Provider Notices

Patient Driven Payment Model (PDPM)

8/22/2019 6:07:57 AM

Effective October 1, 2019 Centers for Medicare and Medicaid Services (CMS)  will put into effect a new classification model for Skilled Nursing Facilities (SNF).  The Patient Driven Payment Model (PDPM) will be used for SNF Prospective Payment System (PPS) for classifying patients in lieu of the RUG-IV model.  SNF’s should cease billing the RUG-IV model September 30, 2019.  In accordance with CMS billing guidelines, PacificSource Medicare Advantage will be reimbursing providers on the PDPM model effective October 1, 2019.

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If you have any questions, please contact your Provider Service Representative.