THURSDAY JUNE 23, 2022 2 PM EASTERN - 90 MINUTES, OHIO HEALTH CARE ASSOCIATION- Virtual Webinar, COST $35 FOR OHCA MEMBERS, $90 FOR NON-MEMBERS,, 6/23/22 Capturing Non-Therapy Ancillary (NTA) in PDPM. It is for this type of services they offer which also categorize them as skilled nursing and rehabilitation facilities becoming a, A long-term care facility provides custodial care requiring supervised, minimal or total dependence in the performance of the activities of daily living (. ) Payment is based on services provided by five disciplines: physical therapy, occupational therapy, speech language pathology, nursing, and non-therapy ancillary (NTA). These components for classification and payment include: Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST), Non-therapy Ancillary (NTA) as well as Nursing. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. $HJ0!$j-g#W d9bEi0~og$.J8-Lb =lZ.SSz|'!`%/ Additionally, PDPM applies variable per diem payment adjustments to three components, PT, OT, and NTA, to account for changes in resource use over a stay. The saying, haste makes waste applies in the completion of MDS assessments and calculation of the maximized PDPM rate for the patient. color: white; These residents may have a significant number of inaccurate or resolved diagnoses if a facility doesnt have a process for ongoing diagnosis reconciliation. Yes, I am aware that ICD-10 codes do change occasionally. MDS 3.0 Section I Thats a lot of white space. No paper. Patient has at least three qualifying inpatient days in an acute hospital. [|Qc\0aXjK@ EdO4&_? 5!!!!!May!be!used!by!permission!only!Proactive!Medical!Review,!LLC!!!!!!!!! For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. RUG Classification Groups based on the volume and intensity of therapy provided to patient: Determinants of Payment for PDPM are summarized below. Note that for the first 3 days of the stay you get 3 times the rate shown on the map. CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. Patients rely on you. Hover over a facility to see the name, NTA Rate, NTA case-mix index and whether the facility is urban or rural. This problem isnt new either but now it will drive reimbursement. The NTA component is an important component to capture and reimburse the facility for costly medications, services, and supplies needed to care for residents. The AHCA Patient Driven Payment Model (PDPM) Resource Center provides AHCA provider members with a suite of original content, tools, and training options and resources to assist providers in how to be successful in implementing the new Medicare Part A PDPM SNF PPS, effective October 2019. Try it out!). Welcome to Gravity healthcare Consulting & Online Education Determinants of payment are based on the patients characteristics assigned to six components: Patients are assigned to classification groups known as RUG Classification Groups based on various characteristics of patients and the intensity of therapy services provided. Highlights: To account for changes in resource PT, OT, and NTA utilization over the course of a SNF stay, PDPM utilizes a variable per-diem adjustment factor that adjusts the per-diem payment for these components over the course of the resident stay. Determinants of Payment on MDS Assessment, Section GG Rehab and Nursing Functional Score, Interdisciplinary Team Members Documentation, Nursing, Social Services, Dietary and Activity Staff), Conduct interview assessments for the Brief Interview for Mental Status (, indicating if resident has a swallowing disorder especially if on a mechanically altered diet (Puree or mechanical soft diet). But, since its new, were going to have to work on understanding how its supposed to work, and how we can most easily and efficiently complete the assessment with accurate information. SNF FY 2022 Proposed Rule Learn the Facts Behind the Headlines Part 3: How is My Rate Calculated, Regulatory Reminder! 66y% NF is the lowest grouper with a score of 0, while NA is highest with a score of 12+. We earn 1 NTA point when Other Skin Problems (foot ulcers/lesions) is coded in MDS item M1040A (infection of the foot such as cellulitis or purulent drainage), M1040B (diabetic foot ulcer), or M1040C (other open lesion of foot). HUO0~^iq3N&@-0*Si$L9)-ziwg';q_}(Ak"CwKi "@~|iA`!c IV medications provided as a resident and coded in Section O would also qualify for NTA points. This button displays the currently selected search type. HU]o0}G?G< m*-$R5k'EC(K@!BE`;s 2I2,[fy@770&05 Bal[|# f1 `j[>,Uf[OrGUXore:qVKP2T(r`~F& +g80qjM8#)A{)@c}A,F^Ec{HN"!l!]