Updates

PDPM Clarification

On July 1, 2023, two rates were calculated, one was based on PDPM nursing component CMI, and one was based on RUGs III. The higher of the two rates was used for each provider as a phase-in to PDPM. However, beginning 07/01/2024, only PDPM rates will be calculated using the PDPM nursing component (no change from 07/01/2023). Colorado will not be 'switching' to full PDPM come 7/1/2024. For the PDPM 'implementation', only the nursing component has been and will be used. No other PDPM components will be included beginning 07/01/24. A link to the PDPM CMI rates has been provided as a reference guide and useful tool.

CMS Released Final MDS 3.0 Item Matrix for Oct. 2024 Item Sets

Going forward CMS will now be posting the matrix and any updates independently on the RAI User’s Manual webpage in the downloads section. The matrix identifies which MDS items will be included on each MDS 3.0 item set and now identifies which program and policy the item is used for.  

The newly released MDS 3.0 Final Item Matrix V1.19.1 will go into effect on October 1, 2024. 

From the Medicare Learning Network: Medical Records Request Scam: Watch out for Phishing 

CMS identified phishing scams for medical records. This may include scammers faxing you fraudulent medical records requests to get you to send patient records in response; see example (PDF).

When you review any requests, look for signs of a scam, including:

• Directing you to send records to an unfamiliar fax number or address

• Referencing Medicare.gov or @Medicare (.gov)

• Indicating they need records to “update insurance accordingly” 

A scam request may include:

• Poor grammar, misspellings, or strange wording

• Incorrect phone numbers

• Skewed or outdated logos

• Graphics that are cut and pasted

If you think you got a fraudulent or questionable request, work with your Medical Review Contractor to confirm if it’s real. Submit medical documentation through the Electronic Submission of Medical Documentation (esMD) system or CMS medical review contractor secure internet portals, when available.