PDPM Documentation Essentials for the IDT: Introduction to Nursing Facility Payment and Documentation-AAPACN PDPM Audit by MDS Section

AAPACN PDPM Audit by MDS Section

Pdf Summary

The 2025 AAPACN PDPM Audit tool provides a structured guide for auditing PPS assessments using MDS (Minimum Data Set) sections A through O to evaluate Patient-Driven Payment Model (PDPM) reimbursement accuracy. It highlights specific MDS items relevant to PDPM components—Physical Therapy/Occupational Therapy, Speech Language Pathology, Nursing, and Non-Therapy Ancillary—and flags areas requiring thorough documentation review.<br /><br />Key sections and relevant items include:<br /><br />- Section B: Communication ability (e.g., comatose status, ability to make self understood).<br />- Section C: Cognitive functioning, including memory and decision-making skills.<br />- Section D and E: Mental health and behavioral symptoms such as mood severity, hallucinations, delusions, rejection of care, and wandering.<br />- Section GG: Functional status measures including eating, oral hygiene, toileting hygiene, transfers, and walking abilities, with attention to specific scoring columns.<br />- Sections K and J: Swallowing and nutritional status (e.g., dysphagia signs, feeding tube use, weight loss) and clinical symptoms like shortness of breath, fever, recent surgery.<br />- Section I: Active diagnoses affecting PDPM such as infections, neurological conditions (stroke, TBI, cerebral palsy), diabetes, respiratory diseases, malnutrition, and wounds.<br />- Sections M and N: Wounds and skin ulcers (stage and type), treatments, and insulin management.<br />- Section O: Clinical treatments including chemotherapy, radiation, oxygen therapy, mechanical ventilation, IV medications, dialysis, isolation for infectious diseases, respiratory therapy, and restorative nursing programs.<br />- Also, Medicare claim diagnosis of HIV/AIDS (ICD-10-CM B20) is noted for relevance.<br /><br />This audit tool is designed solely for PPS assessments (A0310B codes 1 or 8) and aims to ensure coding accuracy aligning with reimbursement rules. It serves as an informative checklist for compliance but does not constitute legal or regulatory advice. The detailed mapping of MDS item codes to PDPM components assists clinicians and auditors in pinpointing areas that could affect payment and require supplementary clinical documentation for validation.

Keywords

AAPACN PDPM Audit Tool

PPS Assessments

Minimum Data Set (MDS)

Patient-Driven Payment Model

Physical Therapy

Occupational Therapy

Speech Language Pathology

Nursing Documentation

Non-Therapy Ancillary

Medicare Reimbursement