Under PDPM the payment follows what was assessed and coded, not what was delivered. A care need that went unrecorded is revenue that never existed, and the error rates are not small.
error rate in the speech PDPM category, the highest of any component, driven by documentation gaps between disciplines. SimpleLTC PDPM assessment data — as reported by Skilled Nursing News
error rates for the non-therapy ancillary and nursing components respectively. SimpleLTC PDPM assessment data — as reported by Skilled Nursing News
many states moved Medicaid onto PDPM, extending the same coding exposure from Medicare to the larger payer. MDS Consultants
civil penalty per day of non-compliance under New York state staffing standards. State floors remain enforceable. Bonadio Group
One correction on the federal picture, because getting it wrong cuts the other way: the CMS 3.48 HPPD minimum staffing standard is NOT in force. Public Law 119-21 section 71111 bars enforcement through September 2034 and CMS rescinded it by interim final rule on December 3, 2025. State floors are unaffected and are what you are actually measured against. Our staffing calculator was updated to say exactly that rather than keep testing against a rule with no force.
Six that close the biggest gaps. 11 in the full senior care and aging services library.
The gap it closes. The per-diem is a sum of component rates with case-mix indices and a variable per-diem adjustment schedule. Computing it explicitly shows which component carries the rate, which is where a coding gap becomes visible.
See it run in your browser →The gap it closes. Your state floor is the operative requirement now that the federal standard is rescinded. This computes hours per resident day against the floor you enter and reports the exact hours needed to close a shortfall.
See it run in your browser →The gap it closes. Benefit-day exhaustion and the day-21 coinsurance step are the two points where a resident silently becomes private-pay or a Medicaid conversion, and where a facility finds out late.
See it run in your browser →The gap it closes. The transfer penalty is arithmetic on dates and the state divisor. Getting it wrong at admission sets an expectation with the family that the facility later has to unwind.
See it run in your browser →The gap it closes. Break-even is not one occupancy number. It moves with payer mix, and a census that works at one Medicare share loses money at another.
See it run in your browser →The gap it closes. Deductible, coinsurance and out-of-pocket-maximum interaction is the estimate families are given verbally and hold the facility to afterwards.
See it run in your browser →These are calculators over cited rules and rates, not billing, clinical or legal advice, and no substitute for your MDS coordinator or reimbursement consultant. Rates and floors are dated inputs you confirm for your state and period, and the tool always shows which figures it used so a stale rate cannot silently change an answer.
Every tool above runs entirely in this browser tab. Nothing is uploaded, nothing is sent to a model, and each result cites the rule it applied.
Free tier, no card, no install. An account saves your work and lets you export a citable record of a run. See all 11 senior care and aging services tools.