_J3? This does not include conditions that are resolved. The decision to change the definition was because CMS believes that therapists, using their clinical judgment, will allow for more flexibility and that residents often benefit from the psychosocial aspects of group therapy. Section I of MDS 3.0 is reserved for Active Diagnoses and Item I8000 is you to enter up to 10 additional active diagnoses with corresponding ICD-10 codes. endstream endobj 1696 0 obj <>stream For the NTA, an adjustment factor of 3.0 is applied to the total NTA CMI for days 1-3. We earn 1 NTA point if we code Protein or Calorie Malnutrition/At Risk for Protein or Calorie Malnutrition in MDS item I5600. At the direction of the attending physician, a patient needs skilled care from and/or under the supervision of a skilled nursing or therapy staff daily. Some sources even noting companies are finding losses of $500 to just over $1500 due to missed diagnoses, of both malnutrition and obesity, throughout total admissions spans of residents 2. It may also include a condition that started while the patient was getting care in the SNF for a hospital-related medical condition such as antibiotic medications via intravenous (IV) route to treat infections even if it was not the reason the patient was admitted to the acute hospital. His I0020B Primary Diagnosis and his claim's Principal Diagnosis is now the aftercare of the hip fracture. These clinical categories are PT, OT, and SLP. The Ministry of Education (MoE), Government of India (GoI) has established the National Testing Agency (NTA) as an independent, autonomous, and self-sustained premier testing organization under the Societies Registration Act (1860) for conducting efficient, transparent, and international standardized tests in order to assess the competency of candidates for admission to premier . Actually, were going to limit our scope to only I8000 items. The PDPM diagnosis list determines the reimbursements for a Medicare Part A stay. The southwest of the US, Michigan, Ohio and West Virginia would have the highest NTA rates. Was there a need for an IV? 0000008175 00000 n There is also the impact of the Variable Per Diem Adjustment Factor that is applied to the NTA Component. } The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation to ensure 100% accuracy. In this post, we going to look at one important piece of the NTA puzzle, section I. You can read more about this in the Official ICD10 Guidelines for Coding and Reporting FY2020, Section II, Subsection K. For example: The definition of Group Therapy has changed. It especially packs a heavy punch when considering that the NTA per diem rate is tripled for the first three days of the stay. Conduct interview assessments for the Brief Interview for Mental Status (BIMS), and Mood ON ASSESSMENT REFERENCE DATE (ARD) OR A DAY PRIOR TO ARD. Continuous training is the key and implementation of what was learned in coordination with the facility team members will ensure success in providing skilled care for the patients and maximizing facility reimbursement. 0000009034 00000 n All Rights Reserved. Verify coding, dont assume. (At this point, I can feel the cold stares from our MDS Experts. These conditions, along with the number of points associated with the condition and how it is reported, can be found by downloading the CMS document titled Fact Sheet: NTA Comorbidity Score. With PDPM payment method, the determinants of payment are categorized into the following case-mix adjusted components: The PDPM rate is adjusted over the course of facility stay by the inclusion of a variable per diem (VPD) adjustment on the following three components: PT, OT and NTA. 0000278826 00000 n Center for Medicare and Medicaid Services. 0000003793 00000 n As a result, patients with AIDS are assigned the highest point value (8 points) of any condition or service for purposes of classification under the PDPMs NTA component, and they also receive a special 18% add-on to the nursing component of the payment. (2019) Fact Sheet: PDPM Payments for SNF Patients with HIV/AIDS 0000006770 00000 n The International Code for Diseases, Tenth Revision, Clinical Modification Codes which popularly known as the ICD-10 CM which is coded on Section I0020B of the MDS assessment is mapped to a clinical category which will be part of the determinant of payment for the PDPM components. A} 2?d`aYW!3,8h|J/K\J:s&Ve>1|9WiixusVo\sGP8saBT!