Patient has at least three qualifying inpatient days in an acute hospital. 437 0 obj <> endobj 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. Evansville, IN 47711, Phone: (812) 471-7777 See the table below. Facilities must ensure efficient processes are in place when selecting the primary diagnosis. This list of options is not used for PDPM payment, but is used as risk adjustments for some of the QRP Quality Measures. SNF PDPM Provider-Specific Impact File. 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. List the 3 MDS items that qualify a resident for the Extensive Nursing Service group. 8cq1o22#|Bm1il,4iw&C|E^F+oq:>_|M\v+iTOigWJ:dCa$Qv_n/q|wCuukk+e';iJB2C &!Ar8c _~r PDPM Series Part 4: Non-Therapy Ancillaries Case Mix Groups. The categories impact a resident's case-mix classification. by Proactive LTC Consulting | Jan 6, 2020 | Audits, Compliance, Education, MDS, Medical Review, PDPM. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. But now, if the resident also happens to have diabetic retinopathy, we can earn an extra NTA point if we also include the specific Diabetic Retinopathy code in I8000. The Patient-Driven Payment Model focuses on the patients unique characteristics and needs based on diagnosis which arise during inpatient hospital stay. NTA has been separated as an independent component, and NTA classification is determined by the presence of certain conditions or the use of certain extensive services that were found to be correlated with increases in NTA costs for SNF patients. Always be on the lookout for new updates which usually happen every year and usually effective by October 1 of each updated year. Continuous training is the key and implementation of what was learned in coordination with the facility team members will ensure success in providing skilled care for the patients and maximizing facility reimbursement. HU]o0}G?G< m*-$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? Of importance to note is the condition of HIV/AIDS under the NTA component. hVmk#7+xG{ZMaMu{vB{[ciF3Viee2!VpIbDAy_X%_A0,R99Kb! The individual NTA conditions have points ranging from 1 to 8. 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. hbspt.cta._relativeUrls=true;hbspt.cta.load(2297384, '30c35813-92d3-4fa1-bc3f-6b232de017b1', {"useNewLoader":"true","region":"na1"}); Topics: 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. var divElement = document.getElementById('viz1528375166404'); var vizElement = divElement.getElementsByTagName('object')[0]; vizElement.style.width='100%';vizElement.style.height=(divElement.offsetWidth*0.75)+'px'; var scriptElement = document.createElement('script'); scriptElement.src = 'https://public.tableau.com/javascripts/api/viz_v1.js'; vizElement.parentNode.insertBefore(scriptElement, vizElement); Use the rate filter to show only the highest or lowest NTA rates. 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. With this component being paid at a 3x rate for 1st 3 days of stay, its important to quickly and accurately identify and code patient conditions. Refer to RAI pages J37-J38 for more on coding J2100. Its important to comprehend more than just the basics of PDPM. For RUGs IV PPS, the payment is based on a per diem rate that is constant for the entire length of stay. 0000008175 00000 n h2430Q0P0430S0 You are never alone in this field and resources are available in seminars, webinars, the CMS website, MDS manual, etc. 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. Fax: (812) 471-7802 The PDPM classification system is based on support of the patients characteristics. Now let's discuss the I0020B Primary Diagnosis and the Claim's Principal Diagnosis. 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 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. 0000002491 00000 n We earn. Whats in it for me? &)` R #V? U? The most up to date guidelines are available at. The saying, haste makes waste applies in the completion of MDS assessments and calculation of the maximized PDPM rate for the patient. The general method for calculation of any NTA category is as follows: PDPM Chart Audit Simple and Easy: Winning in PDPM Payment and Regulatory Strategies . 0000003961 00000 n 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 Other diagnoses will affect the Non-therapy Ancillary (NTA) component. PDPM payments will be based on six groupsone non-case mix group (CMG) and five specific CMGs: PT, OT, SLP, NTA and nursing. Share our insider knowledge and tips! 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. Speaking of individual facilities, lets take a look at that as well. Stay tuned. Specialties What Is a SANE Nurse? Admittedly, thats a lot to look through. Either way, you must still also code the I0020B primary condition I0010 through I8000. For example, an NTA comorbidity score of 11 equals a CMI of 2.53. These clinical categories are PT, OT, and SLP. Luckily, code diving is a lot of fun, right? CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. Five of the six are case-mix adjusted. 