The Centers for Medicare and Medicaid Services (CMS) use the Patient Driven Payment Model (PDPM) methodology for reimbursing Skilled Nursing Facilities (SNF) during a Medicare beneficiary’s covered Part A stay. As a reminder, PDPM has been in effect since October 1, 2019. CHPW is updating this bulletin to ensure new providers or billers are aware of this methodology.
PDPM replaced the Resource Utilization Group (RUG) methodology previously used for SNFs. RUG classifies most patients into therapy payment groups, primarily based on volumes of therapy services provided to patients. PDPM is focused on patient care needs; it classifies SNF patients into payment groups based on specific patient characteristics and conditions. Because PDPM is data driven, this methodology improves the appropriateness and accuracy of SNF payments.
CHPW follows the CMS Medicare methodology; therefore, all skilled nursing services should be billed according to the PDPM guidelines for SNF services provided during a Medicare beneficiary’s covered Part A stay.
Please refer to the following CMS resources for more information:
Questions?
If you have questions about the information in this bulletin, please email [email protected].
What kind of care do you need? Not every medical issue needs emergency care. If you have a medical issue that doesn’t seem to be life-threatening, but you’re not sure what to do, see if your local Community Health Center clinic or primary care doctor offers virtual care. If they do, they will tell you how to set up your virtual care appointment.
