StarPRO, a Start-Up NY software solutions and data analytics company, released PDPMForecaster, a web-based tool that quickly guides health care professionals as to what conditions are reimbursement-sensitive under the new patient-driven payment model, PDPM. The tool goes live just in time to prepare for the implementation of the new PDPM model on Oct. 1.
PDPM is the most significant reimbursement overhaul to the skilled nursing facility industry in 20 years. Payment for services will now be based on the patient’s medical condition as opposed to the number of therapy minutes spent with that patient. At the beginning of the stay, reimbursement is at the highest level to account for increased services and then payment levels reduce over time depending on number of days. Health care professionals now have significantly less time to gather crucial information, so it’s critical to quickly identify and fully understand the extent of the patient’s medical conditions in order to ensure the highest allowable reimbursement.
The PDPMForecaster tool expertly computes clinical categories based on an individual patient’s medical conditions and forecasts an expected daily rate. The tool saves time and money by educating staff on what information to collect based on a customized workflow that adapts to each patient. The automated survey-style form prioritizes questions that are related to the most appropriate complex medical conditions first, thereby eliminating any confusion caused by unrelated categories. The result is an instant snapshot of the relevant clinical information required for conducting a thorough assessment that gauges each patient’s medical needs and allowable daily rate upon admission.
“Unlike other PDPM calculators, you don’t have to be a PDPM expert or MDS expert to start using our tool,” stated Colleen Muncy, managing director at StarPRO. “PDPMForecaster’s step-by-step questions educate users case-by-case on what documentation is critical upfront for payment requirements so the facility can begin capturing the full allowable reimbursement rate from day one.” PDPMForecaster’s reporting includes case mix groups and indexes and rates for each PDPM category as well as ICD-10 to MDS 3.0 crosswalking to ensure proper coding on MDS assessments.