Question

Sal is a Medicare resident in a SNF. Sal has septicemia (serious medical condition I) and depression. His function score is 6. What is the PDPM nursing CMG used in the per diem reimbursement calculation?

Answer 1

The PDPM nursing CMG for a Medicare resident with septicemia, depression, and a function score of 6 is determined by the detailed classification system provided by CMS, reflecting the complexity of required care.

Step-by-step explanation:

The PDPM (Patient-Driven Payment Model) nursing CMG (Case-Mix Group) for Medicare resident Sal in a Skilled Nursing Facility (SNF), who has septicemia and depression, with a function score of 6, is based on a complex algorithm that takes into account his clinical condition, mental status, and functional abilities. The specific CMG can only be determined using the detailed PDPM classification system provided by the Centers for Medicare & Medicaid Services (CMS). The intent of PDPM is to provide a per diem reimbursement to SNF that reflects the costs associated with the complexity of care required for each individual resident.