PDPM Training Summary

Summary

This meeting was the first of three PDPM (Patient-Driven Payment Model) training modules for Paramount Healthcare, led by Candice Gutierrez (Integra Rehab CEO) and Glenna Gilliam (Paramount Healthcare Reimbursement Nurse).
The session provided an overview of the key structural and procedural changes under PDPM, emphasizing the transition from minute-based to outcome- and diagnosis-based Medicare reimbursement in skilled nursing facilities.
Upcoming related trainings (PDPM Bootcamp and PDPM Sniper School) were previewed, and collaboration across nursing, therapy, and administration was emphasized as critical.
Structural changes, assessment timing, documentation, interdisciplinary collaboration, and open lines of communication for questions and further training needs were all discussed.

Within 48 hours of patient admission – Nursing Coordinators: Ensure accurate ICD-10 codes and diagnoses are entered.
By PDPM Bootcamp – Candice/Glenna: Finalize and distribute smart sheets for ICD-10 coding and Section GG scoring.
Ongoing – Paramount EMR Project Team: Coordinate with EMR provider to support diagnosis selection, category identification, and documentation requirements aligned with PDPM.
Before next training – All Departments: Review clinical documentation and MDS assessment processes to ensure timely and accurate submission.
Before next training – Paramount Training Team: Include medical directors and all physicians in PDPM education outreach.
Before October 1, 2019 – Nursing & Therapy Leads: Prepare for in-depth in-person and hands-on PDPM training (Bootcamp and Sniper School).

PDPM replaces the RUG-IV model by basing reimbursement on patient clinical characteristics and functional outcomes, not therapy minutes.
Group and concurrent therapy are capped at 25% per discipline for each patient.
New point system includes nursing, PT, OT, ST, non-therapy ancillaries, and a non-case mix component (flat rate).
Nursing categories reduced from 44 to 25; PT/OT have 16 clinical categories, ST has 12; about 50 non-therapy ancillaries affect scoring.
Upcoming training will cover detailed scoring and category assignments.

Accurate ICD-10 coding and timely entry (within 48 hours) are mandatory for optimal scoring and reimbursement.
Section GG scores (functional status) require close nursing/therapy collaboration, tracked for three consecutive days post-admission.
Two required MDS assessments under PDPM: 5-day and discharge; the Interim Payment Assessment (IPA) is optional for significant patient changes.
Late 5-day assessments result in default (non-payment) codes; timeliness is critical.
Restorative nursing, if provided, can now contribute points and reimbursement.

Interdepartmental teamwork is emphasized for assessment, documentation, and patient care planning.
Medical directors, physicians, social work, therapy, and nursing all have roles in supporting PDPM documentation and outcomes.
Pre-admission records, tracking chronic and acute conditions, and community partnerships (e.g., home health) are important.
Education and collaboration with hospitals and referral partners are encouraged for smooth transitions of care.

Medicare's three-midnight stay rule and requirement for skilled level of care remain unchanged.
Facilities must still demonstrate medical necessity for skilled stays, regardless of non-therapy ancillary presence.

Move to patient-driven, outcome-based reimbursement model under PDPM — Shifts focus from therapy minutes to clinical needs and patient outcomes for more appropriate facility compensation.

Which diagnoses and conditions will be included in the final version of smart sheets for ICD-10 coding and Section GG?
How will EMR enhancements be rolled out to all affected staff before PDPM implementation?
Requests for clarification or additional topics for the PDPM Bootcamp should be sent to the provided Integra Rehab contact page.
Ongoing questions will be addressed in future sessions or escalated to CMS as needed.