Celtic Consulting

PDPM Education

Contact Celtic today for your individualized training agenda. 

Overview of PDPM Payment System (Session Length: 2 Hours)

  • All aspects of the new program
  • For Nursing, MDS, Rehab, Billing, Admission (or hospital liaisons), Administration, Social Services, Dietician, and any other IDT members

ICD-10 Diagnosis Coding Concepts (Session Length: 2-3 hours)

  • Review of intermediate ICD-10 principles for MDS, Admissions, Rehab
  • Chapter specific guidelines pertinent to the Skilled Nursing Facility setting
  • ‘Real World’ Coding Examples & Coding Practice
  • The role of Medication Reconciliation, Drug Regimen Review, and Capturing Conditions

PDPM Training Competencies (Three Sessions)

  • Session 1: Effective Capture of Diagnoses & Condition Categories (Session Length: 1.5 hours)
    • For MDS, Rehab, Admission, Dietician
    • Explain condition category assignment importance
    • Educate on primary code assignment in current (2018) I Section
    • Communicating amongst Providers: Using discharge summaries, provider documentation, & the medical record to capture conditions
  • Session 2: Collaborating to Determine Functional Performance and Outcomes (Session Length: 1 hour)
    • For MDS, Nursing, Rehab
    • Maximize reimbursement
    • Manage outcomes
  • Session Three: Refresher in MDS Coding of Cognition and Mood & Relationship to PDPM (Session Length: 1 hour)
    • For MDS, Social Services, SLP


Concepts for Managing Costs and Reimbursement (Three Sessions)

  • Session 1: Restorative Nursing Programs- MDS, Nursing, Management, Rehab (Session Length: 1.5 hours)
    • Benefits (Clinical and Financial), etc.
    • Program requirements
    • Skilled Care/Medicare coverage
  • Session 2: Group/Concurrent Therapy Limitations- Management, Rehab, MDS (Session Length: 1.5 hours)
    • Benefits (Cost Center vs. Revenue Center)
    • Regulations for each type of therapy
    • Developing treatment schedules for each type
    • Practice with Managed Care
  • Session 3: Link to Medicare Spending Per Beneficiary QRP Measure- Management, Billing (Session Length: 30 minutes)
    • Therapy spending
    • Use of restorative nursing vs. therapy for some cases
    • Managing ‘downstream’ costs
    • Evaluating ‘in-house’ care programs, equipment and exploring program development


Use of IPA to Reset Case Mix Grouping Category (Session Length: 1 hour)

  • Daily case management & tracking
  • Communication and interviewing for success
  • Monitor consults, notes, etc. for clues on additional conditions
  • Setting ARD for the IPA Assessments


Transition Planning for September – October 2019


Nursing Fundamentals for Skilled Patients (Session Length: 1 Hour)

  • Practices nursing should implement to skill patients
  • Skilled Nursing Documentation Competencies
  • Review of Medicare Coverage Guidelines
  • Skilled Nursing and Skilled Rehab criteria


PDPM and Triple Check (Session Length: 1 hour)

  • For MDS, Nursing, Admission, Finance, Rehab
  • New practices to implement
  • How will IDT’s Roles change to accommodate PDPM
  • New Triple Check Checklist reviewed


What Happens after Day 8? Revised MDS Coordinator Duties (Session Length: 30 Minutes)

  • Case Managing Skilled Patients
  • Monitoring criteria for IPA assessments
  • New diagnosis/conditions capture


Rehab under PDPM (Session Length: 1.5 Hours)

  • Therapy contract review
  • Use of group and concurrent therapy
  • Determining clinical appropriateness
  • Skilled therapy diagnoses
  • Reporting rehab services for Medicare meeting


PDPM, VBP and QRP: How It All Pulls Together (Session Length: 3+ hours)

  • Participants will learn how to determine their final per diem rate including VBP penalties, for FY 2019 and beyond under SNF VBP.
  • Attendees will learn the difference between performance and outcome measures and how each type effects reimbursement under the SNF QRP.
  • The audience will come away with best practice ideas for monitoring compliance and reporting in the CMS program.
  • Participants will understand how spending, or the cost of care, will be monitored and how the new PDPM system will encourage cost savings.
  • Presenter will review the various CMS reporting structures.
  • Presenter will demonstrate the use of CMS reports to improve quality rankings and maintain QAPI.


PDPM for the Interdisciplinary Team (Session Length: 3+ hours)

  • Review of new case mix methodology under PDPM
  • Practices to prepare your staff for the changes, and how the IDT needs to shift focus to be successful under PDPM
  • Review how new ADL scoring, clinical classification categories and groupings called “condition categories” will affect payment levels and how “Add-on” point system is derived and what competencies will need to be honed in order to optimize opportunities in relation.
  • Present sample timeline for nursing leadership to utilize when developing their educational programs for building PDPM competencies