(difference of NE-NF and NA-NB). No software installation. The five CMGs then convert to a corresponding case mix index (CMI), which is a multiplier to the base rate for a particular CMG. PDPM and Non-Therapy Ancillaries The non-therapy ancillary (NTA) part of the patient driven payment model (PDPM) is considered by most people I've talked to as being better than what we're currently doing. Ensure you have staff who are trained in ICD-10 coding. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. Do whatever you want with a SKILLED: fill, sign, print and send online instantly. In this post, we going to look at one important piece of the NTA puzzle, section I. 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. 0000003793 00000 n Great info! What if we could limit those codes down to just those ICD-10 codes that are likely to occur. For RUGs IV PPS, the payment is based on a per diem rate that is constant for the entire length of stay. ~,/-I\!/JfB. Primary Diagnosis - List I0020B Surgical Procedures - List J2100/J2300-J5000 Aphasia I4300 Cerebrovascular Accident . yid T[KaEev0D/wRDQhDB['QgDTBEB)2"xt"Xn2 QN[%=> FhzdBI^8/HD Our wound certified educators train, educate, and guide our providers and client facilities on the most efficacious wound care treatments and follow up. In this article, we discuss the non-therapy ancillary (NTA) component. 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. Request for labs, imaging studies and surgical reports whichever is applicable. Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). Each component has its case mix index to determine the component rate. 0 DetI Rloh,mJLEo(DA"pd#Se.e)6d;[+I=R^2rcZ'F6C"x=*!J&[KL~^ogN3#)LNb}:QOd 0}pE` )S ordered by the patients attending physician in the facility. Focuses on clinically relevant factors rather than volume-based services or RUG levels. (PPS) based primarily on the type and intensity of therapy services provided to the patients regardless of their acuity, unique characteristics, specific needs, or goals. 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. (difference of NE-NF and NA-NB). For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. To assist stakeholders in understanding the potential impacts of the proposed PDPM, we are providing a provider-specific impact analysis file, which details the estimated . The administration of IV fluids may qualify for the Parenteral/IV Feeding - High or Parenteral/IV Feeding - low NTA points. The Patient-Driven Payment Model (PDPM), is fast approaching with implementation set for October 2019. MDS Item Field rows in tan represent MDS item groups identified in CMS PDPM documentation and do not have data entry fields. There are a total of five rates that make up your pay under PDPM.) With postpartum preeclampsia, patients are now not seeing a health care provider by NCC News and Content Team | Jan 24, 2023 | Specialties. 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. The higher the total point value, the greater the payment (CMI). SAMPLE Task List for the Nurse Assessment Coordinator (NAC) November 23, 2022. The categories impact a resident's case-mix classification. The following ICD-10 codes qualify: 41 Body mass index (BMI) 40.0-44.9, adult, 42 Body mass index (BMI) 45.0-49.9, adult, 44 Body mass index (BMI) 60.0-69.9, adult, 45 Body mass index (BMI) 70 or greater, adult, 01 Morbid (severe) obesity due to excess calories, 2 Morbid (severe) obesity with alveolar hypoventilation, Cross-train. SLP: NSG: NTA: This audit format form contains the MDS 3.0 items that drive payment for the Part A Medicare PDPM SNF-PPS payment. Five of the six are case-mix adjusted. 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. Preparedness for coding changes will be the key to a smooth transition. 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 NTA comorbidity score is a weighted count of certain comorbidities that a SNF patient has, which is then used to classify the patient into an NTA component payment group. 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 (. ) If your facility has a low NTA rate, it may just mean you have work to do, documentation-wise. 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). Of importance to note is the condition of HIV/AIDS under the NTA component. MDS 3.0 Section I Thats a lot of white space. table, th, td { More than half of them come from I8000 and many of these have multiple qualifying ICD-10 diagnosis codes. Whats in it for me? Comorbidities associated with higher increases in NTA costs are grouped into higher point tiers, while those that are associated with lower increases in NTA costs are grouped into lower point tiers. PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. color: white; For example, Mr. Steve is a long term care resident due to Parkinson's Disease. 0000000016 00000 n This does not include conditions that are resolved. 0000002280 00000 n endstream endobj 1697 0 obj <>stream The higher the score, the higher the NTA rate. Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing 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. Ill also compare urban versus rural facilities when it comes to NTA case-mix. Classifications from the RUG-IV assign patients to payment classification groups, called RUGs, within the payment components: Rehabilitation Plus Extensive Services, Rehabilitation, Extensive Services, Special Care High, Special Care Low, Clinically Complex, Behavioral Symptoms and Cognitive Performance Problems and Reduced Physical Function. PDPM MDS Items ! (2019). 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 . MDS 3.0 RAI Manual. Coding of these areas will affect the, Postpartum Preeclampsia Diagnosis and Management, Hyperemesis Gravidarum: More Than Just Morning Sickness. 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). Rehab and Nursing staff should complete the Section GG on the MDS form for indicated ADL tasks on Day 1-3 of admission with the admission date as Day 1. Refer to the PDPM Calculation Worksheet for more information. 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. In it, youll find the 1,612 codes that map to the different comorbidities. In the past, we only checked this box even if the resident was a diabetic and also had retinopathy. 437 27 The general method for calculation of any NTA category is as follows: PDPM Series Part 4: Non-Therapy Ancillaries Case Mix Groups. 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. background-color: #2c4a88; A Knowledgeable and Compassionate partner. a" I54043lquizzes/446951 (Question 2 5 / 5 pts The PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. On any device & OS. 0000277284 00000 n program for a limited time or on a short-time basis and must meet the following requirements: hospital insurance and have eligible days left to use during the benefit period. 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. Welcome to Gravity healthcare Consulting & Online Education 0000003037 00000 n The NTA case-mix groups are based on NTA score ranges: 0 (NF), 1 2 (NE), 3 5 (ND), 6 8 (NC), 9 11 (NB), or 12+ (NA), according to table 17, NTA Case-Mix Groups, in chapter 6 of the Long-Term Care Facility Resident Assessment Instrument 3.0 Users Manual. by Proactive LTC Consulting | Jan 6, 2020 | Audits, Compliance, Education, MDS, Medical Review, PDPM. Custodial care does not require the assistance of a licensed staff. Explain the impact of the variable per diem rate in the NTA component and how it impacts PDPM payment. No paper. Specialties Hyperemesis Gravidarum: More Than Just Morning Sickness Pregnancy and nausea are terms used in unison with one another. endstream endobj 451 0 obj <>stream His I0020B Primary Diagnosis and his claim's Principal Diagnosis is now the aftercare of the hip fracture. Under PDPM, long-term care facilities will receive reimbursement based on services that each resident receives. When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. 0000009034 00000 n View fullsize HUO0~^iq3N&@-0*Si$L9)-ziwg';q_}(Ak"CwKi "@~|iA`!c 0000189184 00000 n Ive done that for urban and rural for every state. While the SNF certs and the Therapy Certs may contain this documentation, they are often not signed or approved until after the ARD. CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. Item I0020 and I0020B: Item I0020 (primary medical condition category that best describes the primary reason for admission lists several options. List the 3 MDS items that qualify a resident for the Extensive Nursing Service group. Each patient has a different reimbursement rate as compared to the RUG-IV PPS rate in the past. 2 &r}p")|@ O&]LpLk| Mvl(Pv[C0AMfxYp&NymfJXdO@QhCec*2-K8P3Tjp6'+Q :~_%`n/[w}_,0-|:%?h6'#%?7?\o(@Ln 9w9Fhe`P8B09@(@DT\QG+ (CQ {dX r4`H*B4,&0hl3()%zI[)jCN8{SNa%PED~ eT T(m:l] 43FH&"@`BN`Kk(f Now let's discuss the I0020B Primary Diagnosis and the Claim's Principal Diagnosis. 437 0 obj <> endobj To assist in ensuring that you can capture all diagnoses and pertinent information to maximize facility reimbursement, I suggest doing the following (which most MDS nurses I am sure are already doing): Request for Hospital History & Physical, Progress Notes, and consults. the design of the PDPM case-mix system implemented in FY 2020. Find toolkits, webinars, on-demand trainings, templates, and much more to meet the needs of your facility. 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 . 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. endstream endobj 447 0 obj <> endobj 448 0 obj <> endobj 449 0 obj [278 0 0 0 0 889 0 0 333 333 0 0 278 333 0 278 556 556 556 556 556 556 556 556 556 556 278 0 0 584 0 0 0 667 667 722 722 667 611 778 722 278 500 667 556 833 722 778 667 0 722 667 611 722 667 944 0 667 0 0 0 0 0 0 0 556 556 500 556 556 278 556 556 222 222 500 222 833 556 556 556 0 333 500 278 556 500 722 500 500 500] endobj 450 0 obj <>stream 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. 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 (, Behavioral Symptoms and Cognitive Performance Problems, The Centers for Medicare and Medicaid Services (. Also notice there are very few facilities with low NTA rates in the Appalachians. HU]o0}G?G< m*-$R5k'EC(K@!BE`;s 2I2,[fy@770&05 Bal[|# f1 `j[>,Uf[OrGUXore:qVKP2T(r`~F& +g80qjM8#)A{)@c}A,F^Ec{HN"!l!]_J3? 