Question

Felix is a Medicare Resident in a SNF. He is recovering from a hip replacement and has a function score of 7. What is PT case-mix index used in the per diem reimbursement calculation?

Answer 1

The PT case-mix index is a component of the PDPM used to calculate per diem Medicare payments for services provided by SNFs based on a patient's functionality and other factors. For Felix with a function score of 7, the exact case-mix index would be determined by referencing the PT component of the PDPM system.

Step-by-step explanation:

The question pertains to how the Physical Therapy (PT) case-mix index is utilized in the reimbursement calculation for a Medicare resident at a Skilled Nursing Facility (SNF). The PT case-mix index is part of the Patient-Driven Payment Model (PDPM), which is used to determine the per diem Medicare payment for SNF services. A patients function score is an important determinant in this model. In Felix's case, with a function score of 7, you would need to reference the PT component of the PDPM case-mix classification system to determine his case-mix index. Each function score corresponds to a specific case-mix group that has an associated case-mix index value, which influences the reimbursement amount. The exact case-mix index would depend on additional factors beyond the function score, including the severity of the patient's conditions and the services needed.