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Somebody's Watching You: What are your PDP, PEPPER, and Facility Risk Areas? EmbracePremier.com1Presenter Heather Meadows, MS, CCC SLP Executive Director of PA hmeadows@embracepremier.com 800.875.7041EmbracePremier.com2Objectives
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01
Gather all necessary information including patient diagnosis, comorbidities, functional status, cognitive abilities, and prior care settings.
02
Use the Case Mix Index (CMI) value to determine the base rate for the patient's classification group.
03
Calculate the Nursing Component by considering the patient's nursing needs score and adjusting for variable per diem components.
04
Determine the Non-Therapy Ancillary (NTA) Component based on the patient's conditions and diagnoses that contribute to increased costs.
05
Evaluate the Physical Therapy, Occupational Therapy, and Speech-Language Pathology Components based on the patient's therapy needs and adjust for variable per diem components.
06
Sum up all the individual components to get the total per diem rate for the patient's stay under PDPM.

Who needs how to calculate pdpm?

01
Healthcare professionals working in skilled nursing facilities
02
Administrators and managers responsible for billing and reimbursement
03
Insurance companies and government payers setting rates for patient care
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PDPM, or Patient-Driven Payment Model, is a system used by skilled nursing facilities to determine Medicare payment based on the clinical characteristics and care needs of each patient.
Skilled nursing facilities are required to implement and follow the PDPM system for Medicare reimbursement purposes.
Skilled nursing facilities must assess patients using standardized clinical assessments to determine appropriate payment under the PDPM model.
The purpose of PDPM is to ensure that Medicare payments accurately reflect the care needs of individual patients in skilled nursing facilities.
Clinical characteristics, diagnoses, and care needs of each patient must be reported to calculate payment under the PDPM system.
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