PDPM Worksheet Guide
(16 Pages)
 
A simple form to help MDS-involved staff calculate and determine each of the PDPM case-mix components: PT, OT, SLP, Nursing and NTA.  This guide is simplified to be used by a busy MDS nurse or MDS-involved clinician.  The form was made for those who  need to quickly check if a resident has Medicare skilled coverage or to approximately calculate the PDPM HIPPS code.  (This form is similar to the RUG-IV table that breaks down patient conditions to determine the resident's level.)

This is a 16 page PDF file revised based on MDS 3.0 RAI User's Manual v1.18.11 effective October 1, 2023.  The first portion of the file has 5 pages of worksheets (plus 1 blank for page placement) that lists the step-by-step collection of data to calculate levels or codes.  The second portion is a 10-page PDPM guide of 'conversion' tables to calculate scores, levels, groups, classifications and codes.   The ICD 10 mapping (free from CMS.gov and free for download in the Free Forms & Resources page) provided by CMS is to be used in conjunction with this guide. 
 
Reminder:  The sample rate is based on an Urban rate from the Federal Register for the current fiscal year.  Your patient's actual daily reimbursement will vary due to other factors (County, QRP rates, etc.).  Your own county's rate is not in this guide as this form is based on the worksheets in Chapter 6 of the RAI User's Manual which does not include those other factors.  
 
The actual guide will not have the large logo watermark as seen in the sample images.
 
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This is a digital download. If unable to open file, a different format will be emailed within the next business day. Sorry, no refunds because this is a digital format.