EMR Updates for CMS New Patient Driven Payment Module (PDPM)

Announcing Major Functionality Enhancements to ADL Optimum Series EMR

ADL is enhancing its software in preparation for the Patient Driven Payment Module (PDPM). Our goal is to assist facility staff in classifying patients into the appropriate payment groups based on data driven clinical characteristics. PDPM is value based and rewards patient outcomes.

Patient Driven Payment Method (PDPM) Information

Effective October 01, 2019, each patient will be assigned a case mix classification that drives reimbursement. The primary diagnosis (Section I10020B on the MDS) will determine which of the 10 clinical categories the patient will be assigned. Once the clinical category and any comorbidities are taken into account, the patient will be categorized further based on 5 criteria: Nursing, Occupational Therapy, Physical Therapy, Speech Therapy, Non Therapy Ancillary (NTA). These 5 items are the basis of PDPM.

Prepare for PDPM Now:

Things to Review with Staff

1 Ensure staff is proficient in ICD-10 coding and that all codes are accounted for appropriately.
ADL software will display appropriate Diagnosis codes throughout the EMR
2 Make sure relevant staff is familiar with Section GG of the MDS
3 Calculates a residents LACE score to predict the rate of readmission or death within 30 days of discharge
4 Make sure comorbidities are captured upon admission
5 Make sure HIV/AIDS codes are accurate for the increased rate adjustment
6 Reduce burden of multiple assessments – Scheduled MDS assessments will decrease from a minimum of 5 in 100 day stay
to 1 completed at the beginning of care
7 MDS I8000 Active Diagnosis – Make sure to capture accurate and detailed medical diagnosis
8 PDPM scores will be accessible within various places in the EMR as reference

Compliance Requirements

1 MDS new category I10020B for Primary Diagnosis will determine clinical categories
2 Providers will be required to complete an IPA with an ARD by 10/07/2019 for all Medicare Part A residents
(10/01/19 is Day 1 so schedule accordingly)
3 Each should discipline justify and support the level of service provided.
ADL will alert user when assessments are due and ensure that proper ICD-10 codes are used based on conditions and orders
4 Re-certification tracker of all active ICD-10 codes will keep you in compliance

For more information, reference the CMS official website here.

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