PDPM - Skilled Medicare A Residents

Restorative Nursing Programs

by admin

PDPM - Skilled Medicare A Residents

Restorative Nursing Programs

by admin

by admin

The launch of the Patient Driven Payment Model (PDPM) back in October of 2019 made it possible to capture skilled nursing services for reimbursement in addition to rehab services. Such nursing skilled services are categorized in a hierarchy of six levels with multiple care services within each group.

Among the six categories include Restorative Nursing Care

Traditionally, residents receiving Skilled Rehab services utilizing their Medicare Part A Benefits may be referred to Restorative Services usually following the discontinuation of Rehab services. 

Although, in many cases this scenario still exist among the needs of some residents, the new payment model shows us that if a resident does require restorative nursing care at the same time as their skilled rehab treatments, reimbursement for the restorative care is now possible.

Here are a few things to consider when initiating Restorative Nursing concurrently with Skilled Rehab Services under Med A:

1.  Thorough Restorative Nursing Assessment

Completion of a detailed and comprehensive restorative nursing assessment upon admission and as needed is a vital component.

The Restorative functional assessment and other assessments sets the foundation for the need of restorative services for residents. Residents receiving Skilled Rehab Services under their Medicare A benefits are under further scrutiny and subject to additional audits. Included in this audit may be the details and proof of need of such services.

The Assessment process should include specific narrative documentation of the intended program goals and well as a sound plan of care.

2.  Therapy Initial Eval & Treatment Plans

Skilled physical, occupational, and speech therapy services each requires a initial evaluation, goals, and treatment plans.

It will be a good idea to review this documentation for a cohesive approach to initiating restorative care services. Skilled nursing providers do want to proceed with the caution of ensuring  that the need for one service (Rehab vs Restorative care) does not out way each other. In other words, there should be sufficient documentation that supports the need for both services.

For more details on this process you may want to register for the: Understanding Restorative Care for Medicare Residents  

3.  Additional Nursing Skilled Needs & Possible Covid Precautions

As mentioned earlier, under Medicare PDPM payment plan their are 6 categories of nursing services.

Within each category there are multiple care treatment and DX.  Residents with higher levels of skilled nursing care services and Restorative Care Services will be assigned to the payment level reflecting the higher skill service captured on the MDS 3.0 instead of the implemented Restorative Nursing Programs. Restorative Nursing care is assigned in categories 5 and 6.

Residents assigned in a nursing skilled level 1-4 will be assigned in those higher payment categories instead

Popular restorative programs such as walk to dine may need to be altered and adjusted based on current Covid-19 precautions taking place within your facility. The safety of our residents is always the main priority.

For details on this process you may visit: Restorative Nursing Resources – Courses & Programs


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