[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-573313-105":53,"doc-detail-573313-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","pdpm-patient-driven-payment-model-monthly-webinar","PDPM - Patient Driven Payment Model - Monthly webinar","","Monthly webinar notes on the Patient Driven Payment Model (PDPM) used for Medicare Part A payment. The material explains how MDS assessments classify patients into payment categories and how PDPM shifts from an intensity-driven approach to a characteristic need–driven approach. It covers the five case-mix adjusted components (PT/OT, SLP, Nursing, NTA, and assessment indicator), variable per diem adjustment factors by day, component-specific weighting and reductions, and major adjustments such as Medicaid nursing-only CMI, the HIV/AIDS add-on, and case-mix criteria categories.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":11,"@type":70,"position":76},"https://docshare.wps.com/template/presentations/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/pdpm-patient-driven-payment-model-monthly-webinar/573313/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/pdpm-patient-driven-payment-model-monthly-webinar/573313.png","ImageObject",442,249,{"name":88,"@type":89},"Damian","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-18","2026-10-14",true,{"@type":98,"interactionType":99,"userInteractionCount":9},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What is PDPM and which payment setting does it apply to?","Question",{"text":108,"@type":109},"PDPM stands for Patient Driven Payment Model. It is in place for traditional Medicare Part A, with specific 5-day rules for Managed Care/VA/non-Medicare A not transmitted to CMS.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What components does PDPM use for case-mix adjusted payment?",{"text":113,"@type":109},"PDPM consists of five case-mix adjusted components: PT/OT, SLP, Nursing, NTA (Non-Therapy Ancillary), and an assessment indicator.",{"name":115,"@type":106,"acceptedAnswer":116},"How does PDPM handle variable per diem adjustments over a patient stay?",{"text":117,"@type":109},"PDPM applies an adjustment factor for certain components instead of relying on constant per diem rates. For PT/OT and NTA, the case-mix adjusted per diem rate is multiplied by the variable per diem adjustment factor using a day-by-day schedule, including higher NTA weighting in the first three days and PT/OT reimbursement reductions after day 20.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},573313,1792337901,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":8,"category_name":11,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":9,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":135,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":141},137451208677,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","CRYSTAL PLANK, BSN, RN, RAC-CTA, DNS-CT, IP Clinical Consultant/Quality Educator Sinclair School of Nursing QIPMO  \n[plankcl@missouri.edu](plankcl@missouri.edu)[ ](plankcl@missouri.edu)[Cell: 573-819-0173](Cell: 573-819-0173)  \nIMPORTANT – CEU INFORMATION  \nSAMPLE EMAIL FROM GOTOWEB INAR  \nPDPM: Patient Driven Payment Model  \nMDS assessments are used to classify patients into payment categories  \nMoves away from intensity driven model of payment to characteristic need driven model of payment  \nPDPM is  ONLY in place for traditional Medicare Part A  \nPDPM (5 day) for Managed Care/VA/ non-Medicare A (do not get transmitted to CMS)  \nMedicaid uses PDPM Nursing Component only for CMI calculation  \nDaily Rate Covers  \nRoutine costs: regular room, dietary, nursing services, minor medical supplies, social services, psychiatric social services and the use of certain facilities and equipment for which a separate charge is not made.  \nAncillary costs: costs for specialized services, such as therapy, drugs, and laboratory series, that are directly identifiable for individual residents.  \nCapital related costs: costs of land, building, equipment, and the interest incurred in financing the acquisition of such items.  \nPDPM Adjustments  \nResident characteristics: Diagnoses, functional assessment, comorbidities, extensive services and conditions determine which case mix groups the residents will achieve  \nFederal base PT, OT, SLP, Nursing, Non therapy ancillary (NTA) and Non case mix rate  \nFacility urban verses rural status  \nArea labor costs  \nHIV/AIDS Add On: Additional 18% of the nursing component and receives eight points under the NTA component. Documentation is the Medicare claim: B20  \nCase-Mix Criteria Overview  \nPDPM consists of five case-mix adjusted components, all based on data-driven, stakeholder-vetted patient characteristics:  \nPDPM SNAPSHOT  \nCharacter 1: PT/OT  \nCharacter 2: SLP  \nCharacter 3: Nursing  \nCharacter 4: NTA  \nCharacter 5: Assessment Indicator  \nVariable Per Diem Adjustment  \nThe Social Se~~curity Act requires the SNF PPS to pay on a per~~-~~diem basis ~~   \nConstant per diem rates do not accurately track changes in resource utilization throughout the stay and may allocate too few resources for providers at beginning of stay  \nTo account more accurately for the variability in patient costs over the course of a stay, under PDPM, an adjustment factor is applied (for certain components) .  \nFor the PT, OT, and NTA components, the case-mix adjusted per diem rate is multiplied against the variable per diem adjustment factor, following a schedule of adjustments for each day of the patient’s stay.  \nNTA variable will be weighted 3x higher in the first 3 days of the stay.  \nPT/OT, after day 20, this component’s reimbursement is reduced by 2% every 7 days.  \nPatient Classifications  \nUnder PDPM, each patient is classified into a group for each of the five case-mix adjusted components: PT, OT, SLP, Nursing and NTA  \nEach component utilizes different criteria as the basis for patient classification:  \nPT: Clinical Category, Functional Score  \nOT: Clinical Category, Functional Score  \nSLP: Presence of Acute Neurologic Condition, SLP-related Comorbidity or Cognitive Impairment, Mechanically-altered Diet, Swallowing Disorder  \nNursing: Multiple Categories  \nNTA (Non-Therapy Ancillary): NTA Comorbidity Score","cbCaigd36r5T0pBF","https://ap.wps.com/l/cbCaigd36r5T0pBF","pdf",3067309,98,"English","# CEU INFORMATION\n## PDPM: Patient Driven Payment Model\n## Daily Rate Covers\n## PDPM Adjustments\n## Case-Mix Criteria Overview\n## PDPM Snapshot: Five Case-Mix Components\n## Variable Per Diem Adjustment\n## Patient Classifications","[{\"question\":\"What is PDPM and which payment setting does it apply to?\",\"answer\":\"PDPM stands for Patient Driven Payment Model. It is in place for traditional Medicare Part A, with specific 5-day rules for Managed Care/VA/non-Medicare A not transmitted to CMS.\"},{\"question\":\"What components does PDPM use for case-mix adjusted payment?\",\"answer\":\"PDPM consists of five case-mix adjusted components: PT/OT, SLP, Nursing, NTA (Non-Therapy Ancillary), and an assessment indicator.\"},{\"question\":\"How does PDPM handle variable per diem adjustments over a patient stay?\",\"answer\":\"PDPM applies an adjustment factor for certain components instead of relying on constant per diem rates. For PT/OT and NTA, the case-mix adjusted per diem rate is multiplied by the variable per diem adjustment factor using a day-by-day schedule, including higher NTA weighting in the first three days and PT/OT reimbursement reductions after day 20.\"}]","PDPM - Patient Driven Payment Model - Monthly webinar | PDF",1791936908,34]