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Is your organization prepared for PDPM? Check out this readiness checklist!

Posted Jul 1, 20192 min Read

Payment & Reimbursement
Do you understand the full impact of the changes?

It’s time for SNFs to assess and change care delivery systems to maximize efficiencies and reimbursement under the new PDPM. Here’s a checklist of items along with timing recommendations to consider as you develop a collective strategy for patient success – providing the right care for the right clinical complexities.


  1. Start utilizing proper ICD-10 codes on MDS
  2. Review to ensure ICD-10 codes are including appropriately on billing claims
  3. Check with software venders on status of system readiness;
    1. Therapy
    2. MDS
    3. Billing including “scrubbers” and clearing houses
    4. Accounts Receivable to General Ledger
  4. Implement necessary clinical/operational changes identified in Spring
  5. Complete MDS section GG detail under PDPM guidelines
  6. Determine who will identify criteria and need for Interim payment Assessment (IPA) MDS
  7. Evaluate therapy contract for necessary modifications under PDPM
  8. Implement restorative nursing program if appropriate
  9. Understand changes related to billing requirements/claims completion
  10. Update financial impact analysis based on training/education received; include in budget for June/September year-end providers


  1. Modify your Triple Check process
  2. Update your compliance program based on CMS potential risk areas
  3. Understand financial impact after first few months of implementation
  4. Prepare upcoming budget to incorporate PDPM financial impact (if December year-end provider)
  5. Based on current PDPM actual performance what changes need made:
  • Hospital data
  • ICD-10 coding
  • MDS accuracy
  • Therapy delivery
  • Clinical processes
  • Billing

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