Our wound certified educators train, educate, and guide our providers and client facilities on the most efficacious wound care treatments and follow up. 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). 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. 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 If your facility has a low NTA rate, it may just mean you have work to do, documentation-wise. 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. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. (2019) Fact Sheet: NTA Comorbidity Score https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/PDPM_Fact_Sheet_NTAComorbidityScoring_v2_508.pdf, Center for Medicare and Medicaid Services. table, th, td { h2430Q0P0430S0 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. A frequent question: "If the mapping file lists a code as "return to provider", can I still use it on the MDS?". See the table below. You are never alone in this field and resources are available in seminars, webinars, the CMS website, MDS manual, etc. The adjusted PT, OT, and NTA per diem rates are then added together with the unadjusted SLP and nursing component rates and the non-case-mix component, as is done under RUG-IV, to determine the full per diem rate for a given resident. The Primary Diagnosis in I0020B and the Principal Diagnosis should match. This update addresses two issues with the NTA comorbidities mapping. comorbidities used under PDPM for NTA classification is assigned a certain number of points, between one and eight, based on its relative costliness. xref PDPM Chart Audit Simple and Easy: Winning in PDPM Payment and Regulatory Strategies . ;iHIBK = >N]Y}dZ}HvtZ04D8YV4r4Od^/NJ x/i"9WirMdy2d*{E^lEu}Jg t@C`[aNOGgg0?bd'r EVm@Av;*%f?Wp :1&[+cZhqhU;IKBU Patient classification system where patients are grouped according to their care and resource needs. <<50FFC127310FCF468ABFE4B7414A5B70>]/Prev 423154>> Reimbursement, LW Consulting, Inc.5925 Stevenson Avenue, Suite GHarrisburg, PA 17112, Ph:800-320-5401Local Ph: 717-233-6100Fx:717-233-4633. You only need one SLP co-morbidity (either in one of those check boxes or listed in I8000) to meet that SLP co-morbidity qualifier. Therefore, the code in I0020B must be directly related to the I0020 Primary Medical Condition. It's easy to get to those 50, but the tricky part is understanding which ICD-10 codes match to the comorbidities. When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. Holds on recalibrating the PDPM "parity adjustment" that is designed to ensure budget neutrality under the new model to assist SNFs in meeting the demands of the COVID-19 pandemic until FY 2023. With postpartum preeclampsia, patients are now not seeing a health care provider by NCC News and Content Team | Jan 24, 2023 | Specialties. 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 . His I0020B Primary Diagnosis and his claim's Principal Diagnosis is now the aftercare of the hip fracture. The score determines NTA payment groups and indices. Inappropriate Schizophrenia Diagnosis/Coding and Survey Citation Posting, Regulatory Reminders: Consolidated Billing Update 2023. PDPM includes a new pay category, the non-therapy ancillary or NTA. Hover over a facility to see the name, NTA Rate, NTA case-mix index and whether the facility is urban or rural. Yes, I get that is bad. 463 0 obj <>stream 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). 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. Facilities that work to establish these best practices associated with the NTA component will increase revenue and see other benefits such as improved Quality Measures, reduced readmission rates, and improve skilled documentation. How often will the items on this list be available to you when you are doing the 5 day assessment? This information is essential. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. But, since it's new, we're going to have to work on understanding how it's supposed to work, and how we can most easily and efficiently complete the assessment with accurate information. Also notice there are very few facilities with low NTA rates in the Appalachians. Refer to the PDPM Calculation Worksheet for more information. Overview In July 2018, CMS finalized a new case-mix classification model, the Patient Driven Payment Model (PDPM), that, effective beginning October 1, 2019, will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay. the design of the PDPM case-mix system implemented in FY 2020. 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. 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. 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. Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). Items on this list could change at any time with new legislative and 0000008175 00000 n 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. On day 4 it goes back to the rate shown. Classroom Walkthrough Checklist Resource Center K 12 Resources Frontline Education April 18th, 2019 - Broken Arrow Public Schools a large urban suburban district with deep roots in the community serves more than 19 000 students Recognized as one of the top background-color: #2c4a88; 0000277284 00000 n Conduct interview assessments for the Brief Interview for Mental Status (BIMS), and Mood ON ASSESSMENT REFERENCE DATE (ARD) OR A DAY PRIOR TO ARD. 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 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. 