This item also impacts your MDS High Risk Pressure Ulcer QM because it is a high risk qualifier (along with impaired bed mobility impaired transfer, or comatose) for the numerator and denominator of the calculation. Determinant for payment is based on the number of therapy minutes provided regardless of residents acuity, diagnosis and other skilled nursing services provided. When reviewing the CMI components driving PDPM reimbursement its important to consider the critical role of the Non-Therapy Ancillary (NTA) score. 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. NTA has been separated as an independent component, and NTA classification 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. It is important to note the one exception to the MDS coding for NTA comorbidities is HIV/AIDS, which is reported on the SNF Part A claim, but not on the MDS, due to certain state privacy laws. } 0000000836 00000 n Was there a need for an IV? View D0AD3F24-D6BD-4273-B139-8FCA97487E6A.jpeg from NURSING MISC at St. Clair County Community College. The PDPM Rate is derived from the sum of all the PDPM component rates: PT base rate x PT case mix index (CMI) x VPD adjustment factor, OT base rate x OT CMI x VPD adjustment factor, NTA base rate x NTA CMI x VPD adjustment factor, Nursing base rate x Nursing CMI x 18% Nursing adjustment factor (only for AIDS patients). As mentioned earlier, these NTA comorbidities are reported (coded) throughout the MDS. View fullsize 0000002491 00000 n Based on that, I have made you an extreme cheat sheet, that you should use with extreme caution. endstream endobj 452 0 obj <>stream A Knowledgeable and Compassionate partner. INTRODUCTION. This isnt exactly a new problem, but it didnt drive reimbursement before. 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. Hover over a facility to see the name, NTA Rate, NTA case-mix index and whether the facility is urban or rural. HUO0~^iq3N&@-0*Si$L9)-ziwg';q_}(Ak"CwKi "@~|iA`!c This could be a difference of $29.23 per day for Urban and $27.93 per day for a Rural facility. Under PDPM, long-term care facilities will receive reimbursement based on services that each resident receives. 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 . ! As outlined in the SNF PDPM technical report, CMS was looking for the new reimbursement plan to account accurately and appropriately for the increased costs associated with caring for patients with AIDS. 1=BY)#CT 'a7bA(XdHE ? Start (and continue) the conversation. 5!!!!!May!be!used!by!permission!only!Proactive!Medical!Review,!LLC!!!!!www.proactivemedicalreview.com!!!! In this article, we discuss the non-therapy ancillary (NTA) component. It especially packs a heavy punch when considering that the NTA per diem rate is tripled for the first three days of the stay. endstream endobj 451 0 obj <>stream Five of the six are case-mix adjusted. PDPM consists of five case-mix adjusted components: Physical therapy (PT) Occupational therapy (OT) Speech-language pathology (SLP) Nursing Non-therapy ancillary (NTA) PDPM also includes a variable per diem (VPD) adjustment that adjusts the per diem rate to reflect varying costs throughout a patient's stay. Sometimes the code may be a qualifier for other PDPM components, sometimes it won't be. 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. In the past, we only checked this box even if the resident was a diabetic and also had retinopathy. 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. The functional scoring is based on residents performance in eating, oral hygiene, toileting hygiene, sit to lying, lying to sitting on side of bed, sit to stand, chair/bed-to-chair transfer, and toilet transfer assessed on the first three days of admission to the facility with the admission day counted as day 1. . Once completing his Part A stay, the hip fracture will no longer appear on his claim, and Parkinson's Disease now returns as the Principal Diagnosis. 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. 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). 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. 8cq1o22#|Bm1il,4iw&C|E^F+oq:>_|M\v+iTOigWJ:dCa$Qv_n/q|wCuukk+e';iJB2C &!Ar8c _~r In the absence of specific documentation, you may use positive tests, procedures, hospitalization for symptoms). I0020 is also a gateway to the I0020B Primary Diagnosis code. 0000001865 00000 n Points (1-8) are assigned to specific conditions. 463 0 obj <>stream This problem isnt new either but now it will drive reimbursement. 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. (10 items fit). code. (Nursing, Social Services, Dietary and Activity Staff). Variable Per Diem Adjustment Factors and ScheduleNTA. The categories impact a resident's case-mix classification. Inappropriate Schizophrenia Diagnosis/Coding and Survey Citation Posting, Regulatory Reminders: Consolidated Billing Update 2023. last. Admitted in the Skilled nursing facility (SNF) within a short time (generally 30 days) of leaving the hospital and require skilled services related to hospital stay. It is highly recommended for the MDS nurse to make calculations which can determine the highest acceptable reimbursement rate for the facility. hl What do I need to know? mp:U@|8B *zL$#Tk\*SU%mQlTYA Rj&-N _VjWpb[5R8'i, Copyright LW Consulting, Inc 2022. All Rights Reserved. The map below shows every SNF in the US that accepted Medicare Part A patients in 2017. 