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The model reduces administrative burden, targets currently underserved beneficiaries without increasing total Medicare payments, and uses five case-mix adjusted components. It also explains the Variable Per Diem adjustment and contrasts PDPM with RUG-IV’s volume-driven grouping.",{"@graph":63,"@context":122},[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/snf-pps-pdpm-patient-driven-payment-model-j15-part-a-provider-outreach-and-education/573314/",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/snf-pps-pdpm-patient-driven-payment-model-j15-part-a-provider-outreach-and-education/573314.png","ImageObject",442,249,{"name":88,"@type":89},"Marglet","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",[104,110,114,118],{"name":105,"@type":106,"acceptedAnswer":107},"What is PDPM and when does it take effect for SNF PPS payments?","Question",{"text":108,"@type":109},"PDPM (Patient Driven Payment Model) is the SNF PPS payment approach effective October 1, 2019.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"How does PDPM improve payments compared with a volume-driven model?",{"text":113,"@type":109},"PDPM improves accuracy and appropriateness by focusing on patient characteristics and predicted needs rather than the volume of services provided.",{"name":115,"@type":106,"acceptedAnswer":116},"What are the five PDPM case-mix adjusted components?",{"text":117,"@type":109},"The five components are Physical Therapy (PT), Occupational Therapy (OT), Speech Language Pathology (SLP), Nursing, and NTA (Non-Therapy Ancillary).",{"name":119,"@type":106,"acceptedAnswer":120},"What is the Variable Per Diem (VPD) adjustment?",{"text":121,"@type":109},"VPD adjustment modifies the per diem rate over the course of the patient’s stay.","https://schema.org",{"og:url":78,"og:type":124,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":126,"canonical":78},"index,follow",{"doc_id":128,"site_id":56},573314,1792359709,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":88,"user_avatar":133,"doc_module":9,"category_id":8,"category_name":11,"doc_title":59,"doc_description":61,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":9,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":139,"language":140,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":61,"update_tm":144,"read_time":145},2336477982702,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","SNF PPS PDPM:  \nPatient Driven Payment Model  \nJ15 Part A Provider Outreach and Education  \n© 2023 Copyright, CGS Administrators, LLC  \nAcronyms  \n􀂃 AIDS: Acquired Immune Deficiency Syndrome  \n􀂃 ARD: Assessment Reference Date  \n􀂃 BIMS: Brief Interview for Mental Status  \n􀂃 CMI: Case-mix Index  \n􀂃 CMS: Centers for Medicare and Medicaid Services  \n􀂃 COT: Change of Therapy  \n􀂃 CFS: Cognitive Function Scale  \n􀂃 CPS: Cognitive Performance Scale  \n􀂃 HIPPS: Health Insurance Prospective Payment System  \n􀂃 HIV: Human Immunodeficiency Virus  \n􀂃 ICD-10-CM: International Classification of Diseases, Tenth Revision, Clinical Modification  \n􀂃 IPA: Interim Payment Assessment  \n􀂃 MDS 3.0: Minimum Data Set, Version 3  \n􀂃 NF: Nursing Facility  \n􀂃 NTA: Non-Therapy Ancillary  \n􀂃 OBRA: Omnibus Budget Reconciliation Act of 1987  \n􀂃 OMRA: Other Medicare-Required Assessment  \n􀂃 OSA: Optional State Assessment  \n􀂃 OT: Occupational Therapy  \n􀂃 PDPM: Patient Driven Payment Model  \n􀂃 PPS: Prospective Payment System  \n􀂃 PT: Physical Therapy  \n􀂃 RUG-IV: Resource Utilization Group, Version IV  \n􀂃 SLP: Speech Language Pathology  \n􀂃 SNF: Skilled Nursing Facility  \n􀂃 UPL: Upper Payment Limit  \n􀂃 VPD: Variable Per Die  \n 2  March 2023 © 2023 Copyright, CGS Administrators, LLC  \nCGS ADMINISTRATORS , LLC  \nPDPM Overview  \nJ15 Part A Provider Outreach and Education  \n 3  March 2023 © 2023 Copyright, CGS