CMS Change to SNF Payment Model - Community Health Plan of Washington - Medicare Advantage

CMS Change to SNF Payment Model

Effective October 1, 2019, the Centers for Medicare and Medicaid Services (CMS) began using a new methodology, Patient-Driven Payment Model (PDPM), for reimbursing Skilled Nursing Facilities (SNF) during a Medicare beneficiary’s covered Part A stay.

PDPM replaces 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 will follow the new CMS Medicare methodology. Effective for dates of service on and after October 1, 2019, all skilled nursing services should be billed according to the new 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 provider.relations@chpw.org.

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