Patient-Driven Payment Model (PDPM)

The Patient-Drive Payment Model (PDPM) is here, and AADNS will continue to help you through the transition. Visit this page frequently to get new information to help you lead your team and ensure that your facility thrives under PDPM.

CMS Addresses PDPM Claims Issue for Out-of-Sequence Claims, Will Correct in October (2/20)

Posted By: CMS
Post Date: 02/26/2020

Colleagues—

This message will appear in this week’s edition of MLN Connects, but we wanted to give our partners advance notice—please share with your members.

SNF PDPM Claims Issue

Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) initial claims that are processed out of sequence are not paying the correct Variable Per Diem (VPD)-adjusted rate. Also all adjustment claims are not processing correctly. Claims need to process in date of service order for each stay for the VPD to calculate correctly. We will correct this issue in October. In the interim:

  • Submit claims in sequence by waiting at least 2 weeks before billing subsequent claims
  • To adjust claims, cancel the initial claim and all subsequent claims in the SNF stay then rebill in sequential order; or, hold adjustments (when allowable) until October when they will process correctly
  • We encourage you to submit a complete bill at the time of entry

Sincerely,

Robin Fritter

Director, Division of Provider Relations & Outreach

Provider Communications Group
Centers for Medicare & Medicaid Services

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