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. or privately paid by the patient if he/she does not qualify under the Medi-Cal program. hb```b``ia`e`ff@ a(meU=r%::@`uH@V01:000x1p`5`gy4AuG/Dg* ZF:&'[-@ >` t!R AVONA confirms that rural facilities do indeed have lower NTA case-mix. Title: Microsoft Word - FINAL PDPM Triple Check Checklist.docx Author: jleatherbarrow Created Date: 1/29/2020 4:19:17 PM The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation. Item I0020 and I0020B: Item I0020 (primary medical condition category that best describes the primary reason for admission lists several options. Retrieved from: https://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html, Center for Medicare and Medicaid Services. 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. The Non-Therapy Ancillary Services (NTA) component is a total score of all listed conditions and/or extensive services that apply to the resident. of the MDS form is derived by assessing the patients usual self-performance in the ADL task areas during the first three days of facility stay. and the grouper software will pick it up from I8000. After a qualifying hospital stay, he has returned to the SNF for aftercare of the hip fracture. Reimbursement for these services is covered under the. 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 . The saying, haste makes waste applies in the completion of MDS assessments and calculation of the maximized PDPM rate for the patient. The visualization is interactive. Learn More Resource PDPM Series Part 5: Assessment Requirements. Primary reason for SNF care or PDPM diagnosis coded on Section I00200B (ICD-10 code) of the MDS assessment, Functional status coded on Section GG of the MDS assessment, Cognitive Status: BIMS score coded on the Section C of the MDS assessment, presence of a swallowing disorder or mechanically altered diet coded on Section K of the MDS assessment, other SLP-related comorbidities coded on Section I of the MDS assessment, Extensive services received coded on Section of the MDS assessment such as Tracheostomy, Ventilator, and Isolation, Presence of Depression coded on Section D: PHQ9 on the MDS assessment, Restorative nursing services coded on Section O of the MDS assessment, Comorbidities present coded on Section I of the MDS assessment, Extensive services received coded on Section O of the MDS assessment: Tracheostomy, Ventilator and Isolation. Not having the correct codes can have a domino effect and result in missed reimbursement, or claim inaccuracies. Patients rely on you. When also coded in I8000, I69.091 will also contribute again to the case mix group because it is on the SLP comorbidity list. Involve the Interdisciplinary Team. Condition/Extensive Service Source Points Aseptic Necrosis of Bone MDS Item I8000 1 Asthma COPD Chronic Lung Disease MDS Item I6200 2 The list includes diagnosis codes, which will be recorded in the I8000 section of the MDS. [|Qc\0aXjK@ EdO4&_? Which codes are the most important? 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. The MDS software programs such as PointClick Care, Matrix, Net Solutions, to name just a few, automatically calculate the PDPM rates once the MDS assessment is completed. border: 1px solid black; The presence of these conditions and extensive services is reported by providers . CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. @ Homework - Chapter 31: HlTT x + . 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. For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. For the NTA, an adjustment factor of 3.0 is applied to the total NTA CMI for days 1-3. It more accurately accounts for expenses and isnt overshadowed by therapy. One can see from the table above that if comorbidities are missed, the facility could possibly miss out on reimbursement. yid T[KaEev0D/wRDQhDB['QgDTBEB)2"xt"Xn2 QN[%=> FhzdBI^8/HD These components for classification and payment include: Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST), Non-therapy Ancillary (NTA) as well as Nursing. (difference of NE-NF and NA-NB). Below is the full listing of conditions and services used for NTA classification and the associated number of points for that comorbidity. 0000000836 00000 n Identification of NTA conditions and services should start even before the SNF admission. We earn 2 NTA points if Diabetes is coded in MDS item I2900. The non-therapy ancillary (NTA) part of the patient driven payment model (PDPM) is considered by most people Ive talked to as being better than what were currently doing. Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. When expanded it provides a list of search options that will switch the search inputs to match the current selection. 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. HUMk@(h; ! 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. Dietitians are classified in the NTA discipline. We earn 1 NTA point if we code Protein or Calorie Malnutrition/At Risk for Protein or Calorie Malnutrition in MDS item I5600. A} 2?d`aYW!3,8h|J/K\J:s&Ve>1|9WiixusVo\sGP8saBT!+(z$lYnAZZp@6Y1m`[ jKeMQ5i.7HCGIC1iGIc' Good talk. Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). Prior to October 1, 2019, all SNFs which participate under the Medicare program are paid under the Skilled Nursing Facility (SNF) Prospective Payment System (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. Formulate a PDPM group to review the chart and come up with the residents primary or principal diagnosis and do the ICD-10 clinical category mapping. There are a total of five rates that make up your pay under PDPM.) And lastly, an update on therapy revenue codes and the claim CMS Transmittal 2270 from March 13, 2019 states that beginning October 1, 2019, the Medicare contractor will no longer require therapy services to be present on SNF or Swing Bed claims. 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). 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. MDS 3.0 Section I Thats a lot of white space. In this post, we going to look at one important piece of the NTA puzzle, section I. 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. } Highlights: Hiring both part-time 2 days/week and full-time 4-5 days/week (benefits for FT only) Hours: Monday-Friday ~7am to 4pm; no evenings, weekends, call, or holidays . The PDPM Clinical Categories are discussed below. tr:nth-child(even) {background-color: #f2f2f2;} The PDPM diagnosis list determines the reimbursements for a Medicare Part A stay. Skilled nursing services are covered under the Federal Governments. IV medications provided as a resident and coded in Section O would also qualify for NTA points. A good first resource is the PDPM NTA Comorbidity Mapping spreadsheet. Variable Per Diem Adjustment Factors and ScheduleNTA. 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 Specialties What Is a SANE Nurse? With the transition from Resource Utilization Group Version IV (, ) to the Patient-Driven Payment Model (PDPM) on October 1, 2019, the. Other codes can still be listed in I8000. Focuses on clinically relevant factors rather than volume-based services or RUG levels. The PDPM program has six payment components. 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. mapping to one of the clinical categories: Orthopedic Surgery (Except Major Joint Replacement or Spinal Surgery, Non-orthopedic Surgery and Acute Neurologic, Other Orthopedic (non-surgical orthopedics and musculoskeletal), Medical Management (medical management, acute infections, cancer, pulmonary, cardiovascular/coagulation, acute neurologic), The patients functional score which is coded on. Whats in it for me? For the Non-Therapy Ancillary Component, each diagnosis has a corresponding score which is multiplied to the federal NTA case mix index. Remember that on the therapy plan of care the Treatment Diagnoses should be directly linked the Medical Diagnoses. 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. Points are added together for all conditions. Below is a summary of the determinants of payment and which section on the MDS assessment form they are derived from. - Corrected typo in minimum point value thresholds used to ify patients into groups "NA" and "NB" under the NTA component. Lets breakdown the PDPM model to better understand how reimbursement is determined. All Rights Reserved. When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. Le^#N"TaAKTt Securely download your document with other editable templates, any time, with PDFfiller. 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. 437 0 obj <> endobj An NTA comorbidity score of 12 = a CMI of 3.24. "FE"u PsFO;416ib_z/[E>#~.G+Y6l|)31}Q50B}Wk?/1wo USIek~)zR*u:1\np2}HPs}@I#RM=e1JtJ22;3(TYt&8W1UN@ID7{V Z +MykUW? [email protected], Blog by Jessica Cairns, RN, RAC-CT, CMAC, and Eleisha Wilkes, RN, RAC-CTA, Click to share on LinkedIn (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Twitter (Opens in new window), Deep Dive into Federal Regulations in a Year, Mission Possible: SNF Department Head Briefing, https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2020-Coding-Guidelines.pdf, https://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/PDPM_Fact_Sheet_NTAComorbidityScoring_v2_508.pdf, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/PDPM_Fact_Sheet_AIDS_v3_508.pdf, Special Treatments/Programs: Intravenous Medication Post-admit Code, Special Treatments/Programs: Ventilator or Respirator Post-admit Code, Special Treatments/Programs: Transfusion Post-admit Code, Major Organ Transplant Status, Except Lung, Active Diagnoses: Multiple Sclerosis Code, Active Diagnoses: Asthma COPD Chronic Lung Disease Code, Bone/Joint/Muscle Infections/Necrosis Except: Aseptic Necrosis of Bone, Active Diagnoses: Diabetes Mellitus (DM) Code, Other Foot Skin Problems: Diabetic Foot Ulcer Code, Special Treatments/Programs: Tracheostomy Care Post-admit Code, Active Diagnoses: Multi-Drug Resistant Organism (MDRO) Code, Special Treatments/Programs: Isolation Post-admit Code, Specified Hereditary Metabolic/Immune Disorders, Special Treatments/Programs: Radiation Post-admit Code, Stage 4 Unhealed Pressure Ulcer Currently present, Psoriatic Arthropathy and Systemic Sclerosis, Proliferative Diabetic Retinopathy and Vitreous Hemorrhage, Other Foot Skin Problems: Foot Infection Code, Other Open Lesion on Foot Code, Except Diabetic Foot Ulcer Code, Complications of Specified Implanted Device or Graft, Bladder and Bowel Appliances: Intermittent catheterization, Special Treatments/Programs: Suctioning Post-admit Code, Myelodysplastic Syndromes and Myelofibrosis, Systemic Lupus Erythematosus, Other Connective Tissue Disorders, and Inflammatory Spondylopathies, Diabetic Retinopathy Except: Proliferative Diabetic Retinopathy and Vitreous Hemorrhage, Nutritional Approaches While a Resident: Feeding Tube, Disorders of Immunity Except: RxCC97: Immune Disorders, Pulmonary Fibrosis and Other Chronic Lung Disorders.