Patient Driven Payment Model (PDPM) Jeopardy
What does PDPM stand for?
Patient Driven Payment Model
What determines a resident’s nursing case-mix group?
Clinical conditions, ADL score, and presence of depression or restorative nursing
Under PDPM, are therapy minutes the main driver of payment?
No — clinical needs are
Share information to ensure consistent coding and documentation
Minimum Data Set
What does “case mix” mean?
The mix of resident needs that determine reimbursement levels
What year did PDPM replace RUG-IV?
October 1, 2019
What tool is used to calculate the nursing score?
MDS (Minimum Data Set)
Which PDPM components are affected by therapy?
PT, OT, and SLP
What is the ARD in MDS coding?
Assessment Reference Date
How often must Interim Payment Assessments (IPAs) be completed
Only when there’s a significant change affecting payment
PDPM bases payment on what three things?
Resident condition, needs, and characteristics (not therapy minutes)
Name two conditions that can increase the nursing case-mix.
Extensive services, infections, or wound care
What MDS section captures swallowing and speech issues for SLP reimbursement?
Section K and I
Why must MDS coding match nursing notes?
Discrepancies can cause payment loss or survey citations
Why are documentation audits important for PDPM?
They prevent missed reimbursement and survey deficiencies
How many components make up PDPM?
Five (PT, OT, SLP, Nursing, and Non-Therapy Ancillary/NTA)
What does “Extensive Services” include under PDPM?
Ventilator use, IV meds, or suctioning
Why is restorative nursing important under PDPM?
It can impact the nursing component and maintain function
Who is responsible for ensuring accurate MDS coding?
The MDS Coordinator, with input from all departments
What is one common PDPM survey citation?
Inaccurate or incomplete MDS coding
What is the main goal of PDPM?
To focus payment on resident care needs rather than therapy minutes
Why must nurses document treatments like suctioning or trach care accurately?
They directly affect the nursing reimbursement level
How should therapy and nursing coordinate under PDPM?
Share information to ensure consistent coding and documentation
What happens if conditions are not documented within the look-back period?
They won’t count toward PDPM reimbursement
What phrase sums up PDPM success?
“Document what you see, code what you document.”