1. What is PDPM Calculator for FY 2023?

Definition: This calculator computes the daily rate under the Patient-Driven Payment Model (PDPM) for skilled nursing facilities in fiscal year 2023.

Purpose: It helps healthcare administrators and financial analysts determine the reimbursement rate for Medicare Part A patients in SNFs.

2. How Does the Calculator Work?

The calculator uses the formula:

Where:

• \( PT \) — Physical therapy component rate
• \( OT \) — Occupational therapy component rate
• \( SLP \) — Speech language pathology component rate
• \( Nursing \) — Nursing component rate
• \( NTA \) — Non-therapy ancillary component rate
• \( Non\text{-}Case\text{-}Mix \) — Non-case-mix component rate

Explanation: The daily rate is the sum of all six PDPM components as defined by CMS for FY 2023.

3. Importance of PDPM Calculation

Details: Accurate PDPM rate calculation ensures proper Medicare reimbursement and helps facilities maintain financial stability while providing quality care.

4. Using the Calculator

Tips: Enter all component rates in dollars. Values must be ≥ 0. The calculator sums all components to give the total daily rate.

5. Frequently Asked Questions (FAQ)

Q1: Where do I find the component rates?
A: Component rates are determined by CMS based on patient characteristics and can be found in the PDPM grouper tool or CMS documentation.

Q2: Does this include variable per diem adjustments?
A: No, this calculates the base rate. Variable per diem adjustments for NTA and PT would need to be applied separately.

Q3: Is this calculator specific to FY 2023?
A: Yes, rates and components are specific to FY 2023. Later years may have different rates or components.

Q4: How often should I calculate the PDPM rate?
A: Rates should be calculated for each patient at admission and reassessed with any significant change in condition.

Q5: What about the urban/rural adjustment?
A: This calculator shows the unadjusted rate. Apply the appropriate wage index separately based on facility location.