Nearly a Quarter of Skilled Nursing Facilities Unprepared for Patient Driven Payment Model (PDPM) Audit by Centers for Medicare and Medicaid Services

CHICAGO (Nov. 26, 2019) – A flash poll conducted by Baker Tilly Virchow Krause, LLP (Baker Tilly) indicates nearly 25% of skilled nursing facilities are not prepared for their first Centers for Medicare and Medicaid Services (CMS) Patient Driven Payment Model (PDPM) post-implementation audit to show that they are in compliance with the new Medicare fee-for-service reimbursement system.

“PDPM is one of the most significant regulatory changes to skilled nursing facilities that CMS has implemented in decades,” Jennifer Schwalm, CPA, partner and leader of Baker Tilly’s senior services practice, said. “There are several items that affect facilities beyond Medicare reimbursement, which is why the regulation’s implementation also involves changes to organizational culture and provider collaboration.”

“An essential step of PDPM implementation, and in preparing for an organization’s first CMS audit, is conducting a  PDPM Triple Check procedure,” Sophie Campbell, MSN, RN, CRRN, RAC-CT, CNDLTC, director of Baker Tilly’s clinical advisory practice, said. “By including an effective Triple Check process in post-implementation efforts, healthcare organizations can add an extra verification that their facility’s billing allocation and supporting documentation is accurate prior to any audit by CMS.”

Baker Tilly recently held an educational webinar, The Patient Driven Payment Model (PDPM): Checking in after implementation, to assist healthcare professionals in reviewing the items they need to address now that PDPM is effective.

The presenter discussed:

• The Triple Check process
• Medical record documentation support
• Minimum data set (MDS) assessment coding and data collection
• Interim payment assessment (IPA)
• Capturing the medical diagnoses for non-therapy ancillary (NTA) component
• Variable per diem rate

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