70th AHCA/NCAL Convention and Expo
For each Medicare Part A admission the skilled nursing facility must determine the primary reason for skilled care within the Initial Medicare Assessment (IMA) eight day window. If the IMA is completed 9 days or later, SNFs are paid the default PDPM rates – the lowest payment Case Mix Group rates for each component. Even when the IMA is completed components with variable per diems will not begin on day one, rather the ARD for the late IMA. To ensure the IMA eight day window is hit, clearly defined information exchange methods and structured communication among hospital discharge planners, clinicians and MDS Coordinators is critical. In many instances hospitals and SNFs struggle to share information and clinicians historically have not been required to go as in depth on the primary reason for SNF care, and identifying the PDPM ICD-10 related code. Additionally, under PDPM certification and recertification requirements have not changed. As a condition of coverage, the physician must certify on admission and then recertify by day 14 and every 30 days thereafter that skilled care is required and; the reason for skilled care, the discharge plan and the estimated duration of inpatient care.