+(z$lYnAZZp@6Y1m`[ jKeMQ5i.7HCGIC1iGIc' In the past, we only checked this box even if the resident was a diabetic and also had retinopathy. (difference of NE-NF and NA-NB). You can also zoom in to see detail. As a result, client facilities realize improved wound healing results, improved survey scores and NTA reimbursement under PDPM. The categories impact a resident's case-mix classification. by Proactive LTC Consulting | Jan 6, 2020 | Audits, Compliance, Education, MDS, Medical Review, PDPM. While mild nausea and vomiting is a common discomfort of pregnancy, patientswith severe cases become diagnosed with hyperemesis by NCC News and Content Team | Dec 6, 2022 | Specialties. 18% of the Nursing adjustment factor is multiplied to the Nursing rate only patients with diagnosis of AIDS. Often overlooked, Non-Therapy Ancillaries or NTAs will be more important than ever in PDPM. Character 3: Nursing Case Mix Group (NSG CMG) Character 4: NTA Case Mix Group (NTA CMG) Character 5: Assessment Indicator HIPPS Code PT/OT CMG SLP CMG NSG CMG NTA CMG HIPPS Code A TA SA ES3 NA A B TB SB ES2 NB B C TC SC ES1 NC . Under PDPM, an adjustment is applied to certain PDPM components that varies the per diem payment over the course of the stay. The Centers for Medicare and Medicaid Services (CMS) have provided the SNFs with a list of ICD-10-CM codes mapping to one of the clinical categories: These clinical categories are used as the Primary PDPM diagnosis giving weight to the calculation of PDPM rates for PT, OT, SLP and Nursing components. The MDS nurse should be alert to these changes to ensure timely completion of the required MDS assessment. The general method for calculation of any NTA category is as follows: The Fiscal Year (FY) 2021 PDPM ICD-10-CM Mappings file includes the NTA Comorbidity to ICD-10-CM Mapping, which maps comorbidities in the NTA component captured in item I8000 to allowable ICD-10 codes. Updates the ICD-10 mapping used to classify patients under the PDPM framework. Non-Therapy Ancillary (NTA) classification in PDPM is determined by the presence of certain conditions or the use of certain extensive services that were found to be correlated with increases in NTA costs for SNF patients. Which codes are you most likely to actually see in the wild? 0000001085 00000 n A good first resource is the PDPM NTA Comorbidity Mapping spreadsheet. Below is the full listing of conditions and services used for NTA classification and the associated number of points for that comorbidity. When RUG classification was used as the basis of reimbursement, all patients with different patient characteristics were classified in the same RUG level based on the volume and intensity of therapy services provided. Any delay in getting this information is going to be problematic. The FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. CMS identified 50 conditions and services that were related to an increased cost for skilled nursing facilities. background-color: #2c4a88; For the Non-Therapy Ancillary Component, each diagnosis has a corresponding score which is multiplied to the federal NTA case mix index. Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. At the start of 2019, 63% of respondents to SNN's annual outlook survey identified a greater emphasis on coding as a a key PDPM strategy. Good talk. (Click either image to enlarge.). This article was originally published in February 2019, and has been updated in October 2019 with several more tips. The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. This item includes diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. Points are added together for all conditions. var divElement = document.getElementById('viz1528375166404'); var vizElement = divElement.getElementsByTagName('object')[0];'100%';*0.75)+'px'; var scriptElement = document.createElement('script'); scriptElement.src = ''; vizElement.parentNode.insertBefore(scriptElement, vizElement); Use the rate filter to show only the highest or lowest NTA rates. These maps look significantly different from a lot of the others weve seen. PATIENT DRIVEN PAYMENT MODEL |4 . Refer to the CMS PDPM ICD-10 NTA Comorbidity Crosswalk for I8000-derived comorbidities with acceptable ICD-10 codes that map to the NTA component and the NTA item listing for a complete list of NTA conditions/services. Whats in it for me? Contact us now and sign up to receive our newsletters here. |Pa(E8BNJA!