05, 06 4 04 3 03 2 02 1 01, 07, 09, 88 0 1 = Dependent 6= Independent Montero Therapy Services Copyright 7
Function Score Calculation: PT / OT Use the following table to determine the Function Score for: Eating Admission Performance (GG0130A1) Oral Hygiene Admission Performance (GG0130B1) Toileting Hygiene Admission Performance (GG0130C1) Admission Performance (Column 1) = Function Score = 05, 06 4 04 3 03 2 02 1 01, 07, 09, 88 0 Average of 2: Sit to Lying Admission Performance (GG0170B1) AND Lying to Sitting on Side of Bed Admission Performance (GG0170C1) Average of 3: Sit to Stand Admission Performance (GG0170D1) AND Chair/Bed-to-Chair Transfer Admission Performance (GG0170E1) AND Toilet Transfer Admission Performance (GG0170F1). Determine if the resident can walk using item GG0170H1. If the resident cannot walk (GG0170H1=0 or 1), then the Function Score for Walk 50 Feet with Two Turns (GG0170J1) and Walk 150 Feet (GG0170K1) is 0. Average of 2: If the resident can walk (GG0170H1=2), then determine the Function Score for Walk 50 Feet with Two Turns (GG0170J1) and Walk 150 Feet (GG0170K1) using the following table. TOTAL POSSIBLE: 24 Montero Therapy Services Copyright 8
PT and OT Case Mix Group Assignment Montero Therapy Services Copyright 9
Speech Clinical Category: Neuro or Not Primary Diagnosis Clinical Category Major Joint Replacement or Spinal Surgery Orthopedic Surgery (Except Major Joint Replacement or Spinal Surgery) Non-Orthopedic Surgery Acute Infections Cardiovascular and Coagulations Pulmonary Non-Surgical Orthopedic/Musculoskeletal Acute Neurologic Cancer Medical Management SLP Clinical Category Non-Neurologic Non-Neurologic Non-Neurologic Non-Neurologic Non-Neurologic Non-Neurologic Non-Neurologic Acute Neurologic Non-Neurologic Non-Neurologic Montero Therapy Services Copyright 10
Speech Co- Morbidities: Yes or No MDS Item I4300 I4500 I4900 I5500 I8000 I8000 I8000 I8000 I8000 I8000 O0100E2 O0100F2 Description Aphasia CVA, TIA, or Stroke Hemiplegia or Hemiparesis Traumatic Brain Injury Laryngeal Cancer Apraxia Dysphagia ALS Oral Cancers Speech and Language Deficits Tracheostomy Care While a Resident Ventilator or Respirator While a Resident Montero Therapy Services Copyright 11
ALS G12.21 Amyotrophic lateral sclerosis Apraxia I69.990 Apraxia following unspecified cerebrovascular disease Dysphagia I69.991 Dysphagia following unspecified cerebrovascular disease Speech Co- Morbidities: Yes or No Laryngeal Cancer C32.0 Oral Cancers C00.0 Speech and Language Deficits Speech and Language Deficits Speech and Language Deficits Speech and Language Deficits Speech and Language Deficits Speech and Language Deficits I69.928 Other speech and language deficits following unspecified cerebrovascular disease I69.920 Aphasia following unspecified cerebrovascular disease I69.921 Dysphasia following unspecified cerebrovascular disease I69.922 Dysarthria following unspecified cerebrovascular disease I69.923 Fluency disorder following unspecified cerebrovascular disease I69.928 Other speech and language deficits following unspecified cerebrovascular disease See ICD-10 Mapping for inclusive list of codes Montero Therapy Services Copyright 12
Speech: Cognitively Impaired? If the PDPM cognitive level is cognitively intact, then the resident does not have a cognitive impairment. Otherwise, if the resident is assessed as mildly, moderately, or severely impaired, then the resident classifies as cognitively impaired. Presence of Cognitive Impairment? (Yes/No) Montero Therapy Services Copyright 13
BIMS Calculate the resident s PDPM cognitive level using the following mapping: Table 1: Calculation of PDPM Level from BIMS: PDPM Cognitive Level BIMS Score Cognitively Intact 13-15 Mildly Impaired 8-12 Moderately Impaired 0-7 Severely Impaired - Montero Therapy Services Copyright 14
Swallowing Disorder and/or Mechanically Altered Diet If any are checked, then a Swallowing Disorder is present Is Mechanically altered diet checked? Montero Therapy Services Copyright 15
SLP Case Mix Group Determination Start Here Montero Therapy Services Copyright 16
Non-Therapy Ancillary Example Montero Therapy Services Copyright 17
Details: How Is Payment Derived? Nursing PT OT Speech Non- Therapy Ancillary Non-Case Mix Flat Rate Total Daily Rate CMI Value x Assigned Unadjusted Federal Rate Montero Therapy Services Copyright 18
Sample Rate for Multiplier Montero Therapy Services Copyright 19
Sample Payment Case Examples Comparison of 3 Case Examples Elective Total Knee Replacement Pneumonia Secondary Parkinsonism Montero Therapy Services Copyright 20
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This information for this presentation was current at the time it was published. Source documents and links are provided. Due to the frequent change in Medicare policy, participants should verify policy change at the time of study. This presentation was prepared to provide general information on the subject material. Participants are encouraged to further review the specific statutes, regulations and other materials for a full understanding of how to utilize this information in practice. Montero Therapy Services is available for consulting on specific practice issues or concerns related to this or any other material. Disclaimer Montero Therapy Services Copyright 5 3