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PDPM resources

Symbria has a variety of tools built specifically to ensure coding and reimbursement under PDPM is accurate.  (We have on-demand training available for each of these tools.)  These tools include:

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  • IPA Focus – explores the various elements in the MDS, when scored differently, as changes occur, may warrant the completing of an IPA. It provides examples to help MDS staff understand how small changes in a patient can support a community’s decision to complete an IPA.
  • IPA Check√ – provides MDS with a grouper type tool that allows staff to enter new data that will compare with the Initial Medicare Assessment data and assist MDS personnel to determine whether an IPA will result in a positive or negative financial impact.
  • Case Mix Impact – a tool to help MDS and other personnel sort through functional scoring scenarios and resultant impact we see on case mix.
  • Nursing IPA Considerations – outlines the impact of the presence or absence of depression has on the reimbursement for patients in the clinically complex, special care low or special care high nursing categories. Other factors that can make a difference in patient placement in a nursing RUG/CMG include participation in respiratory therapy services on a daily basis, and involvement in restorative nursing programs.
  • PT/OT IPA Considerations – outlines how changes in diagnostic categories and functional changes can impact the decision-making regarding IPA’s.
  • SLP IPA Considerations – ensures that any SLP co-morbidities are considered and that all of the SLP factors are reviewed in decision making around the completion of an IPA. Neurological diagnosis with any level of cognitive impairment, swallowing difficulties and mechanically altered diets are all factored into the decision-making process.
  • NTA IPA Considerations – provides a structured framework for reviewing the 50 elements considered in the NTA component of the PDPM payment so that as patients change and potentially new conditions are considered as a part of the plan of care, pertinent items are properly captured for reimbursement.
  • NTA/ST Comparison Report – a critical report that utilizes medication information, PDPM ICD-10 mapping – conditions/diagnoses, and SLP evaluation data to flag patients that may be incorrectly coded as related to NTA and SLP CMGs. The goal of this report is to be an added checkpoint to ensure that everything that should be coded on the MDS, is coded.
  • BIMS participation – Symbria has developed a program to train therapists (OTs and SLPs) how to administer the BIMS in exact adherence with the script as outlined in the BIMS protocol. Our data has revealed that the therapists are identifying cognitive deficits that were otherwise not observed.