In the ever-evolving landscape of senior care, the growing emphasis on value-based care and its significant benefits for skilled nursing facilities (SNF) has gained substantial momentum. Yet even after more than five years since the implementation of the Patient-Driven Payment Model (PDPM), skilled care providers still have their work cut out for them.

Take Gamble Guest Care, for instance. The Shreveport, Louisiana-based skilled nursing provider was facing three major challenges:

• Difficulty identifying and documenting conditions to optimize Non-Therapy Ancillary (NTA) points
• Incomplete documentation of medical diagnoses resulted in suboptimal Medicare rates
• Manual processes and lack of automated guidance slowed down staff workflows

What they needed was not just a solution to those challenges but guidance that could help them get there every time.

Enter PDPM Coach.

The new solution from PointClickCare gives skilled nursing organizations accurate guidance for submissions to optimize workflow and drive reimbursement. With PDPM Coach, SNFs gain a simple, intuitive and efficient way to complete the 5-day Admission Minimum Data Set (MDS), improve financial outcomes and succeed in a value-based landscape.

For Gamble Guest Care, that included a $30 average increase in Medicare revenue PPD across their entire organization.

“PDPM Coach has helped us identify and document conditions more effectively, increasing our NTA points and improving our Medicare rates-up to $60 more per resident in some facilities,” says Charlotte Duncan, Director of Reimbursement Gamble-Machen Guest Care Management, LLC. “The tool guides our team to uncover critical details, like checking referrals or patient history, ensuring we capture the full value of the care we provide.”

Here is a look at how PDPM Coach helps SNFs in three key areas.

Three key benefits

1. Optimizing organizational outcomes

PDPM Coach lets providers accurately forecast and track PDPM reimbursement by resident. They can use comprehensive diagnoses and condition codes to receive MDS decision support and guide MDS submissions with visibility into revenue capture and case mix index, while proactively minimizing risk and reducing audits.

In short, they can:

• Improve financial health with MDS guidance to maximize reimbursements
• Quickly see reimbursement forecasts at the resident level
• Gain full visibility into their day-one rate and anticipated length of stay reimbursement
• Receive optimal Medicare reimbursement with diagnosis accuracy and real-time visibility into reimbursement and case mix index

“In the beginning, I needed to be very hands on and had massive amounts of recommendations after auditing,” says a Director of Clinical Reimbursement at a PointClickCare customer. “Since using PDPM Coach in PointClickCare, staff are more educated and better able to manage at the facility level. I’ve definitely seen accuracy improve, which increases reimbursement in the sense we are getting paid for the care we provide.”

2. Increase staff efficiency

By utilizing PDPM Coach, SNFs can ease administrative burden, improve workflow and support staff responsible for critical MDS submissions, quickly moving clinical data to revenue with accurate, real-time reimbursement. Benefits include:

• Reducing technology barriers with access to secure MDS completion within the Electronic Health Record (EHR) platform
• Increasing staff confidence and reducing time spent on MDS completion
• Optimizing ICD-10 coding practices with accurate mapping to enable seamless claim processing, ensure clinical compliance, and maximize PDPM reimbursement
• Quickly identifying changes needed and correct errors for successful MDS completion
• Safeguard for staff turnover disruption and improve training and employee MDS knowledge with education on PDPM best practices

3. Modernized certification process

By improving practitioner engagement and boosting participation with automated SMS messaging, providers gain streamlined collection and signing of Medicare A and Managed Care Payers certifications and recertifications. This delivers three key wins:

• Accelerated responses. Increase physician engagement and expedite response times to ensure compliance and meet reimbursement requirements.
• Streamlined workflows. Enhance workflow processes to increase convenience and encourage greater participation from practitioners.
• Simplified participation. Improve practitioner engagement and boost participation by leveraging automated SMS messaging for streamlined collection and signing of Medicare A and Managed Care Payers certifications and recertifications.

Three major outcomes from PDPM Coach

For Gamble Guest Care, the benefits have been immense. Benefits they’ve seen include:

• 24% average increase in residents at NTA points 6 or higher
• $30 average increase in Medicare revenue PPD
• Staff improved diagnosis documentation, boosting reimbursement outcomes, improving the accuracy of our MDS, and preparing for upcoming Medicaid PDPM transitions

“It has already made a big impact,” Duncan says. “And as we prepare for Medicaid PDPM, we know we’re ahead of the game.”

This Views article is sponsored by PointClickCare, which knows that by adopting value-based care strategies, your organization can explore solutions to future-proof your success. To learn more about how PointClickCare’s PDPM Coach can help your organization meet MDS demands with optimal financial results, click here!