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PDPM Reimbursement

Ways to Manage an MDS Nurse for Your PDPM Reimbursement


For PDPM reimbursement to work, a holistic approach must be taken. It encompasses the systems in the facility and how they work together to provide care to the residents. It is a combination of departments that views the residents from different angles. In that case, admissions, social workers, dietitians, nurses, and billing work collectively to provide these angles. Therefore, keeping these systems in good shape makes it easy to maximize your PDPM reimbursement. The MDS nurse is the facility detective who ensures all processes are met. Therefore, all entities must collaborate to support the nurse in raising the reimbursement score. Even though the MDS is key to calculating PDPM reimbursement, they require support from others. This article will discuss the role of several team members in supporting the MDS nurse. For MDS in nursing homes to work well, different parties must be involved to provide the correct documentation to help secure reimbursement.

Nursing Home Administrator Support

Nursing home administrators play a significant and vital role in the facilities. They must ensure their systems are in good shape. Therefore, the administrator should communicate with the MDS nurse and confirm if they are interacting with nurses and physicians in the facility. MDS nurses need to get the information requires to calculate PDPM scores in the care software system. The administrator does not have to worry about the state of PDPM as long as there are no problems. They should make the nurse’s job easy by ensuring they have ample time to document. They can do this by lending a hand in places like communicating concerns, as the MDS nurse focuses on the details they have not registered.

The administrator should also set PDPM meetings where PDPM details will be discussed. During the meeting, the administrator will ask questions about PDPM on their new and old residents. They should use the details they get from the sessions to improve things and hold the people responsible accountable. Even if they are not in the meetings in person, they have a role of getting involved in the PDPM reimbursement details and understanding how the system impacts the reimbursement.

Director of Nursing Support

The work of the director of nursing is to look into financial and care matters. They need to oversee the systems in the facility and ensure they are getting the resources they need to keep these systems going. They carry out all the processes required to run the systems that allow the MDS nurse to secure PDPM reimbursement in the software.

They also play the duty of interacting with systems to make sharing of information possible. They ensure the residents get the necessary care and that everything is correctly documented in the long-term care software. In short, the director of nursing plays a significant role in helping the MDS nurse get the reimbursement details. This makes it easy for MDS nurses to calculate the DPM score in line with Medicaid and Medicare PDPM guidelines.


It is crucial for leaders in nursing home facilities to understand how PDPM works and how systems interactions impact reimbursement. They must enhance communication between nurses and doctors to make it easy for MDS nurses to follow up and collect the necessary details. Therefore, various systems play a vital role in the progress of the MDS nurse.

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