Community Health Plan of Washington Medicare Advantage Plans Community Health Plan of Washington Medicare Advantage Plans

CMS SNF Payment Model

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:


If you have questions about the information in this bulletin, please email [email protected].


A Nap a Day Could Keep The Doctor Away

An older man taking a nap on the couch.Many Americans do not get enough sleep and this can contribute to a number of health issues. Taking a nap during the day can help your body restore itself and promotes brain and heart health. A 20-minute nap has a variety of health benefits – from improved mood, to better focus and memory function. In some cultures, napping is even prescribed as a health treatment by doctors!

If you have trouble sleeping, take steps to improve your quality of sleep.


Sales Team

Get real answers
from real people

Phone: 1-800-944-1247
Email: [email protected]