Series Title:  PDPM Master Class (12-month series)

Session Title: Addressing PDPM Medical Review Risks in the SNF Compliance & Ethics Work Plan

Presentation Dates:  Sept. Live Webinar

Presented By: 

• Eleisha Wilkes
• Shelly Maffia
• Amie Martin
• Kristen Walden

Course Description:

This session of the PDPM Master Class Series will focus on PDPM Medical Review risks for providers and key strategies to address those risks in the Compliance and Ethics Work Plan. The webinar will emphasize risks related to supporting daily skilled services, medical necessity, MDS coding decisions impacting reimbursement (e.g. modified diets, NTA items, etc.), therapy service provision patterns including the volume and mode of treatment, and justifying functional patient outcomes. Strategies for driving ethical practice and facility compliance through a targeted work plan that addresses Medical Review risks will be emphasized.

Learning Objectives

1. Review key Medical Review risk areas associated with the Patient Driven Payment Model (PDPM)
2. Describe targeted Compliance and Ethics Work Plan strategies to address identified PDPM risks such as but not limited to effective risk assessment, policy development/implementation, auditing and monitoring activities and oversight
3. Develop a working knowledge of the fundamental compliance work plan activities that may be used to drive PDPM quality and mitigate Medical Review risk.

Course Content

30 minutes            Overview key Medical Review risks under PDPM

30 minutes            Examine elements of the SNF Compliance & Ethics Program and reducing identified risks through targeted work plan strategies including, but not limited to: effective risk assessment, policies, auditing/monitoring, and oversight

10 minutes            Review sample Compliance & Ethics Program work plan related to PDPM risks

5 minutes              Closing Comments/ Q&A

Target Audience:   Administrators, Directors of Nursing, Nursing, QA, MDS, Staff Development, Therapy, Social Services, Board Members, Compliance Officer/Designee

Instructional Level:                Intermediate     Contact Hours: 1.25