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

1Ensure 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
2Make sure relevant staff is familiar with Section GG of the MDS
3Calculates a residents LACE score to predict the rate of readmission or death within 30 days of discharge
4Make sure comorbidities are captured upon admission
5Make sure HIV/AIDS codes are accurate for the increased rate adjustment
6Reduce 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
7MDS I8000 Active Diagnosis – Make sure to capture accurate and detailed medical diagnosis
8PDPM scores will be accessible within various places in the EMR as reference

Compliance Requirements

1MDS new category I10020B for Primary Diagnosis will determine clinical categories
2Providers 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)
3Each 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
4Re-certification tracker of all active ICD-10 codes will keep you in compliance

For more information, reference the CMS official website here.