Health Reform WK-EDGE Overall SNF payments likely to increase by $784M in 2021
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Monday, April 20, 2020

Overall SNF payments likely to increase by $784M in 2021

By Kayla R. Bryant, J.D.

CMS’ proposed SNF PPS rule would change some ICD-10 code mappings for 2021, and the agency is looking for stakeholder feedback on these changes.

CMS’ skilled nursing facility (SNF) prospective payment system (PPS) proposed rule estimates a 2.3 percent market basket update factor for unadjusted federal per diem rates. This number reflects a market basket increase of 2.7 percent adjusted downward 0.4 percent due to the multifactor productivity (MFP) adjustment. CMS will continue to monitor the impact of the patient driven payment model (PDPM), which was implemented for the FY 2020 year (Proposed rule, 85 FR 20914, April 14, 2020).

Unadjusted federal rates. The PDPM created a new case-mix classification system, which divided rates into six components: physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), nursing, non-therapy ancillaries (NTA), and a non-case-mix component. For 2021, prior to adjustment for case mix, the urban proposed per diem rates are:

  • PT: $62.04;
  • OT: $57.75;
  • SLP: $23.16;
  • Nursing: $108.16;
  • NTA: $81.60; and
  • Non-case-mix: $96.85.

The rural proposed rates are:

  • PT: $70.72;
  • OT: $64.95;
  • SLP: $29.17;
  • Nursing: $103.34;
  • NTA: $77.96; and
  • Non-case-mix: $98.63.

PDPM ICD-10 mappings. The PDPM uses ICD-10 codes to assign patients to clinical categories under the PT, OT, SLP, and NTA components. CMS proposes several changes to PDPM code mappings and lists for FY 2021. Clinical classifications may change if the patient had a major procedure during the inpatient stay prior to the SNF stay, and current ICD-10 codes associated with cancers do not include the major inpatient procedure option. CMS proposes to add surgical clinical category options to many category mappings for certain diagnoses, because the presence of a surgical procedure may affect the plan of care. Other changes include default clinical categories for fracture codes, surgery aftercare code default mapping, and NTA comorbidity code mapping.

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