1. What is PDPM Calculator FY 2025?

Definition: This calculator determines the daily rate under the Patient-Driven Payment Model (PDPM) for skilled nursing facilities in fiscal year 2025.

Purpose: It helps healthcare administrators calculate the total per diem rate by summing all PDPM components.

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
• \( \text{Nursing} \) — Nursing component rate
• \( NTA \) — Non-therapy ancillary component rate
• \( \text{Non-Case-Mix} \) — Non-case-mix component rate

Explanation: The PDPM daily rate is the sum of all six component rates that make up the payment model.

3. Importance of PDPM Calculation

Details: Accurate PDPM rate calculation ensures proper reimbursement for skilled nursing services and helps facilities maintain financial stability.

4. Using the Calculator

Tips: Enter each component rate in dollars. All values must be ≥ 0. The calculator will sum all components to give the total daily rate.

5. Frequently Asked Questions (FAQ)

Q1: What is PDPM?
A: The Patient-Driven Payment Model is the Medicare payment system for skilled nursing facilities that focuses on patient characteristics rather than volume of services.

Q2: How often are PDPM rates updated?
A: CMS typically updates PDPM rates annually. This calculator reflects FY 2025 rates.

Q3: Where can I find the component rates?
A: Component rates are published by CMS in the Federal Register and can vary based on patient classification and facility characteristics.

Q4: Does this include all adjustments?
A: This calculates the base rate. Additional adjustments (wage index, rural, etc.) may apply to the final payment.

Q5: How is Non-Case-Mix different from NTA?
A: Non-Case-Mix is a fixed per diem amount, while NTA varies based on patient conditions and services.