There were a lot of unknowns with PDPM, but thanks to MatrixCare, we were set up to get reimbursed on time, the first time.

Greg Sewell, Director of Clinical Analytics & Reimbursement, Healthcare Management Services
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Patient-driven payment model

MatrixCare resources to support your preparation.

MatrixCare is fully prepared to guide providers toward success under the Patient-Driven Payment Model (PDPM)! Here you’ll find a wealth of related information and resources about the MatrixCare integrated platform for active care management—how we are addressing PDPM compliance within our technology, as well as how our solution is designed to help you maximize reimbursements under value-based care. We will continue to add resources to this page as they become available.

Prepare for PDPM and beyond


Webinar resources

High performing SNF operators leverage technology and innovative practices to maintain superior leadership status. Don’t miss the opportunity to engage with industry experts and MatrixCare by registering for our PDPM front runner webinar series every month.

Register for upcoming events

Video resources

On demand recorded webinar: developing a successful facility action plan for Patient-Driven Payment Model (PDPM) & ICD-10-CM

In this session:

  • An overview of the requirements of PDPM
  • The impact of ICD-10-CM codes on reimbursement
  • The importance of clinical documentation
  • Strategies for developing a successful facility action plan
Watch now

On demand recorded webinar: get ready for the Patient Driven Payment Model (PDPM)

In late July, CMS released the Final rule for FY 2019 which “replaces the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUG-IV) model, with a revised case-mix methodology called the Patient-Driven Payment Model (PDPM) beginning on October 1, 2019”. Learn how PDPM differs from RUGS-IV and what you need to do in order to be ready for the proposed October 1, 2019 implementation date.

Watch now

CMS resources

CMS has published a PDPM site that includes a variety of educational and training resources to assist stakeholders in preparing for PDPM implementation including PDPM Fact Sheets, FAQs, Training Presentations, and PDPM Resources.

Important highlights:

  • Fact Sheets > MDS changes
    • Page 3, New MDS Item Sets: IPA and OSA
    • Page 3, New MDS Item: Section I: SNF Primary Diagnosis
    • Page 3, New MDS Items: Section J: Patient Surgical History
    • Page 5, New MDS Item: Section GG: Interim Performance
  • PDPM Frequently Asked Questions > PDPM FAQs
    • Page 34, Section 14: Transition Policy and Medicaid Issues2: How will I get a PDPM payment code to bill starting October 1, 2019?
  • PDPM Resources > PDPM classification walkthrough
    • New version of the document that defines each portion of the PDPM calculation

Draft version of 2019 MDS item sets now available
CMS has posted a new DRAFT version of the 2019 MDS item sets (v1.17.0). This version is scheduled to become effective October 1, 2019. There are a large number of changes that are outlined for what is coming.

Changes include:

  • First look at the Interim Payment (IPA) and Optional State Assessment (OSA) forms.
  • The only response values for A0310B are:
    • 5-day
    • IPA
    • Not PPS Assessment (None of the above)
  • The OSA form has added a new question: A0300B- Assessment type. Responses include:
    • Start of therapy assessment.
    • End of therapy assessment
    • Both Start and End of therapy assessment
    • Change of therapy assessment
    • Other payment assessment
  • Question I0020, answer value 14, Other Medical Condition has been deleted and the associated diagnosis code I0020A has also been deleted, replaced by I0020B.

Visit CMS website to download MDS 3.0 Item Sets v1.17.0 (DRAFT) for October 1, 2019 Release.

PDPM (Patient Driven Payment Model): outcomes matter! (blog)

Preparing for the patient-driven payment model (blog)

MatrixCare PDPM technology empowers providers to transition with ease (blog)

American Association of Nurse Assessment Coordination (AANAC)

MatrixCare is proud to partner with American Association of Nurse Assessment Coordinators (AANAC) in providing you easy access to their publicly available PDPM content. Founded in 1999, AANAC has earned the reputation as the premier resource and network for long-term care professionals involved in the RAI/MDS process. AANAC is known for their excellent resources in all aspects of information regarding long-term care resident assessment and care planning.

Learn more

Do you have questions about how MatrixCare is helping prepare you for PDPM?

Learn more about how our services can help you succeed.

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