A software tool designed for the Patient Driven Payment Model (PDPM) helps determine reimbursement rates for skilled nursing facilities. This tool typically takes inputs related to a patient’s classification, including clinical characteristics and functional capabilities, and calculates the expected payment. For example, it might consider a resident’s nursing needs, physical therapy requirements, and cognitive status to arrive at a per diem rate.
Accurate and efficient payment determination is essential for the financial health of skilled nursing facilities. These tools offer a streamlined method for calculating PDPM payments, ensuring compliance with regulations and reducing administrative burden. This system replaced the Resource Utilization Group (RUG-IV) system in 2019, aiming for a more patient-centered approach to reimbursement. The shift to a model focusing on individual patient characteristics rather than therapy minutes incentivizes facilities to provide the most appropriate care based on individual needs.