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. Remember that after the 3 day interrupted stay he is considered a new admission for purposes of Part A PDPM. Identification of NTA conditions and services should start even before the SNF admission. Five are case-mix adjusted to allow for variances in diagnoses, severity of illness and other variables associated with the probability of improvement with treatment: Physical therapy (PT) - includes a variable per diem factor Occupational therapy (OT) - includes a variable per diem factor The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. For situations like this, the MDS nurse will choose to complete an Interim Payment Assessment (IPA) to capture such changes and eventually increase the daily reimbursement rate. .center {text-align: center;}, Foot Code, Except Diabetic Foot Ulcer Code, Once we have totaled the score from the table above, we use it to map to a case-mix group and case-mix index. Patient classification system where patients are grouped according to their care and resource needs. Not all NTAs are ICD-10 codes, some are MDS items. The FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. The presence of these conditions and extensive services is reported by providers . Other specific items will be recorded in various parts of the MDS including Section K, M, N, and O. You can rely on us. With every dollar spent on nutrition screening and interventions, the Academy of Nutrition and Dietetics has reported savings of $3.25 3. If your therapist are doing Group therapy, remind them that there must be supportive documentation regarding the benefit to the resident when participating in a larger group. For example, an I69.091 code (dysphagia following non-traumatic sub-arachnoid hemorrhage) in I0020B will map to Acute Neurological category and contribute to determining the case mix group. Under PDPM, Section GG drives PT and OT, and nursing which affects reimbursement. Lets breakdown the PDPM model to better understand how reimbursement is determined. Research indicated that for those SNF patients with AIDS, NTA costs per day were 151% higher and wage-weighted nursing staff time was 18% greater than for other patients. endstream endobj 1695 0 obj <>stream endstream endobj 453 0 obj <>stream (difference of NE-NF and NA-NB). Intermittent Catheterization? The higher the score, the higher the NTA rate. 0000009611 00000 n 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. Item I0020 and I0020B: Item I0020 (primary medical condition category that best describes the primary reason for admission lists several options. With several big changes ahead, the margin for error slim for most providers. Section I8000 alone has 27 of these conditions, while sections K, M, N, and O also have items that can contribute to the NTA score. With this component being paid at a 3x rate for 1st 3 days of . It's easy to get to those 50, but the tricky part is understanding which ICD-10 codes match to the comorbidities. Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing components. 0000002038 00000 n PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. We earn 1 NTA point for second or third degree burn coded in M1040F. 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. How should you prioritize your search for ICD-10 codes? Coding of these areas will affect the, Postpartum Preeclampsia Diagnosis and Management, Hyperemesis Gravidarum: More Than Just Morning Sickness. Title: Microsoft Word - FINAL PDPM Triple Check Checklist.docx Author: jleatherbarrow Created Date: 1/29/2020 4:19:17 PM Also, there is a 25% combined limit on concurrent and/or group therapy. Yes, I am aware that ICD-10 codes do change occasionally. Consider adding the list of NTAs to current pre-admission screening forms or otherwise creating a way to identify and communicate potential conditions and services that may continue during the SNF stay. If the resident went from the hospital directly to a LTCH first, then to your SNF, you can code the surgery because an LTCH is a post-acute long term care hospital, not an acute care hospital. There are a total of five rates that make up your pay under PDPM.) As a result, client facilities realize improved wound healing results, improved survey scores and NTA reimbursement under PDPM. There are two look back periods that must be met when coding conditions on the MDS: #1 Diagnosis Identification - Documented by the physician or physician extender within the last 60 days. A long-term care facility provides custodial care requiring supervised, minimal