Medicare's PPS PDPM for the Skilled Nursing Provider
- Thursday
- October
- 17
- 2024
Reta Underwood Overview:
The Patient Driven Payment Model (PDPM) is Medicare Part A reimbursement of skilled services provided in a skilled nursing facility and is part of the Prospective Payment System (PPS) with federal oversight by the Centers for Medicare/Medicaid Services (CMS). It is updated annually with a direct relationship to the RAI Process and it’s MDS v3.0 Assessment.
Why you should Attend:
Methodology of the PDPM calculation and the PPS MDS v3.0 assessments integrity requirements to be successful in reimbursement. This will include the therapy component of PT/OT, SLP and the nursing department skilled status items; the NTA scoring of points and the deciphering of the HIPPS code upon calculations completion.
Areas Covered in the Session:
- Are you a member of the IDT? If so, do you know your accountability and responsibilities towards the financial income for the services and/or care you provide?
- What does the HIPPS code tell you about the patient?
- Are you aware of what MDS PPS assessment do not get submitted?
- Do you know the one item that will fail an audit and cause potential pay-back of a claim?
- How important is Section GG to nursing reimbursement?
Who Will Benefit:
- Corporate Professionals
- Administrative Staff
- Directors and Nurses
- Business Office Staff
Speaker Profile
Reta has over 35+ years of professional work experience in the long-term care industry. Reta’s experience has included management and director positions with nursing facilities and healthcare companies. She has also provided corporate-wide MDS support services, conducted numerous mock surveys, regulatory compliance correction, education programs, clinical documentation, quality assurance programming and, implemented and supports PDPM in facilities nationwide. Most recently you may have heard her speak on the new 5-Star Rating during McKnight News Spring Expo last month.
Reta has supplied IRO services and input to CMS on a variety of projects and discussions pertaining to post-acute care. She holds national certifications through the American Association of Nurse Assessment Coordination (AANAC) as a Resident Assessment Coordinator (RAC-CT); Quality Professional and Nurse Manager and is a ICD-10-CM coder.
Reta has had numerous articles published in the long-term care industry trade publications and has been used as an expert resource professional for media interviews including McKnight News; HCPro MDS and PPS Advisor and Provider AHCA magazine. She has also copyrighted several clinical documentation forms and tools, such as for Medicare Post Billing Review (triple check process), nutritional assessment, skilled clinical and MDS documentation, and restorative nursing programs.