Quiz: PDPM – Mastering the Patient Driven Payment Model – RMTP 2025

The original reason the Patient Driven Payment Model was created for was to drive reimbursement for residents in the SNF with which active primary payer:

The main reason CMS decided to retire the RUG-IV system and transition to the new PDPM model on 10/1/19 was:

What were the main therapy trends for Medicare Part A residents that CMS was concerned about under the RUG System?

PDPM is made up of 5 components that are solely determined by how the MDS is answered. The 5 components are:

The PDPM will allow Medicare Part A covered resident to score in each of the 5 case mix component groups (based on the MDS) AND the SNF will receive payment for each group even if the resident is not on an active therapy program.

(ie: The facility is reimbursed for the PT, OT and Speech Components whether the resident is on therapy or not)

Both the Nursing Function Score and the Therapy Function Score are derived from what Section of the MDS?

Which statement(s) about Section GG are true?

The Nursing Function Score uses 4 Sections from GG: Eating, Toileting Hygiene, Bed Mobility and Transfers. The Therapy Function Score uses these same 4 Sections, and also uses 2 additional questions/sections from GG. These are:

A Nursing Function Score ranges from 0-16 and a Therapy Function Score ranges from 0-24. A resident with a score of 24 would represent a resident with what type of function in the Self Care and Mobility items?

Using your PDPM (cheat sheet) handout, how would you code the following resident for the Nursing Case Mix Group Component:

• Respiratory Therapy for 7 days of the look-back period coded in Section O
• PHQ2-to-9 Score (Mood Interview) of 0 = Not depressed
• Nursing Function Score of 10

Using your NTA Point Guide handout, how many points would a resident with the following receive?

• IV Feedings/Fluids for dehydration received in the HOSPITAL
• IV Medication while a resident
• COPD
• Malnutrition

The Main Clinical Categories for the PT and OT Component are:

1. Major Joint Replacement or Spinal Surgery
2. Other Orthopedic
3. Medical Management
4. Non-Orthopedic Surgery or Acute Neuro

Where the resident falls is determined by the Primary ICD-10 Code put in Section I0020B of the MDS.

How do you know which Clinical Category the main ICD-10 code selected by your SNF will fall into?

True or False: PT and OT will always share the Case Mix Group (ie: TA, TB, TC…). However, the total daily reimbursement rate for PT and OT will always be different because the Case Mix Index values and unadjusted per diem Federal Rates for each discipline are different.

Using your PDPM Case Mix Group Green Sheet, what is the likely Case Mix group for the PT and OT Component with a resident having the following characteristics:

• Total Knee Replacement
• Therapy Function Score of 8

Which one of the following is NOT a factor in determining the Speech Therapy Component under PDPM?

CMS stated Group Therapy need, type and size should be determined ONLY by the clinician and have supporting documentation in the record as to why Group is needed vs Individual. If a Medicare Part A resident is part of a group treatment, how many residents can be in the same group?

The total combined amount of Concurrent and Group Therapy provided over the course of a resident’s Medicare Part A coverage, per discipline is:

Using your Non-Therapy Ancillary Point Guide print-out, what would be the total number of points and the resulting Case Mix Group for a resident with the following:

• COPD
• Diabetes

Total payment to the SNF per day is determined by:

The resident’s Case Mix Groups and resulting daily reimbursement rate for the entire Part A stay will be determined by 1 MDS assessment (assuming no IPA’s are done). What is this assessment?