-tUiX%:h~GJ?J.H% kZ*qyXjBy@C(zHhzQhhlL2cO`.$p6_[3R^IrHrr6#eq7**2uWytb$HyZi[F2_ GBM*.`k@/9cO9R*^fo_MOK6_xg,eM'jv}5E|SWNH0$z|.WL7y9 ;4H*h;H8H"*RW l? Under PDPM, there are six payment components. Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. Medical records department should already code and map for the clinical category to be able to determine principal diagnosis code and calculate expected daily rate for the facility using either the manual PDPM worksheet or software-generated calculation. Title: Microsoft Word - FINAL PDPM Triple Check Checklist.docx Author: jleatherbarrow Created Date: 1/29/2020 4:19:17 PM The skilled services are provided by a Medicare-certified SNF. 1694 0 obj <>stream oYyTQb`y{y;..nI^vY5[3?O%5;5E8_kT}m}02|E}}q4:>9=6 /W=.8,w,8m_?Y\Y\v &0,/}["JO=>?]"y;?P'WY4[;of}7gh.RF)# `,J Z5FXMM:&Dh,A*hJtiL."%oKt Not having the correct codes can have a domino effect and result in missed reimbursement, or claim inaccuracies. The Centers for Medicare & Medicaid Services (CMS) realizes that the cost impact of medications, at the time of admission, is extensive. It is highly advisable for MDS nurses to review each assessment to ensure that all skilled services are captured during the assessment period to maximize reimbursement rate for the facility based on the patients diagnosis and acuity. It is for this type of services they offer which also categorize them as skilled nursing and rehabilitation facilities becoming a step-down facility from an acute hospital stay. Notice there is a big pocket of low NTA rates that covers most of Iowa. Securely download your document with other editable templates, any time, with PDFfiller. Remember, the CMS list is authoritative, mine is only for your convenience. For the NTA component, the CMI is multiplied against the applicable per diem adjustment factor and is then applied to determine the case-mix adjusted payment associated with each of these payment components for each utilization day under PDPM. I wish I could be in your training the 29th. Copyright LW Consulting, Inc 2022. }|YAxz .diS\]0}3sfowMm@ In this fourth webinar of our six part series, learn which items on the MDS or Medicare claim will be used to determine the NTA score and its impact on payment. Not all NTAs are ICD-10 codes, some are MDS items. Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing components. Everyone I've talked to agrees the NTA payment is a good idea. PDPM NTA Case Mix Classification Groups NTA Score Range NTA Case Mix Group NTA Case Mix Index NTA HIPPS Character 12+ NA 3.24 A 9-11 NB 2.53 B 6-8 NC 1.84 C 3-5 ND 1.33 D 1-2 NE 0.96 E 0 NF 0.72 F . 0000277284 00000 n SAMPLE Task List for the Nurse Assessment Coordinator (NAC) November 23, 2022. - Corrected typo in minimum point value thresholds used to ify patients into groups "NA" and "NB" under the NTA component. %PDF-1.6 % This NTA CMI is added to the other components to calculate the total reimbursement for the patient. #2 Diagnosis Status - The diagnosis must have a direct relationship to the resident's current functional status, cognitive status, mood or behavior status, medical treatments, nursing monitoring, or risk of death during the 7-day look-back period. Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing components. Under PDPM, if a facility completes an IPA, and more points are achieved in the NTA component, the first 3 payment days of the IPA will NOT have the adjustment factor of 3% like it would at the start of the Medicare stay. This PDPM model aims to utilize the individual patient's characteristics and needs based on diagnosis as opposed to the RUG-IV system relying on volume of services. There must be a reason for it, right? Hopefully I dont lose my blogging privileges, but I looked at a years worth of Part A admissions to every SNF in the country and found, gasp, not all codes occur that often. Preparedness for coding changes will be the key to a smooth transition. Learn More Resource PDPM Series Part 5: Assessment Requirements. Hospitals | Specialties Postpartum Preeclampsia Diagnosis and Management Postpartum preeclampsia is a condition that can affect women from the time after delivery and up to 6 weeks after. code. We also qualify for Special Care Low in the Nursing Category when there is an application of a dressing to the foot with the ulcer. Do not be apprehensive to query the physician if a diagnosis is not clear or is suspected and not documented. You should understand those things too, reader.). 