Ensure you have staff who are trained in ICD-10 coding. What do I need to know? When reviewing the CMI components driving PDPM reimbursement it's important to consider the critical role of the Non-Therapy Ancillary (NTA) score. We earn 1 NTA point and qualify for Nursing Category Special Care Low for a Stage IV Pressure Ulcer when coded in M0300. Focuses on clinically relevant factors rather than volume-based services or RUG levels. 437 0 obj
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For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. For the Non-Therapy Ancillary Component, each diagnosis has a corresponding score which is multiplied to the federal NTA case mix index. They are assisted by certified nursing assistants (. There are a lot of items from section I8000. (By the way, we created a PDPM Calculator for you to experiment with and get a better understanding of how PDPM works. 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. Retrieved from: https://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html, Center for Medicare and Medicaid Services. Remember, the CMS list is authoritative, mine is only for your convenience. Nursing and NTA Components of PDPM - Hansen Hunter & Co. P.C. It's easy to get to those 50, but the tricky part is understanding which ICD-10 codes match to the comorbidities. The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. z@~. 0
Inappropriate Schizophrenia Diagnosis/Coding and Survey Citation Posting, Regulatory Reminders: Consolidated Billing Update 2023. What Dietitians Need To Know About PDPM ENSURE TO CAPTURE EVERYTHING PRIOR TO COMPLETION OF THE 5-DAY MDS ASSESSMENT! hb```b``ia`e`ff@ a(meU=r%::@`uH@V01:000x1p`5`gy4AuG/Dg* ZF:&'[-@ >` t!R
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Refer to the PDPM Calculation Worksheet for more information. hWmo6+( 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. Understanding PDPM and the Interim Payment Assessment - LW Consult View fullsize 0000189184 00000 n
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Preparedness for coding changes will be the key to a smooth transition. Basic versions of many 2019 AHCA PDPM Academy copyrighted document resources and webinars are available to . 0000003793 00000 n
Start (and continue) the conversation. 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. 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. 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. endstream
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a" I54043lquizzes/446951 (Question 2 5 / 5 pts The In this article, we discuss the non-therapy ancillary (NTA) component. When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. It is not clear why this would be the case. All PDPM components are assigned an appropriate score to multiply to the federally assigned case mix index group. This has been a key consideration in designing the various elements of the new model. 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. @ Homework - Chapter 31: HlTT x + . The saying, haste makes waste applies in the completion of MDS assessments and calculation of the maximized PDPM rate for the patient. ;DktP'pm}iE/4K~bY?c~220E+t;sdvGHz P,
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. 437 27
If you have an idea lets discuss! Specialties Hyperemesis Gravidarum: More Than Just Morning Sickness Pregnancy and nausea are terms used in unison with one another. 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. code. Yes, I get that is bad. It more accurately accounts for expenses and isn't overshadowed by therapy. The functional scoring is based on residents performance in. ~,/-I\!/JfB. endstream
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When reviewing the CMI components driving PDPM reimbursement its important to consider the critical role of the Non-Therapy Ancillary (NTA) score. This PDPM model aims to utilize the individual patients characteristics and needs based on diagnosis as opposed to the RUG-IV system relying on volume of services. PDF Patient Driven Payment Model - Missouri Long-Term Care Information Update 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 . 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. The Primary Diagnosis in I0020B and the Principal Diagnosis should match. How can a facility ensure that they are not leaving money on the table due to under-coded NTAs? We earn 2 NTA points if Diabetes is coded in MDS item I2900. Based on that, we can calculate the rate. 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. background-color: #2c4a88; Do not be apprehensive to query the physician if a diagnosis is not clear or is suspected and not documented. Ive done that for urban and rural for every state. 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. 66y% PDF PDPM Component Variable Per-Diem and RUG-IV Rate Reference Tables Le^#N"TaAKTt Reimbursement, LW Consulting, Inc.5925 Stevenson Avenue, Suite GHarrisburg, PA 17112, Ph:800-320-5401Local Ph: 717-233-6100Fx:717-233-4633. 5!!!!!May!be!used!by!permission!only!Proactive!Medical!Review,!LLC!!!!!www.proactivemedicalreview.com!!!! Patient Driven Payment Model | CMS CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. 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 RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. At first, it took me longer to get used to making calculations in determining the highest allowable rate for the patient. The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. SNF Reimbursement - TRICARE West The NTA looks at conditions and extensive services that are associated with significant increase in costs for a skilled nursing facility. Based on that, I have made you an extreme cheat sheet, that you should use with extreme caution. Dietitians are classified in the NTA discipline. 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). With the transition from Resource Utilization Group Version IV (, ) to the Patient-Driven Payment Model (PDPM) on October 1, 2019, the. 0000006770 00000 n
