The new Medicare fee-for-service reimbursement model known as Patient Driven Payment Model (PDPM) will drastically change how reimbursement will be determined. In the past, the Resource Utilization Groups (RUG-IV) have determined reimbursement, in which the amount of therapy a resident received played a significant part in the amount of reimbursement the facility received for that resident. Reimbursement will transition away from the volume-based payments of RUG-IV toward the new PDPM model. With PDPM, ICD-10 codes will be a crucial driver for reimbursement.
Trepidation, fear and confusion have all been experienced by minimum data set (MDS) coordinators and staff alike at various long-term post-acute care (LTPAC) facilities regarding selecting and/or having to code diagnosis for residents—especially upon admission. Some common questions include: “What do I choose?” “How do I know if it is the correct primary or admitting diagnosis?” “I’m not a coder—how do I know what diagnosis to choose?”