October 11, 2019
CMS updated several of its resources on PDPM last week. Here is the link to their resource page. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/PDPM.html Many of the revisions do not reflect “new” information, but rather insuring all the documents are in alignment with each other, so more of a “clean-up”. The ICD-10 mappings file was also updated and does reflect some changes – most importantly NEW codes added to the Return to Provider List.
Falls Prevention Awareness Day Toolkit developed by the Balance and Falls Special Interest Group of the Academy of Geriatric Physical Therapy is available, OPEN ACCESS here https://geriatricspt.org/special-interest-groups/balance-falls/nfpad/
This toolkit provides all of the documents you need to plan and host an event or even just provide education to the community or other professionals on falls prevention.
We are pleased to offer access to these research “1-pagers” on the value of physical activity and role of physical therapists in preventing falls or reducing fall risk; value of physical therapists in reducing readmissions; and the value of early mobilization.
NEW TRAINING EVENT — Updated Section GG Web-based Training Course
The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course on how to properly code of Section GG. This 45-minute course is intended for providers in the following care settings: Skilled Nursing Facilities (SNFs), Long-Term Care Hospitals (LTCHs), Inpatient Rehabilitation Facilities (IRFs), and Home Health Agencies (HHAs); and is designed to be used on demand anywhere you can access a browser. The course is divided into the following four lessons and includes interactive exercises that allow you to test your knowledge in real life scenarios:
• Lesson 1: Importance of Section GG for Post-Acute Care
• Lesson 2: Section GG Assessment and Coding Principles
• Lesson 3: Coding GG0130. Self-Care Items
• Lesson 4: Coding GG0170. Mobility Items
If you have technical questions or feedback regarding the training, please email the PAC Training mailbox. Content-related questions should be submitted to the Quality Reporting Program Help Desk for your care setting.
Video Tutorials Available to Assist with Coding Specific Section GG Items
The Centers for Medicare & Medicaid Services is releasing a series of short videos to assist providers with coding select Section GG items on the OASIS, IRF-PAI, LTCH CARE Data Set, and the MDS. These videos, ranging from 4-12 minutes, are designed to provided targeted guidance using simulated patient scenarios. To access the videos, click on the links below:
Thank you to the members of AGPT’s Evidence-Based Documents (EBD) Committee and the EBD Editorial Board, the Balance and Falls Special Interest Group, the AGPT/NCOA Partnership Task Force, and the Payment and Legislative Committee for their assistance in responding to the US Senate Special Committee on Aging request for information on falls and fall prevention as they prepare to release an annual report on this topic in the coming months.
Home Study Modules Now Available on the APTA Learning Center
Physical Therapy and the Aging Adult: Limb Loss in Older Adults (Just Released!) Details at
Management of Falls and Fall Prevention in Older Adults
Tool Kit for the Prevention of Diabetic Foot Ulcers
Assistive Devices, Adaptive Equipment, Orthotics, and Wheeled Mobility for the Older Adult
Bariatric Obesity in the Older Adult
End of Life Ethics
Breast Cancer Related Lymphedema
Biopsychosocial and Environmental Aspects of Aging
Full details can be found at http://geriatricspt.org/?dd90jb
Medicare payment system is in the midst of a paradigm shift—away from the fee-for-service payment structure, in which providers are rewarded solely by the volume of services provided, and toward a structure that holds providers accountable for patient outcomes and costs. This move to value-based care is intended to advance the goals of health care's "triple aim"—improving the patient experience of care (including quality and satisfaction), bettering the health of populations, and reducing the per-capita cost of health care.
As part of this effort, CMS has finalized significant changes that will affect the home health and skilled nursing facility payment systems—beginning in FY 2020 for SNFs and CY 2020 for home health agencies. These payment systems align payment with patient characteristics and patient needs, and eliminate the connection between therapy utilization and reimbursement. CMS finalized the Skilled Nursing Facility Patient-Driven Payment Model (PDPM) and Home Health Patient-Driven Groupings Model (PDGM) in 2018.
Links to two PDPM Q&A sessions are below:
Tuesday, March 12: http://apta.adobeconnect.com/p4jqrt2c5467/
Thursday, March 14: http://apta.adobeconnect.com/pdvlv2jsjbiu/
APTA staff and members of the Home Health Section Government Affairs committee recorded an overview of the Patient-Driven Groupings Model and recorded 2 live Q&A sessions.
Challenging the Myths Associated With PDPM and PDGM - 11/15/18
Unfortunately, there are a number of myths about these 2 new payment systems, shaping biases and working against the long-term success of these models.
APTA Recorded Webinar via Adobe Connect
How Changing Post-Acute Payments Impact the Role of PT- 10/11/18
Recorded Webinar (October 2018) Free to APTA Members via APTA Learning Center
A New SNF PDPM Webinar Recording is Now Available
An Overview of the Skilled Nursing Facility Patient-Driven Payment Model webinar is now available at http://apta.adobeconnect.com/pch0i3flsz1w/
The webinar was put together by the Post-Acute Care Educational Collaborative and was done by AGPT and HPA members along with APTA staff. The webinar recording is open to all members and non-members.
A new MLN Matters Article MM11081 on Home Health Patient-Driven Groupings Model (PDGM) – Spilt Implementation is available. Learn about the payment reform requirements.
A new MLN Matters Article MM11152 on Implementation of the Skilled Nursing Facility (SNF) Patient Driven Payment Model (PDPM) is available. Learn about the required changes.
On February 5, the Centers for Medicare and Medicaid Services (CMS) posted on their MDS 3.0 Technical Information Webpage a new draft version (V3.00.0) of the MDS 3.0 Data Specifications. This version is scheduled to become effective October 1, 2019. These specifications are used for software developers and vendors to update SNF PPS grouper, MDS, electronic health record, and billing systems to align with annual updates to the MDS-RAI (yet to be issued) and SNF PPS billing requirements. Note that there are many significant changes, to align with the transition to the new Skilled Nursing Facility Prospective Payment System (SNF PPS) from the Resource Utilization Groups, Version 4 (RUG-IV) to the Patient Driven Payment Model (PDPM). These changes include the removal of eight RUG-IV assessment item sets (NS, NSD, NO, NOD, SS, SSD, SO, SOD), the addition of two new PDPM assessment item sets (IPA – Interim Payment Assessment and OSA – Optional State Assessment), and item additions in Sections A, GG, I, J, O and Z. See this link for the draft MDS 3.0 Item Sets v1.17 for October 1, 2019) that were issued on January 3. The MDS draft data specifications also accommodate the utilization of the PDPM grouper (not issued yet) , which also begins on October 1, 2019. In addition, a new version (V1.04.0) of the MDS 3.0 CAT Specifications was posted. This version is also scheduled to become effective October 1, 2019. The specification for CAT 12 (Nutritional Status) has been updated in accordance with the changes in V3.00.0 of the MDS 3.0 Data Specifications.
With aging might come changes in older adults’ ability to get around and do the things they want and need to do. These mobility changes may affect older adults’ health and independence and are related to an increased risk of falls and motor vehicle crashes—the two leading causes of older adult injury.
The CDC released a new mobility planning tool to help older adults create a personalized MyMobility Plan. This planning tool, along with a supporting fact sheet about medicines that might increase risk of a fall or motor vehicle crash, helps older adults plan for mobility changes similar to the way that many plan financially for retirement.