or total dependence in the performance of the activities of daily living (ADLs) such has bed mobility, transfers in and out of bed, walking in the room, walking in the corridor, locomotion on unit peripheral to the patients room, locomotion off unit which involves areas farther from the patients room such as dining areas, rehabilitation rooms, activity rooms and other administrative offices, toileting, eating, personal hygiene and bathing. The calculation of payments is based on the five case-mix adjusted components: Physical Therapy (PT), Occupational Therapy (OT), Speech Language Pathology (SLP), Nursing and Non-therapy ancillary (NTA). PDPM Chart Audit Simple and Easy: Winning in PDPM Payment and Regulatory Strategies . Ill also compare urban versus rural facilities when it comes to NTA case-mix. 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. ;DktP'pm}iE/4K~bY?c~220E+t;sdvGHz P, 0000002742 00000 n } More than half of them come from I8000 and many of these have multiple qualifying ICD-10 diagnosis codes. IV medications provided as a resident and coded in Section O would also qualify for NTA points. 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. Find toolkits, webinars, on-demand trainings, templates, and much more to meet the needs of your facility. And so, you will need to determine how your facility will obtain the initial Diagnosis Identification documentation by the ARD, because it is a "look back" period. 0000006770 00000 n 0000277284 00000 n An NTA comorbidity score of 12 = a CMI of 3.24. Next you multiply the case-mix index by the rate, either rural ($74.56) or urban ($78.05). Either way, you must still also code the I0020B primary condition I0010 through I8000. Primary Diagnosis - List I0020B Surgical Procedures - List J2100/J2300-J5000 Aphasia I4300 Cerebrovascular Accident . PDPM Series Part 4: Non-Therapy Ancillaries Case Mix Groups. tr:nth-child(even) {background-color: #f2f2f2;} 2207 Morgan Ave, Suite D Which codes are you most likely to actually see in the wild? The higher the total point value, the greater the payment (CMI). In 2019, CMS has further revised and finalized the version of PDPM that will go into effect October 1, 2019. When expanded it provides a list of search options that will switch the search inputs to match the current selection. No paper. The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation to ensure 100% accuracy. For example, if a resident admits and the dietitian notes the BMI is over 40, query the physician to confirm a morbid obesity diagnosis. First, it corrects an issue where diagnosis codes were mapped to NTA comorbidities as 1 to 1 mappings where 1 to 2 mappings were intended from the PDPM_ICD10_Mappings_FY20XX Excel sheet. It will be imperative that the coding is accurate on the MDS for the NTA conditions. You should understand those things too, reader.). Everyone Ive talked to agrees the NTA payment is a good idea. The PDPM Clinical Categories are discussed below. These nurses are also trained to complete a full All Rights Reserved By Nursingcecentral 2022 |. MDS 3.0 Section I Thats a lot of white space. Our wound certified educators train, educate, and guide our providers and client facilities on the most efficacious wound care treatments and follow up. On any device & OS. You can filter by NTA rate. But if the resident is transferred back to the hospital and is admitted as an inpatient, let's say for pneumonia, then returns to the SNF after the 3-day interrupted stay window, a new 5-Day will be required and the surgery will not be able to be coded in J2100, because the surgery did not occur "during the inpatient hospital stay that immediately preceded the residents Part A admission". This information is essential. hWmo6+( Remember, the CMS list is authoritative, mine is only for your convenience. These components for classification and payment include: Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST), Non-therapy Ancillary (NTA) as well as Nursing. For RUGs IV PPS, the payment is based on a per diem rate that is constant for the entire length of stay. MDS Item Field rows in tan represent MDS item groups identified in CMS PDPM documentation and do not have data entry fields. A frequent question: "If the mapping file lists a code as "return to provider", can I still use it on the MDS?". pdpm nta listhorse heaven hills road conditionshorse heaven hills road conditions The resulting sum is the NTA comorbidity score, which is used to classify each resident into an NTA case-mix group. F |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? }|YAxz .diS\]0}3sfowMm@ However, if a provider chooses to ignore the importance of this MDS item, it will cost them 1 NTA point which could possibly impact their Case Mix Group's CMI. The patients NTA comorbidity score is the sum of the points associated with each relevant comorbidity. The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. Refer to RAI pages J37-J38 for more on coding J2100. The list includes diagnosis codes, which will be recorded in the I8000 section of the MDS. Patients rely on you. Payment is based on services provided by five disciplines: physical therapy, occupational therapy, speech language pathology, nursing, and non-therapy ancillary (NTA). 