PDPM margin calculator for SNF admissions.
Rate calculators tell you what a stay pays. This models what it may net: your per-diem against your cost of care over the expected stay — one input admissions teams weigh when deciding whether a referral is a fit. A planning estimate with your own inputs, in your browser, no sign-up.
Model one admission.
Enter the per-diem you expect for the stay, the expected length of stay, and your cost of care. Defaults are illustrative placeholders — not benchmarks, industry averages, or typical results. Replace them with your own numbers before reading the output. Every output is an estimate, not a guarantee.
What this calculator does and does not do.
It multiplies your assumptions
Reimbursement, stay length, and costs are your inputs. If the referral packet does not support them — diagnoses, therapy needs, med list, payer terms — the estimate is wrong before it starts.
It does not set your rate
PDPM component rates come from the MDS assessment after admission; Medicare Advantage rates come from your contract. The methodology page explains how the classification works.
It cannot read the packet
The expensive surprises live in the referral packet: an unverified payer, a missing authorization, an undocumented high-cost medication. Arithmetic does not catch those — review does.
Where AdmitScore picks up
AdmitScore™ reviews the actual packet — payer risk, authorization gaps, missing documentation and high-cost meds, with source quotes behind packet-derived findings. Margin stays an administrator-only planning estimate. Staff verification remains required. See a sample report.
Verify the inputs this math depends on.
A margin estimate is only as good as the packet behind it. These are the checks admissions teams run before trusting the number.
Payer and authorization
Is the payer verified, and does a Medicare Advantage plan require prior authorization for this admission? Authorization readiness explains what to confirm.
Documentation behind the rate
Do the diagnoses, comorbidities, and functional status in the packet actually support the case-mix classification your rate assumes? PDPM admissions signals lists what to look for.
The medication list
One undocumented specialty medication can consume the modeled margin. High-cost med review covers the screen worth running.
Questions teams ask about this calculator.
Is this calculator a guarantee of margin?
No. It multiplies the numbers you enter — a flat per-diem, an expected length of stay, and your costs of care. Real PDPM payment varies over a stay and depends on documentation and payer terms, so treat the output as a planning estimate to verify, never a guaranteed result.
Where do I find my per-diem rate?
For Medicare Part A stays, your MDS classification (via your rate software) determines the PDPM per-diem; for Medicare Advantage, the contract sets the rate. If you only have a HIPPS code, a PDPM rate calculator converts it to component rates. This page explains margin modeling, not rate setting.
Does this send my numbers anywhere?
No. The calculator runs entirely in your browser. The numbers you enter are never stored, transmitted, or logged, and it never asks for patient information — dollars and days only. Site analytics are separate and load only if you accept cookies.