0000008175 00000 n Often overlooked, Non-Therapy Ancillaries or NTAs will be more important than ever in PDPM. Refer to the CMS PDPM ICD-10 NTA Comorbidity Crosswalk for I8000-derived comorbidities with acceptable ICD-10 codes that map to the NTA component and the NTA item listing for a complete list of NTA conditions/services. Based on that, we can calculate the rate. This can be revised if there is a change in a patients condition which requires additional skilled services such as IV medications which were not administered initially. With supportive documentation, it can be coded in I5600. Hoo0Gw7I18J+-+hLC&QI$[3iB:s]:?\GqA ATc#(R2:nl/?e. ` 0!RJ3t f{ WN"Y@L1+;HXZL@\uB*4c*fi$1( )}hciksm2hn 1cU(YTS46ye&? &JHyBIQ fF Under the PDPM structure, there are no rules regarding when nursing home staff can perform an IPA, McCarthy noted, and even slight changes to a resident's care plan could result in additional NTA points that could bring in extra per-day reimbursement dollars. You can also zoom in to see detail. Reimbursement for these services is covered under the State of Californias Medi-Cal program or privately paid by the patient if he/she does not qualify under the Medi-Cal program. We earn 2 NTA points if Diabetes is coded in MDS item I2900. The functional scoring is based on residents performance in. 463 0 obj <>stream comorbidities used under PDPM for NTA classification is assigned a certain number of points, between one and eight, based on its relative costliness. With the transition from Resource Utilization Group Version IV (, ) to the Patient-Driven Payment Model (PDPM) on October 1, 2019, the. you could miss something. Note that for the first 3 days of the stay you get 3 times the rate shown on the map. NTA Componenet NTA Component NTA Comorbidity Score NTA Case Mix Group CMI 12+ NA 3.25 9-11 NB 2.53 6-8 NC 1.85 3-5 ND 1.34 1-2 NE 0.96 0 NF 0.72 Presumption of Coverage Comorbidities Included in NTA Comorbidity Score and Assigned Points Condition/Extensive Service MDS Item Points HIV/AIDS SNF Claim ICD-10 B20 8 Parenteral IV Feeding: Level High Speaking of individual facilities, lets take a look at that as well. Dietitians are classified in the NTA discipline. 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. They are assisted by certified nursing assistants (CNAs) and licensed staff assist them during medication administration ordered by the patients attending physician in the facility. The visualization is interactive. We earn 1 NTA point and qualify for Nursing Category Special Care Low for a Stage IV Pressure Ulcer when coded in M0300. These skilled services are for a medical condition that is a hospital-related medical condition treated during the three-day qualifying inpatient hospital stay (not including the day of discharge from the hospital). The map below shows every SNF in the US that accepted Medicare Part A patients in 2017. 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. HUMk@(h; ! PATIENT DRIVEN PAYMENT MODEL |4 . An NTA comorbidity score of 12 = a CMI of 3.24. Retrieved from: https://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html, Center for Medicare and Medicaid Services. This is to offset the high cost of medications and supplies that would be required to support the patient characteristics with these NTA conditions upon admission. This isnt exactly a new problem, but it didnt drive reimbursement before. Intermittent Catheterization? This problem isnt new either but now it will drive reimbursement. The Clinical Categories by Diagnosis mapping file only applies to the code listed in I0020B. Try Now! Resolved conditions should not be listed since therapy would not be treated for a resolved condition. These nurses are also trained to complete a full All Rights Reserved By Nursingcecentral 2022 |. PDPM Chart Audit Simple and Easy: Winning in PDPM Payment and Regulatory Strategies . Learn More Resource PDPM Series Part 5: Assessment Requirements. 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). Patients rely on you. This is an important financial consideration that facilities will not be able to afford to miss out on because of sloppy documentation or review of the records. This item includes diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. Zi@Ym"l?]L?*;YaRxwFhSGkhSFRQJIp.V4v!fbN91GE]Y:+s xref 0000006001 00000 n 0000278826 00000 n }|YAxz .diS\]0}3sfowMm@ Inappropriate Schizophrenia Diagnosis/Coding and Survey Citation Posting, Regulatory Reminders: Consolidated Billing Update 2023. CMS All about coding rehabilitation for joint replacements: Its important to know the reason for the joint replacement since coding a joint replacement due to a fracture is different than when a joint replacement is due to an elective surgery. PDPM includes a new pay category, the non-therapy ancillary or NTA. Center for Medicare and Medicaid Services. Points are scored if the condition or service is present. 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 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. Yes, I get that is bad. 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 Good talk. 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. These are: Physical Therapy (PT): 14 MDS items Occupational Therapy (OT): 14 MDS items Speech Language Pathology (SLP): 33 MDS items Nursing: 129 MDS items Non-Therapy Ancillary (NTA): 33 MDS items RUG-IV: Resource Utilization Groups version 4