PDPM and You!

Angie Szumlinski
|
August 23, 2019
PDPM and you

There are many changes coming in the next few weeks and PDPM is one that will likely have the most impact on your operations. The goal of PDPM is to address our residents unique, individual needs (thus Patient Driven) and ultimately improving outcomes. The assessment process will change significantly with the PDPM model and it is critical that your team is trained and ready to hit the ground running!

The Interrupted Stay Policy sets out criteria for determining when Medicare will treat multiple SNF stays. Share on X

One of the changes that will impact the assessment and reimbursement process is the “Interrupted Stay”. The Interrupted Stay Policy sets out criteria for determining when Medicare will treat multiple SNF stays occurring in a single Part A benefit period as a single “interrupted” stay, rather than as separate stays for the purposes of the assessment schedule and the variable per diem payment schedule.

CMS defines an “interrupted” SNF stay as one in which a patient is discharged from SNF care and subsequently readmitted to the same SNF (not a different SNF) within 3 days or less after the discharge (the “interruption window”). The interruption window is a 3-day period, starting with the calendar day of discharge and including the 2 immediately following calendar days, ending at midnight. In other words, the resident must return to the same SNF by 12:00 am at the end of the third calendar day.

Sound familiar? It is! Very similar to the 3-day required acute care stay to qualify for skilled care. That said, it is also a process that needs to be tracked carefully and CMS developed a fact sheet that will assist you. As the payment model changes be sure your team is educated and communication is maintained at daily stand up meetings to assist in avoiding hiccups that could affect your reimbursement. Additional information on the CMS Fact Sheet can be found at the link below:

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/PDPM_Fact_Sheet_InterruptedStay_Final.pdf


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