Skilled Nursing Facility Alert: Payment Structure Changes — Action by October 1, 2023
Significant updates to SNF payment structure effective October 1, 2023.
Action required by
October 1, 2023
Review the Action Required section below and ensure your team has completed all compliance steps before this date.
The Federal Register Final Rule introduces significant updates to the payment structure for Skilled Nursing Facilities (SNFs) under the Medicare Prospective Payment System, effective September 30, 2023.
What Changed The primary change involves adjustments to the Patient-Driven Payment Model (PDPM) parity adjustment, impacting reimbursement rates for SNFs. These adjustments are based on new mappings of diagnosis codes, which may lead to increased or decreased payments depending on the specific diagnoses assigned to patients. Clinical coders should be aware that various ICD-10 codes will be affected, and accurate coding is crucial to reflect the new payment structure.
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Quick answers
What are the key changes to the PDPM for SNFs?
The key changes involve adjustments to the PDPM parity adjustment affecting reimbursement rates based on new diagnosis code mappings.
How should we prepare for the upcoming changes?
Review updated diagnosis code mappings, update encoder systems, and train coding staff before the compliance deadline.
What is the compliance deadline for these changes?
The compliance deadline for implementing these changes is October 1, 2023.
Content summarized from publicly available federal publications including CMS, MAC contractors, and the Federal Register. CLV Intelligence is not affiliated with or endorsed by any government agency. This is not legal or medical advice.