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 toward the end of January, reporter Maggie Flynn poked holes in the idea that ICD-10 mastery was a necessity. ordered by the patients attending physician in the facility. 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. THURSDAY JUNE 23, 2022 2 PM EASTERN - 90 MINUTES, OHIO HEALTH CARE ASSOCIATION- Virtual Webinar, COST $35 FOR OHCA MEMBERS, $90 FOR NON-MEMBERS, https://webinars.ohca.org/?pg=semwebCatalog&panel=showLive&seminarid=16339, 6/23/22 Capturing Non-Therapy Ancillary (NTA) in PDPM. As we continue to become more knowledgeable in coding accuracy to drive care and maximize reimbursement, here are 15 quick tips to keep in mind: Those were just a few quick tips that are derived from recent Q&A's with clients. We earn 2 NTA points if Diabetes is coded in MDS item I2900. Determinant for payment is based on the number of therapy minutes provided regardless of residents acuity, diagnosis and other skilled nursing services provided. Remember that on the therapy plan of care the Treatment Diagnoses should be directly linked the Medical Diagnoses. This could be a difference of $29.23 per day for Urban and $27.93 per day for a Rural facility. Learn why in this video from Aegis Therapies. 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. Note that for the first 3 days of the stay you get 3 times the rate shown on the map. Securely download your document with other editable templates, any time, with PDFfiller. Base rates are either rural or urban as determined by geographic location. Ill also compare urban versus rural facilities when it comes to NTA case-mix. We must also understand all the aspects of PDPM coding from every single angle, the relationship between each facet of the components, and the impact on care and revenue. Complete a blank sample electronically to save yourself time and money. Verify coding, dont assume. For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. 0000005276 00000 n 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. The required MDS data would be entered in the sub-items listed below the item group identifier. 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. There are a lot of items from section I8000. z@~. It is highly recommended for the MDS nurse to make calculations which can determine the highest acceptable reimbursement rate for the facility. 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. Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. 0000001690 00000 n Patients rely on you. 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). you could miss something. This button displays the currently selected search type. With every dollar spent on nutrition screening and interventions, the Academy of Nutrition and Dietetics has reported savings of $3.25 3. What do I need to know? (difference of NE-NF and NA-NB). 66y% 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. 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. View D0AD3F24-D6BD-4273-B139-8FCA97487E6A.jpeg from NURSING MISC at St. Clair County Community College. When these conditions and extensive services are reported on the MDS 3.0, they are weighted and used to classify a resident into a specific NTA case-mix group. 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. They are assisted by certified nursing assistants (. ANOVA Rural versus Urban NTA case-mix (click to enlarge). code. 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). 463 0 obj <>stream 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. PATIENT DRIVEN PAYMENT MODEL |4 . No paper. As far as treating for late effects, such as weakness after an episode of pneumonia, you should obtain documentation from the physician or physician extender linking the late effects of the unsteady gait and weakness directly to the episode of pneumonia and that the pneumonia has a direct relationship to the current functional status and treatment. The resulting sum is the NTA comorbidity score, which is used to classify each resident into an NTA case-mix group. In summary, the NTA component is an important component to capture and reimburse the facility for costly medications and supplies that are needed to support patient characteristics. The list includes diagnosis codes, which will be recorded in the I8000 section of the MDS. This is especially important for those residents who are long-term and later qualify for skilled care. (4.0CSVMEB3nHSQ(9gvNtp}|srUzUX/%3vf+R6Fe Kb`Mr"yWz~tck~>1gK\,)?yt_Jy2Z2poUa-GFjRC'.`?/`;Mwk!