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PDPM Medicare Classification and Mobile X-ray Reimbursement



The Patient Driven Payment Model (PDPM) is a new Medicare classification system that changes the way health service providers are reimbursed. The PDPM is designed to improve the quality of care and reduce costs by paying providers based on the patient's needs rather than the volume of services provided.


Under the PDPM, providers are reimbursed for the following:

  • Patient-level assessments and care planning

  • Patient-level interventions

  • Patient-level outcomes

Providers are paid a base rate for each patient, and then additional payments are made for patient-level assessments and interventions. The amount of additional payment is based on the complexity of the patient's needs and the quality of care provided.


Reimbursement Changes

The PDPM is being implemented in phases, with the first phase starting in January 2023. By 2026, all Medicare-certified home health agencies will be required to use the PDPM.


The PDPM is a significant change to the way Medicare reimburses home health agencies. Providers will need to make changes to their operations in order to comply with the new requirements.


The PDPM is a complex system, and providers will need to take steps to prepare for its implementation. Here is a worksheet provided by CMS to help calculate for SNF’s. By understanding the requirements of the PDPM and making the necessary changes to their operations, providers can ensure that they are reimbursed fairly for the care they provide.

Impact on Mobile X-ray Services

Mobile X-ray services are impacted by the Patient Driven Payment Model (PDPM) in a few ways. 


  1.  PDPM requires providers to develop a patient-centered care plan for each patient. This plan must include a list of all the services that the patient will need, as well as the frequency of those services. Mobile X-ray services will need to be included in this plan if they are necessary for the patient's care.

  2. PDPM requires providers to track patient outcomes and report them to Medicare. This means that mobile X-ray services will need to be able to track the results of the X-rays and report them to Medicare.

  3. PDPM requires providers to use evidence-based practices to improve the quality of care. This means that mobile X-ray services will need to use the latest technology and techniques to ensure that the X-rays are accurate and of high quality.

MLA is Prepared

Overall, the PDPM is a significant change to the way Medicare reimburses home health agencies. Mobile X-ray services will need to make changes to their operations in order to comply with the new requirements. However, by making these changes, mobile X-ray services can ensure that they are reimbursed fairly for the care they provide. Mobile X-ray of Louisiana is preparing to implement those changes in the new year. 


In addition to the above, there are a few specific ways in which mobile X-ray services are impacted by the PDPM for chest X-rays.


  1. PDPM includes a new payment category for chest X-rays. This category is called "Complex Chest X-ray" and it is used to reimburse mobile X-ray services for chest X-rays that are complex or difficult to interpret. The amount of reimbursement for a Complex Chest X-ray is based on the complexity of the X-ray and the time it takes to interpret the X-ray.

  2. PDPM includes a new payment modifier for chest X-rays. This modifier is called "Remote Interpretation" and it is used to reimburse mobile X-ray services for chest X-rays that are interpreted by a radiologist who is not located at the same site as the patient. The amount of reimbursement for a Remote Interpretation is based on the time it takes to interpret the X-ray and the distance between the patient and the radiologist.


Overall, the PDPM is a significant change to the way Medicare reimburses mobile X-ray services for chest X-rays. By understanding the new payment categories and modifiers, mobile X-ray services can ensure that they are reimbursed fairly for the care they provide.

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