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Transitioning to Medicare Part A PDPM: Why Software alone is not the answer

Posted Jul 1, 20192 min Read

Payment & Reimbursement

With the transition to Medicare Part A Patient Driven Payment Model (PDPM) coming, we’ve found that many facilities believe that implementing a new software in the fall is the answer. While software can be part of the solution, it can only be effective when used by trained professionals. Staff training will be essential in your organization’s ability to implement PDPM successfully.

Just a Few Reasons Why Training is Essential:

Payment drivers for the new PDPM are patient characteristics. Licensed staff will be key in identifying these characteristics and will need training to be able to do so. Being able to understand your facility’s readiness for the impact of PDPM is crucial. Payment swings can vary from ten dollars up to hundreds per day depending upon the clinician’s proper assessment and documentation of your patient.

Questions Owners/Operators Should Have Answered at This Time:

Does your organization’s operational leadership have the ability right now to see how you would perform financially under the new PDPM model?

  • Does your organization have a clear understanding of a strategy through PDPM and have an implemented action plan through their QAPI process?
  • Does your organization have a clear plan developed to help them navigate through risk mitigation, which provides detailed justifications for therapy interventions in order to mitigate any legal or regulatory issues?

These are some of the most important questions to consider before the PDPM implementation takes effect on October 1, 2019. If you haven’t started preparing for this upcoming change, don’t delay any further and get your team fully equipped with the necessary resources and trainings that are required for a successful transition to PDPM.

For more information, contact:

Blue and Company at or call 502-992-3500

About the Author

Jennifer Scott, Manager, Blue & Co, LLC, BSN, RN, PLNC, CDP, QRP-CT