Chapter 6 workbook
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Dec 6, 2023
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Chapter 6
Beginner Exercises
1.
PDPM Key Terms Word Search (Level 1—Remembering)
Use the clues to determine the key term, then find the key term in the grid.
Copyright ©2021 by the American Health Information Management Association. All rights reserved.
Principles of Healthcare Reimbursement and Revenue Cycle Management
Student Workbook
Chapter 6
2.
Chapter 6 PPS Grid (Level 2—Understanding)
For this exercise use the file AB202019_Ch06_Payment System Grid.docx. Complete the grid by using
information provided in the textbook. Students should include a brief explanation for each category rather
than a “yes” or “no.” This grid may be used as
a study guide for exams.
Intermediate Exercises
1.
Practice with PDPM CMGs (Level 3—Applying)
Determine the CMG for the PDPM component discussed in each case presented below. Use
tables included in chapter 6 to determine the CMG.
Case 1—PT and OT (Table 6.1)
The resident’s clinical category is “Other Orthopedic” and the patient has a function score of 7.
CMG:
TF
Case 2—SLP (Table 6.4)
The resident’s clinical category is “Acute Neurologic.” The resident has a swallowing disorder
and cognitive impairment.
CMG:
SH
Case 3—Nursing (Table 6.5)
The resident has a clinical condition category of “Serious Medical Conditions I.” The resident
has depression and a function score of 12.
CMG:
HBC2
Case 4—NTA (Table 6.6)
The resident has a NTA socre of 15.
CMG:
NA
2.
Examining Resource Consumption (Level 4—Analyzing)
In the Medicare Skilled Nursing Facility Services Payment System, the case-mix index value
represents the level of resource consumption, similar to the relative weight of MS-DRGs in the
Medicare Hospital Acute Inpatient Services Payment System. Examine table 6.5 in the textbook.
Using the questions below as a guide, analyze the connection between PDPM nursing elements
and resource consumption.
Note:
A higher function score indicates that the resident is more
independent (i.e., can perform tasks alone or with some help). A lower function score indicates
the resident is dependent on assistance.
a.
Review the “Serious Medical Conditions I” rows in table 6.5. How does depression impact
the case-mix index?
Depression does impact the case-mix index by performing a PHQ-9
Copyright ©2021 by the American Health Information Management Association. All rights reserved.
Principles of Healthcare Reimbursement and Revenue Cycle Management
Student Workbook
Chapter 6
b.
Review the “Serious Medical Conditions II” rows in table 6.5. How does the function score
impact the case-mix index?
The function score is Serious Medical Conditions II and it impacts the case-mix index by either
increasing or decreasing reimbursement to the facility. The higher the function score of the
illness, the higher the payment for what it would take to care for this type of patient.
c.
Review the “Conditions requiring Complex Medical Care” rows in table 6.5. How does the
combination of depression and function score impact the case-mix index?
The combination of depression and function score in Conditions requiring Complex Medical
Care impacts the case-mix index by decreasing reimbursement to the facility. The
combination depression and complex medical care function would have a lower payment to
to care for this type of patient.
d.
Examine “Behavioral or Cognitive Symptoms” and “Assistance with Daily Living and
General Supervision” rows in table 6.5. How does the use of restorative nursing impact case-
mix index?
The use of restorative nursing in Behavioral or Cognitive Symptoms and Assistance with Daily
Living and General Supervision impacts cae-mix index by decreasing payment because its
included as the facility’s basic care.
Copyright ©2021 by the American Health Information Management Association. All rights reserved.
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