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CMS Releases Medicare General Information, Benefit Policy, and Claims Processing Manual Updates Related to PDPM Implementation

Dan Ciolek 

This week, the Centers for Medicare and Medicaid Services (CMS) issued sub-regulatory guidance related to the Skilled Nursing Facility Medicare Part A Prospective Payment System (SNF PPS) Patient Driven Payment Model (PDPM) in recent Program Manual update transmittals.  The Medicare General Information, Eligibility, and Entitlement Manual PDPM transmittal contains minor updates to certification guidance.  The Medicare Benefit Policy Manual PDPM transmittal contains minor updates to the SNF benefit period and benefit days sections in chapter 3, and major changes to the SNF PPS guidance in Chapter 8.  Finally, the Medicare Claims Processing Manual PDPM transmittal provides substantial updates to the chapter 6 SNF PPS claims processing instructions.  AHCA has conducted a preliminary review of these updates and will be highlighting key observations later this week.  We will also be highlighting key points during the upcoming “Week 2 of PDPM Implementation Status Update” all-member webinar on Friday, October 11, 2019 from 3:00-4:00 PM eastern.  You may register for the webinar here. 

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