Administrators, LLC  \nProgram Overview  \nThe Patient Driven Payment Model (PDPM), effective October 1, 2019, will improve payments made under the SNF PPS in the following ways:  \n􀂃 Improves payment accuracy and appropriateness by focusing on the patient, rather than the volume of services provided  \n􀂃 Significantly reduces administrative burden on providers  \n􀂃 Improves SNF payments to currently underserved beneficiaries without increasing total Medicare payments  \n 4  March 2023 © 2023 Copyright, CGS Administrators, LLC  \nPDPM Components  \nPDPM consists of five case-mix adjusted components, all based on datadriven, stakeholder-vetted patient characteristics:  \n􀂃 Physical Therapy  \n􀂃 Occupational Therapy  \n􀂃 Speech Language Pathology  \n􀂃 Nursing  \n􀂃 NTA  \nPDPM also includes a “Variable Per Diem (VPD) adjustment” that adjusts the per diem rate over the course of the stay  \n 5  March 2023 © 2023 Copyright, CGS Administrators, LLC  \nRUG –IV vs PDPM  \nRUV-IV reduces everything about a patient to a single, typically volume-driven, case mix group  \nRUG-IV Group  \nPDPM focuses on the unique, individualized needs, characteristics, and goals of each patient.  \n7  March 2023 © 2023 Copyright, CGS Administrators, LLC  \nOutcome of PDPM  \nBy addressing each individual patient’s unique needs separately, PDPM improves payment accuracy and helps establish a more patient specific care model.  \nPatient A  \nNTA Needs  \nSLP Needs  \nNursing Needs  \nOT Needs  \nPT Needs  \nPatient B  \nNTA Needs  \nSLP Needs  \nNursing Needs  \nOT Needs  \nPT Needs  \n 8  March 2023 © 2023 Copyright, CGS Administrators, LLC  \nPDPM Patient Classification  \n􀂃 Under PDPM each patient is classified into a group for each of the five case-mix adjusted components: PT, OT. SLP, Nursing, and NTA  \n􀂃 Each component utilizes different criterial as the basis for classification:  \n• PT: Clinical Category, Functional Score  \n• OT: Clinical Category, Functional Score  \n• SLP: Presence of Acute Neurologic Condition, SLP Related Comorbidity or Cognitive Impairment, Mechanically altered Diet, Swallowing Disorder  \n• Nursing: Same characteristics as under RUG-IV  \n• NTA: NTA Comorbidity Score  \n 9  March 2023 © 2023 Copyright, CGS Administrators, LLC  \nPT & OT Components: RUG-IV & PDPM  \n􀂃 Under RUG-IV, the number of PT, OT, and SLP therapy treatment minutes are combined for a total number of treatment minutes that is used to classify a given patient into a given therapy RUG  \n􀂃 Under PDPM, patient characteristics will be used to predict the therapy costs associated with a given patient, rather than rely on service use  \n􀂃 For the ","cbCaiiCvQ77c3KWK","https://ap.wps.com/l/cbCaiiCvQ77c3KWK","pdf",404749,62,"English","# PDPM Overview\n## Program Overview\n## PDPM Components\n## RUG-IV vs PDPM\n## Outcome of PDPM\n## PDPM Patient Classification\n## PT & OT Components: RUG-IV & PDPM","[{\"question\":\"What is PDPM and when does it take effect for SNF PPS payments?\",\"answer\":\"PDPM (Patient Driven Payment Model) is the SNF PPS payment approach effective October 1, 2019.\"},{\"question\":\"How does PDPM improve payments compared with a volume-driven model?\",\"answer\":\"PDPM improves accuracy and appropriateness by focusing on patient characteristics and predicted needs rather than the volume of services provided.\"},{\"question\":\"What are the five PDPM case-mix adjusted components?\",\"answer\":\"The five components are Physical Therapy (PT), Occupational Therapy (OT), Speech Language Pathology (SLP), Nursing, and NTA (Non-Therapy Ancillary).\"},{\"question\":\"What is the Variable Per Diem (VPD) adjustment?\",\"answer\":\"VPD adjustment modifies the per diem rate over the course of the patient’s stay.\"}]","SNF PPS PDPM - Patient Driven Payment Model - J15 Part A Provider Outreach and Education | PDF",1791936908,22]