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Presenter: Leah Klusch, RN, BSN, FACHCA

Date: January 17, 2019

Time: 12:30 – 1:30 PM


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  • Meeting ID: 614 993 291


During this fast paced program, Leah Klusch, RN, BSN, FACHCA, Founder & Director of the Alliance Training Center, will discuss the key components that skilled nursing facilities and their staff members must understand to be successful as we move from P.P.S to the P.D.P.M. payment process in October, 2019.

Operational and clinical professionals need to begin working now to focus their teams on the key issues that will impact the payment process. This is a total change and needs to have a new and very interdisciplinary approach with significant communication between Nursing and Therapy as plans of care are formulated and monitored during the stay. MDS data is a vital part of this process and accuracy of coding needs to be addressed in many areas that have not contributed to payment in the past.

Teams should realize that this change in the payment process is a total change and must be viewed with significant operational and clinical focus. The new payment process has a complex structure that includes large amounts of MDS data and calculations of functional performance that are much more detailed than the PPS process. Combined with the new focus on person centered care and specific outcome documentation in the new survey process this is a significant task.

Facilities must know their data formulation, reporting and review process. This involves all departments. Training and competency documentation must be established now and documentation of competency must be specific. Resident records must substantiate the MDS data set with reproducible information specific to the data collection process. Therapy data and outcome documentation must be consistent with the entire resident record.

The entire interdisciplinary team has responsibility for data collection and formulation into the MDS with many new or additional coding guidelines and instructions in the October 2018 RAI Manual update. Errors in coding or a lack of training on the new process will produce payment loss or negative regulatory outcomes.

The facility must monitor and be aware of the therapy delivery and documentation process including policies, protocols and compliance with Medicare coverage guidelines in the Medicare Benefit Policy Manual. The resident specific plan, interventions and outcomes must be consistent with other resident specific documentation with a focus on proper diagnostic coding primarily at the time of admission.

Once the data is formulated then the facility must know the specifics of their data to manage the process. This requires an operational focus on outcomes, patterns of care delivery, length of stay, diagnostic codes and services delivered. The flow of data from the MDS and claims into 5 Star, Nursing Home Compare and Quality Measures must be monitored constantly for accuracy and quality reporting.

Each facility needs to assess the training, and competency of the staff managing the MDS process as well as the knowledge of the significant updated coding and documentation guidelines in the update October ,2018. There will be additional items in 2019 and more coding guidance before the October 2019 implementation date.

Can’t attend the webinar? Still want to discuss PDPM?

Our team of experts is ready to answer your PDPM questions and make sure your team is on the path to success as you prepare for the big changes on the horizon. Call us at 877-TMI-8171 or email us today.