0000190726 00000 n ;DktP'pm}iE/4K~bY?c~220E+t;sdvGHz P, RUG-IV vs Patient-Driven Payment Model (PDPM), Prior to October 1, 2019, all SNFs which participate under the Medicare program are paid under the Skilled Nursing Facility (SNF). A list of these specific retinopathy codes are in the SLP mapping file from CMS. We earn 1 NTA point and qualify for Nursing Category Special Care Low for a Stage IV Pressure Ulcer when coded in M0300. Other specific items will be recorded in various parts of the MDS including Section K, M, N, and O. The PT and OT payment would be based on: primary reason for SNF care and functional status at admission The sum of the lowest per diem rate under each PDPM component, plus the non-case-mix component is the: default code Which of the following is NOT a case-level adjustment for a MS-LTC-DRG long term stay outlier Reimbursement, LW Consulting, Inc.5925 Stevenson Avenue, Suite GHarrisburg, PA 17112, Ph:800-320-5401Local Ph: 717-233-6100Fx:717-233-4633. The individual NTA conditions have points ranging from 1 to 8. 0 The choice of PDPM diagnosis has become rocket science for MDS nurses as this gives more weight in the calculation of the PDPM rate for the facility. The required MDS data would be entered in the sub-items listed below the item group identifier. The PDPM clinical categories represent groups of similar diagnosis codes, which are used as part of the resident's classification under the PT, OT, and . ordered by the patients attending physician in the facility. MDS Item Field rows in tan represent MDS item groups identified in CMS PDPM documentation and do not have data entry fields. Under PDPM, long-term care facilities will receive reimbursement based on services that each resident receives. You can view either rural, urban or both. Zi@Ym"l?]L?*;YaRxwFhSGkhSFRQJIp.V4v!fbN91GE]Y:+s The functional scoring is based on residents performance in. Documentation by the physician and nursing must also support the skilled nature of the codes that are recorded as NTA conditions. Five of the six are case-mix adjusted. As under the previous RUG-IV model, the presence of an AIDS diagnosis continues to be identified through the SNFs entry of ICD-10-CM code B20 on the claim. Variable Per Diem Adjustment Factors and ScheduleNTA. (Right). But now, if the resident also happens to have diabetic retinopathy, we can earn an extra NTA point if we also include the specific Diabetic Retinopathy code in I8000. The Patient-Driven Payment Model focuses on the patients unique characteristics and needs based on diagnosis which arise during inpatient hospital stay. The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. To further understand the difference between long-term care facilities and skilled nursing/rehabilitation facilities, we will focus on the services they offer. What do I need to know? by NCC News and Content Team | Mar 1, 2023 | Hospitals, Specialties. 0000004542 00000 n hWmo6+( 0000003037 00000 n . Which codes are the most important? (Ui7A7dR;5|jDM\sEamJFK3O.C[=vBD:]'N+T_ rhc_ex>mHR&o6Bfr*W0zG3KWmxK6P46n=Jt0Pn'OGC~&S};& Dt];vwj+E0R"^T the design of the PDPM case-mix system implemented in FY 2020. Its important to comprehend more than just the basics of PDPM. I believe that this payment method acknowledges not only the skilled rehabilitation services provided to the patient, but also the complexity of skilled nursing services rendered to the patient and appropriately incorporated in the PDPM rate calculation. Coding of these areas will affect the, Postpartum Preeclampsia Diagnosis and Management, Hyperemesis Gravidarum: More Than Just Morning Sickness. As under the previous RUGIV model, the presence of an AIDS diagnosis continues to be identified through the . endstream endobj 454 0 obj <>stream A Knowledgeable and Compassionate partner. After a qualifying hospital stay, he has returned to the SNF for aftercare of the hip fracture. The long-term care facilities have emerged not only as a permanent home for the elderly during their retirement or post-retirement years but as respite and recuperative facilities even for the younger patients.