The free PDPM patient classifier used by MDS coordinators and clinical teams. Enter ADL scores and clinical indicators — get the case mix group and estimated daily reimbursement range in seconds.
Complete clinical profile → case mix group assignment → estimated daily rate range. Use during assessment planning, discharge planning, and billing review. Not a substitute for certified MDS coding.
Case mix group and rate estimates are based on published FY2026 CMS PDPM rates. Actual reimbursement depends on your facility's geographic wage index, specific MDS coding, and payer contracts. This tool is for planning and review purposes only — not for billing use. Always confirm with a certified MDS coordinator.
Under PDPM, the case mix group drives payment. Accurate classification is simultaneously a clinical accuracy requirement and a revenue integrity issue. Getting it wrong — in either direction — has consequences.
Under the old RUG system, more therapy minutes meant higher payment. Under PDPM, what drives payment is the patient's clinical profile — diagnosis, functional status, comorbidities, and care needs. Therapy is provided based on clinical need, not billing optimization.
→ Accurate MDS coding is now the revenue driverThe Non-Therapy Ancillary (NTA) component triples for the first three days of a SNF stay. This rewards facilities for accepting medically complex patients. Facilities that document and code NTA comorbidities accurately capture significantly higher reimbursement during this high-acuity window.
→ The 72-hour documentation window is irreversibleSection GG captures functional self-performance during the 3-day assessment window. Coding the patient's usual performance (not their best or worst performance, not their anticipated performance) requires clinical judgment, direct observation, and accurate documentation. Section GG errors affect both PDPM payment and quality measure reporting.
→ What the patient actually does, not what they can doThe Program for Evaluating Payment Patterns Electronic Report (PEPPER) flags facilities whose case mix patterns fall outside normal ranges. Facilities with unusually high proportions of high-complexity NTA or nursing categories may face targeted audit activity. Accurate coding protects both revenue and compliance.
→ Your case mix tells a story that surveyors readPDPM updates, MDS guidance, NTA documentation tips, and case mix benchmarking — delivered before your morning meeting.