0000008175 00000 n As we prepare for the transition to the Patient-Driven Payment Model (PDPM), which is expected to occur on October 1, 2019, we have been reviewing the primary components that make up the Case Mix Index (CMI) for reimbursement. Other diagnoses will affect the Non-therapy Ancillary (NTA) component. Section I has a lot of items that can effect NTA pay. Lastly, lets look a little more closely at rural versus urban. Of importance to note is the condition of HIV/AIDS under the NTA component. Complete Section K ON ARD or a DAY PRIOR TO ARD indicating if resident has a swallowing disorder especially if on a mechanically altered diet (Puree or mechanical soft diet). Whats in it for me? Yes, Im aware that if you dont look at every. List the 3 MDS items that qualify a resident for the Extensive Nursing Service group. The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. Any delay in getting this information is going to be problematic. Involve the Interdisciplinary Team. Love what you read? The PDPM program has six payment components. Resolved conditions should not be listed since therapy would not be treated for a resolved condition. Comorbidities are assigned points based on the cost in care associated with the condition or service, with points ranging from 1 to 8. $HJ0!$j-g#W d9bEi0~og$.J8-Lb =lZ.SSz|'!`%/ The saying, haste makes waste applies in the completion of MDS assessments and calculation of the maximized PDPM rate for the patient. They likely need the extra protein because either they have protein malnutrition (can be verified by lab results) or they are "at risk" for protein malnutrition. Not having the correct codes can have a domino effect and result in missed reimbursement, or claim inaccuracies. The administration of IV fluids may qualify for the Parenteral/IV Feeding - High or Parenteral/IV Feeding - low NTA points. (2019). Once you have identified the condition/extensive service on the MDS or claim, the points associated with each comorbidity are added up for a total NTA score which is associated with 1 of the 6 case-mix groups shown below. - Corrected typo in minimum point value thresholds used to ify patients into groups "NA" and "NB" under the NTA component. 0000190726 00000 n A year later, he falls and sustains a hip fracture. Conduct interview assessments for the Brief Interview for Mental Status (BIMS), and Mood ON ASSESSMENT REFERENCE DATE (ARD) OR A DAY PRIOR TO ARD. color: white; (Note that this map is showing ONLY the NTA rate. comorbidities used under PDPM for NTA classification is assigned a certain number of points, between one and eight, based on its relative costliness. 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. In order to determine the patients NTA comorbidity score accurately, providers must identify all comorbidities for which a resident would qualify, then total the points. While the SNF certs and the Therapy Certs may contain this documentation, they are often not signed or approved until after the ARD. <<50FFC127310FCF468ABFE4B7414A5B70>]/Prev 423154>> The functional scoring is based on residents performance in. The Clinical Categories by Diagnosis mapping file only applies to the code listed in I0020B. Ensure you have staff who are trained in ICD-10 coding. Updates the ICD-10 mapping used to classify patients under the PDPM framework. Documentation by the physician and nursing must also support the skilled nature of the codes that are recorded as NTA conditions. CMS stated in the final rule for FY 2023 that they intend to take a more cautious approach to mitigate the potential negative impacts on the nursing home industry with this parity adjustment by spreading it across a two-year period. SNF PDPM Provider-Specific Impact File. The Non-Therapy Ancillary Services (NTA) component is a total score of all listed conditions and/or extensive services that apply to the resident. Think about this A resident with a Stage IV pressure ulcer has physician orders and Registered Dietician recommendations for a protein supplement. by Proactive LTC Consulting | Jan 6, 2020 | Audits, Compliance, Education, MDS, Medical Review, PDPM. In it, youll find the 1,612 codes that map to the different comorbidities. Often overlooked, Non-Therapy Ancillaries or NTAs will be more important than ever in PDPM. 0 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. The Patient-Driven Payment Model (PDPM), is fast approaching with implementation set for October 2019. endstream endobj 1696 0 obj <>stream 0000004542 00000 n (By the way, we created a PDPM Calculator for you to experiment with and get a better understanding of how PDPM works. 3HFDRkse$:stHqPJoHK-qL_sh|Kg?unioWAsfH8[^9{'~-? 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).