FY 2023 Changes & Updated Tools for PDPM Management

On July 29, 2022, CMS issued its FY 2023 SNF PPS Final Rule spelling out changes SNF providers can expect in the upcoming fiscal year. Concept Rehab, a leader in post-acute care for over 40 years, serves as a business partner working side by side to assure each customers’ success. So, when CMS levies changes that impact our partners daily operations, we respond with updated tools and resources to support success operating under new guidelines. With the advent of FY 2023 SNF PPS Final Rule, post-acute care providers will see a flurry of changes beginning October 1, 2022. The most notable result of the Final Rule are the changes to PDPM reimbursement.

Parity Adjustment

This has long been referred to as the PDPM parity adjustment as we have repeatedly heard from CMS since the inception of PDPM given that it was not budget neutral as intended. CMS stated in the Final Rule for FY 2023 that they intend to take a more cautious approach to mitigate the potential negative impacts on the nursing home industry with this parity adjustment by spreading it across a two-year period. Adjustments to the PDPM rates include a 2.3% reduction in FY 2023 and an additional 2.3% decrease in FY 2024. We will see this as adjustments/reductions in the Case Mix Indices for each of the PDPM categories.

Overall Medicare Payment Increase

Despite the 2.3% parity adjustment decrease that is taking effect October 1st, SNFs are still going to see an overall increase of 2.7% or $904 million in their Medicare payment due to the annual market basket increase. This comes from adjustments to the FY 2023 Federal Base Rates for urban and rural facilities increasing as compared to the rates for FY 2022. Below is an illustration of what SNF providers can expect for each category to reflect the market basket increase.

Updated Tools & Quick Guides

Prior to the implementation of PDPM and as a result of a national pandemic, the post-acute care industry experienced significant shifts. Margins were eroded even further as costs skyrocketed. Understanding and operating successfully in this new payment model during a pandemic means accurately capturing every dollar providers are entitled to. Concept Rehab was an early adopter responding to these needs by putting forth education, tools and resources to support providers and to drive their success. Concept Rehab’s proprietary PDPM Analyzer is an innovative interdisciplinary tool that assures accurate and optimal reimbursement while focusing on enhancing quality as well. Our PDPM Quick Guides are discipline-specific, reference coding tools that ensure accurate coding and capture of all patient characteristics to match the level of care being provided with reimbursement.

In response to the latest reimbursement changes and updates, Engage Consulting, a subsidiary of Concept Rehab, has made key updates to all of these tools and Quick Guides that are essential to assist MDS teams and facilities in strategically managing PDPM. Feedback indicates that these tools have been essential to enhancing the performance of their MDS and Interdisciplinary teams when used on a daily basis and infused within the daily operations of their SNF.