$e#W,rLz:+ZL`Y4;Z%Up|h\/nzD]#N. hrmct requires an analytical mind and financial knowledge to determine the highest allowable reimbursement for the facility. What if we could limit those codes down to just those ICD-10 codes that are likely to occur. How often will the items on this list be available to you when you are doing the 5 day assessment? (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. 0000002742 00000 n CMS identified 50 conditions and services that were related to an increased cost for skilled nursing facilities. endstream endobj 451 0 obj <>stream @ Homework - Chapter 31: HlTT x + . endstream endobj 454 0 obj <>stream With this component being paid at a 3x rate for 1st 3 days of . IV medications provided as a resident and coded in Section O would also qualify for NTA points. SNF FY 2022 Proposed Rule Learn the Facts Behind the Headlines Part 3: How is My Rate Calculated, Regulatory Reminder! ,: >i*S7O=X8ZA'ic2+(!olVz`zz_"K@I 0000001865 00000 n 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. The PDPM Clinical Categories are discussed below. 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. thead { 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. Below is a summary of the determinants of payment and which section on the MDS assessment form they are derived from. PDPM includes a new pay category, the non-therapy ancillary or NTA. The provider will report on the Minimum Data Set (MDS) each of the comorbidities that a person has. The score determines NTA payment groups and indices. Identification of NTA conditions and services should start even before the SNF admission. A} 2?d`aYW!3,8h|J/K\J:s&Ve>1|9WiixusVo\sGP8saBT!+(z$lYnAZZp@6Y1m`[ jKeMQ5i.7HCGIC1iGIc' The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. comorbidities used under PDPM for NTA classification is assigned a certain number of points, between one and eight, based on its relative costliness. The Centers for Medicare & Medicaid Services (CMS) realizes that the cost impact of medications, at the time of admission, is extensive. The higher the total point value, the greater the payment (CMI). The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation. Whats in it for me? When reviewing the CMI components driving PDPM reimbursement it's important to consider the critical role of the Non-Therapy Ancillary (NTA) score. Which codes are you most likely to actually see in the wild? ~,/-I\!/JfB. Wound Care? Suctioning? endstream endobj 1695 0 obj <>stream Condition/Extensive Service Source Points Aseptic Necrosis of Bone MDS Item I8000 1 Asthma COPD Chronic Lung Disease MDS Item I6200 2 Also notice there are very few facilities with low NTA rates in the Appalachians. The FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. 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 FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. I wish I could be in your training the 29th. Your NTA payment is driven by the presence of a number of conditions and/or extensive services. 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. In 2019, CMS has further revised and finalized the version of PDPM that will go into effect October 1, 2019. Patients are assigned a clinical category based on the primary diagnosis for SNF stay. (At this point, I can feel the cold stares from our MDS Experts. CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. There must be a reason for it, right? The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. Daily Medicare charting should focus on all possible nursing clinical categories, special care high, special care low, clinically complex, behavioral symptoms and cognitive performance, and reduced physical function. 0000189184 00000 n The NTA component is an important component to capture and reimburse the facility for costly medications, services, and supplies needed to care for residents. 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. Items on this list could change at any time with new legislative and Basic versions of many 2019 AHCA PDPM Academy copyrighted document resources and webinars are available to . yid T[KaEev0D/wRDQhDB['QgDTBEB)2"xt"Xn2 QN[%=> FhzdBI^8/HD How should you prioritize your search for ICD-10 codes? .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. PDPM HIPPS Coding Crosswalk In order to accommodate the new payment groups, the PDPM HIPPS algorithm is . 0000007482 00000 n The new nurse assessment coordinator (NAC) may be overwhelmed with the numerous tasks required of the position. The idea is that the facility should be paid for the care they are delivering, based on the patients characteristics. As under the previous RUGIV model, the presence of an AIDS diagnosis continues to be identified through the . Payment is based on services provided by five disciplines: physical therapy, occupational therapy, speech language pathology, nursing, and non-therapy ancillary (NTA). 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 .
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