Setting your Unknown CMI Values for PDPM Electronic Health Records

Most EHRs will require you to set up some CMI estimates for the rate components of your PDPM rate calculation.  The purpose of this is to set a place holder rate for your “Unknown” PDPM scores.  

We tried to take a realistic look at where the majority of patients would fall into and set a conservative average of those numbers.  You can adjust your estimates based on the type of patient that you usually get.  It is generally better to be conservative and adjust to the good in the following month. 

As a conservative estimate I suggest the following scores for this step:

PT: 1.45

OT 1.50

SLP 1.80

Nursing 1.75

NTA 1.15

The NTA estimate is the wildest.  Because, when you are setting the Unknowns, you are talking about patients in their first few days of their stay.  That is when, for the first 3 days, the NTA component is tripled.  The NTA portion has a great amount of variance to begin with, and then you are primarily addressing the first 3 days. This portion of the rate will vary from the low $200’s to over $700 for these first 3 days.

Whatever you choose, be sure to let your finance folks know to expect a lot of variance out of that portion of the rate estimate.