Implementation of the Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM)

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare®

Friday, February 8, 2019, CMS posted Transmittal 2252/Change Request 11152 along with MLN Matters Number: MM11152.  I recommend reviewing the 3-page MLN Matters document first as it describes clearly what CR11152 is addressing.

In short, “CR 11152 effectuates changes to the SNF Prospective Payment System (PPS) that are required for the PDPM. These changes were finalized in the FY 2019 SNF PPS Final Rule (83 FR 39162). SNFs billing on Type of Bill (TOB) 21X and hospital swing bed providers billing on TOB 18X, (subject to SNF PPS) will be subject to these requirements.”

Overall PDPM changes are briefly but clearly provided:

  • HIPPS code structure changes
  • PPS assessment schedule changes
  • Per Diem adjustment
  • Interrupted Stay policy
  • AIDS/HIV patients
  • Transition to PDPM

Share these documents with your management and billing team. PDPM is being implemented as of October 1, 2019.