DRL Holdings Intelligence · Internal methodology

PDPM Component Driver Card

Focus on PT/OT and SLP — the therapy-related case-mix components that most often drive both under-documented revenue and audit exposure. Use on every chart review. Evidence-only · Flat-fee · BAA-first.

Workbook Sheet 12 Components PT/OT · SLP Version 1.0

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Under PDPM

Five case-mix adjusted components

Payment is driven by PT/OT, SLP, Nursing, NTA, and non–case-mix. This card focuses on the two therapy-related drivers (1 & 2). Facility CMI = average of case-mix weights across Medicare Part A stays. Full formula: How to calculate CMI.

CMI at a glance
Item	Definition
CMI	Σ (Case-Mix Weight of each stay) ÷ Number of stays · Excel: `=AVERAGE(weight_range)`
CMI Gap	Observed CMI − Neutral (or Peer) CMI · negative = under-capture · Excel: `=Observed_CMI - Neutral_CMI`
Workbook	Sheet 12 · Section G — Methods 1–3 + copy-paste formula summary
Leak link	~0.08–0.15 pt gap below neutral often ≈ 4–8% Medicare revenue shortfall

Evidence Strength (assign on every finding)
Flag	Meaning
Strong	Notes + orders + MDS aligned — claim or opportunity well supported.
Partial	Notes exist; MDS incomplete or timing/GG mismatch — typical opportunity.
Weak / Missing	Payment claimed or opportunity present with thin concurrent support — audit risk.

Component 1

PT / OT Component Drivers

What drives the PT/OT case-mix group: primary reason for SNF stay (clinical category); functional score from Section GG (self-care + mobility); comorbidities or surgical history that map to higher payment groups.

Most frequent documentation gaps
Gap	Why it matters	Typical $ / stay	How it shows in charts
Incomplete or conservative Section GG	GG score is a direct input to the PT/OT payment group	$80–$250+	Missing items, “activity not attempted” overused, or scores that don’t match therapy notes
Therapy minutes under-recorded / not linked	Incomplete therapy documentation weakens clinical category and GG justification (PDPM is not minute-driven like RUG-IV)	$100–$300	Therapy notes exist but are not reflected in the MDS or are too generic
Primary diagnosis lacks specificity	Wrong or vague primary diagnosis can drop the patient into a lower clinical category	$150–$400	“Aftercare” or symptom codes instead of the underlying condition
Function not reassessed on schedule	GG must be completed in the required look-back; late or missing assessments default to lower scores	Variable	Assessment timing errors

Workbook sub-drivers (Sheet 12)
Sub-driver	Use
Section GG scoring quality	Compare GG to therapy narrative. Conservative GG → opportunity. Aggressive GG without support → Doc Risk.
Primary diagnosis / clinical category	Non-specific primary → lower clinical category (opportunity). Unsupported category → audit risk.

Opportunity signal: GG systematically lower than therapy narrative, or non-specific primary diagnoses.
Audit signal: Overly aggressive GG not supported by concurrent therapy notes or nursing documentation.

Component 2

SLP Component Drivers

What drives the SLP case-mix group: acute neurologic condition, swallowing disorder, or related comorbidity; cognitive impairment (BIMS or staff assessment); mechanically altered diet or swallowing indicators; SLP services provided and documented.

Most frequent documentation gaps
Gap	Why it matters	Typical $ / stay	How it shows in charts
Swallowing / diet texture not clear	Direct SLP payment triggers	$70–$200	Diet orders exist but the MDS item is blank or “no”
Cognitive impairment under-coded	BIMS score or staff assessment missing or incomplete	$50–$180	Nursing notes describe confusion but BIMS is not completed or is outdated
SLP evaluation not reflected in MDS	Services happened; the payment group never activated	$80–$220	Therapy notes present, MDS SLP items blank
Neurologic dx not primary/secondary	Clinical category or comorbidity list misses the driver	$100–$300	CVA, Parkinson’s, etc. buried in history rather than active diagnoses

Opportunity signal: SLP saw the patient, a modified diet is ordered, or nursing describes cognitive changes — yet MDS SLP items are blank or minimal.
Audit signal: SLP payment groups claimed without concurrent clinical evidence of the neurologic condition, swallowing problem, or cognitive impairment.

System fit

How these two components feed the scores

Score linkage
Finding pattern	Score effect
High PT/OT + SLP opportunity (Partial/Strong evidence)	Raises Revenue Opportunity Score
High unsupported SLP or aggressive GG (Weak / Missing)	Raises Documentation Risk Score

Enter component gaps on workbook sheet 12_CaseMix_PDPM. Assign Evidence Strength on every row. Suggested score uplifts are calculated there for judgment — they do not silently overwrite sheet 06.

Download workbook Methodology Card v1.1 Disclosures

DRL Holdings Intelligence · PDPM Component Driver Card v1.0
Evidence-only · Flat-fee · BAA-first · Not coding advice — facility clinicians validate before billing changes