Harmony Healthcare Blog

PDPM: Lessons Learned from Month One of PDPM

Posted by The Harmony Team on Tue, Jan 07, 2020

Edited by Kris Mastrangelo


Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency

Tom studyingMany teams in the field have been asked what they have learned over the last month of dealing with the Patient Driven Payment Model (PDPM) and MDS Assessments.

  1. Choice of the primary diagnosis and the ICD-10 Code really counts. It impacts not only the Case Mix Groups but needs to be supported in the Nursing Documentation.  The Nursing Notes must connect the dots between the assessments being completed, the Nursing Notes and the primary diagnosis.
  1. Look at the overall condition of the patient and not just their functional status or their therapy needs.
  1. Review medications as they can be key to understanding the patient’s overall status and provides insight into their diagnoses that may have dropped off their diagnosis list.
  1. Software screws up. CMS also is not fool proof.  There have been and will continue to be bugs to work out on the part of CMS and the MDS and billing software used in the industry. 
  1. Communication is vital. The BIMS, the PHQ-9 and the pain interview results should impact more than the PDPM categorization.  This information should direct care as well as the other factors considered when treating patients.
  1. Triple Check needs refinement. New Tool available to download, see below.

Harmony Healthcare International (HHI) highly recommends using the Hopforce PDPM Calculator which is always being refined.


This tool is made for:

Preadmission Screening
Documentation Support (in Progress)
Post Admission Analysis (in Progress) 

Triple Check Form

Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have.  You can contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 

 harmony20 October 29-30 2020 Encore Boston Harbor

Tags: PDPM

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