Patient Driven Payment Model (PDPM)

The Patient Driven Payment Model (PDPM) is designed to focus on the individual needs of the patient, as opposed to the “volume of services provided” mindset. Physicians that understand the importance of documentation and how it crosswalks into the various categories ensures SNFs are reimbursed properly for the care that is provided. 

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Impact Core Areas of Your SNF With PDPM From First Docs

Our physicians work with the Interdisciplinary Team (IDT) to discuss the reason for the SNF stay and develop a plan of care. Our physician and non-physicians providers (NPP) are also available to educate staff about the cause of these conditions. The better clinicians understand the nature of the problem, the better resident care will be, and the more accurate the payment category.

The primary diagnosis will be entered into the EHR supporting the reason for SNF care, along with other pertinent diagnosis codes that support nursing, NTA and SLP comorbidities. These codes will be used to support the patient characteristics for all the clinical components to determine the PDPM CMI for reimbursement. 

Physician and nursing documentation must support the existing need for skilled care based on the active patient characteristics. 

Physician training includes:

  • Documentation/coding 
  • NTA Categories
  • Nursing Categories
  • SLP 
  • PT & OT

Optimizing PDPM & Clinical Reimbursement with First Docs

At First Docs, we understand the challenges skilled nursing facilities face in navigating complex reimbursement systems like the Patient-Driven Payment Model (PDPM), as well as the broader landscape of healthcare reimbursement, including Case Mix Index (CMI), the role of Accountable Care Organizations (ACOs), and the larger shifts to value-based care. Our internal medicine practice is dedicated to helping SNFs have accurate and optimized documentation and coding to ensure proper clinical reimbursement.

Timely and Accurate Diagnosis
First Docs physicians and APPs undergo specialized training to provide comprehensive medical assessments and accurately diagnose patients. By ensuring proper and specific diagnoses in our documentation, we help SNFs receive appropriate reimbursement based on each patients’ individual care needs.

Care Planning and Management
First Docs providers actively participate in interdisciplinary team (IDT) meetings to develop individualized care plans for patients. Our physicians identify specific care needs and outline appropriate interventions, contributing to optimal patient outcomes while maximizing reimbursement under PDPM and other value-based care models.

Clinical Documentation Improvement (CDI)
We actively participate in CDI initiatives aimed at enhancing the accuracy and specificity of clinical documentation. By providing detailed and thorough documentation of patients’ medical conditions, treatments, and outcomes, we facilitate appropriate reimbursement, while also supporting SNFs in achieving optimal CMI scores.

Rehabilitation and Therapy Oversight
We collaborate with rehabilitation physicians and therapy teams to oversee patient progress and adjust treatment plans as needed. Our involvement in goal-setting and treatment decisions ensures that therapy services align with patients’ clinical needs, contributing to improved functional outcomes and reimbursement under PDPM and value-based care arrangements.

Medication Management
Our physicians are experienced in medication management, including prescribing and monitoring medications for patients with complex medical conditions. By ensuring medication appropriateness and compliance, we help prevent adverse events and hospital readmissions, ultimately supporting higher reimbursement and improving ACO performance metrics.

Technology-Driven Documentation
We leverage our proprietary, integrated electronic health record (EHR) technology to streamline documentation and coding processes. Proper mapping of all PDPM compliant codes allows us to capture patient complexity more effectively, resulting in improved accuracy and specificity in clinical documentation, ultimately leading to better reimbursement.

How It Works

Clinical Excellence

Our physicians are committed to delivering high-quality, evidence-based care tailored to the unique needs of SNF residents.

Operational Efficiency

We optimize clinical reimbursement and streamline administrative processes, helping SNFs achieve financial sustainability and operational success in the transition to value-based care.

Collaborative Partnership

We believe in fostering collaborative partnerships based on trust and transparency, working closely with SNF administration, nursing staff, and MDS to align clinical objectives and drive performance improvement in the era of value-based reimbursement.

Learn More About Our Reimbursement Optimization Solutions

To learn more about how First Docs can help your SNF optimize clinical reimbursement, improve patient outcomes, and succeed in the transition to value-based care, contact us today. Our team is dedicated to supporting you in navigating the complexities of healthcare reimbursement and achieving your organizational goals.

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