Briefly summarize the course including how it relates to the business operations and/or the care of residents in the facility.

Effective October 1st, the new PDPM payment model will rely on very specific ICD-10 codes reported on the MDS to determine the resident’s “Clinical Category” payment rate. Many codes that have been previously been reported and accepted on claims will be rejected. Now is the time to prepare by studying CMS PDPM materials, assessing the current state of coding in each building, and ensuring that facility software will provide functionality that will enable a successful transition with minimal reimbursement delays.

Participants will understand:

  • Basic concepts of what the coding process with ICD-10 involves.
  • Impact of ICD-10 on PDPM and how it drives the 10 “Clinical Categories”.
  • Specific examples of the 27,854 codes that will be rejected October 1, 2019.
  • Specific examples of the 37,214 codes that will be accepted October 1, 2019.
  • Comorbidities and how they can affect the Comorbidity Score.
  • Specific examples where acceptable mappings conflict with coding guidelines.
  • Strategies for coding success under PDPM in their own facility.

Speaker: Bill Roush

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