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These nurses are also trained to complete a full All Rights Reserved By Nursingcecentral 2022 |. For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. Coding Speech Related Comorbidities Under PDPM - Language Fundamentals Anyone involved with ICD-10 coding should have ready access to the coding guidelines. I0020 is also a gateway to the I0020B Primary Diagnosis code. Everyone I've talked to agrees the NTA payment is a good idea. PDF PMR MDS Items PDPM - nehca.org Remember, a diagnosis has to be active and documented by a physician or nonphysician extender to qualify as an NTA item. 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. Conduct interview assessments for the Brief Interview for Mental Status (BIMS), and Mood ON ASSESSMENT REFERENCE DATE (ARD) OR A DAY PRIOR TO ARD. 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 . 2207 Morgan Ave, Suite D Item I0020 and I0020B: Item I0020 (primary medical condition category that best describes the primary reason for admission lists several options. Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing components. Its interesting to note that the data CMS provided, that I am using here, came from some assessments that we no longer will be doing. With such a close relationship to payment, it is critical the staff member(s) responsible for ICD-10 coding are knowledgeable in this area. endstream
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Any delay in getting this information is going to be problematic. $HJ0!$j-g#W d9bEi0~og$.J8-Lb =lZ.SSz|'!`%/ It more accurately accounts for expenses and isnt overshadowed by therapy. endstream
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PDF MDS Item Fields - All PDPM Case-Mix Adjusted Components Try it out!). Under PDPM, an adjustment is applied to certain PDPM components that varies the per diem payment over the course of the stay. PDPM and Non-Therapy Ancillaries The non-therapy ancillary (NTA) part of the patient driven payment model (PDPM) is considered by most people I've talked to as being better than what we're currently doing. The Centers for Medicare and Medicaid Services (CMS) have provided the SNFs with a list of ICD-10-CM codes mapping to one of the clinical categories: These clinical categories are used as the Primary PDPM diagnosis giving weight to the calculation of PDPM rates for PT, OT, SLP and Nursing components. In 2019, CMS has further revised and finalized the version of PDPM that will go into effect October 1, 2019. Good talk. The NTA component is an important component to capture and reimburse the facility for costly medications, services, and supplies needed to care for residents. The categories impact a resident's case-mix classification. Hoo0#=)HU64*)T%DH!$swwb4fc|i]\/8gr? Far more items than would actually fit on the MDS 3.0 Instrument. These maps look significantly different from a lot of the others weve seen. Below is a summary of the determinants of payment and which section on the MDS assessment form they are derived from. 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 PDPM program has six payment components. 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. (Note that this map is showing ONLY the NTA rate. The PDPM Clinical Categories are discussed below. A}
2?d`aYW!3,8h|J/K\J:s&Ve>1|9WiixusVo\sGP8saBT!+(z$lYnAZZp@6Y1m`[ jKeMQ5i.7HCGIC1iGIc' Whats in it for me? Great info! HUO0~^iq3N&@-0*Si$L9)-ziwg';q_}(Ak"CwKi "@~|iA`!c Was there a need for an IV? This NTA CMI is added to the other components to calculate the total reimbursement for the patient. you could miss something. As a result, client facilities realize improved wound healing results, improved survey scores and NTA reimbursement under PDPM. Welcome to Gravity healthcare Consulting & Online Education PDF PDPM HIPPS Coding Crosswalk - naviHealth When also coded in I8000, I69.091 will also contribute again to the case mix group because it is on the SLP comorbidity list. There is also the impact of the Variable Per Diem Adjustment Factor that is applied to the NTA Component. On day 4 it goes back to the rate shown. 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. 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. %PDF-1.6
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These residents may have a significant number of inaccurate or resolved diagnoses if a facility doesnt have a process for ongoing diagnosis reconciliation. In this post, we going to look at one important piece of the NTA puzzle, section I. 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. Skilled nursing facilities now have more than a year of experience with the Patient-Driven Payment Model (PDPM), the updated case-mix classification system used in the Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS) that includes five case-mix-adjusted payment components: physical therapy (PT), occupational therapy oYyTQb`y{y;..nI^vY5[3?O%5;5E8_kT}m}02|E}}q4:>9=6
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Z5FXMM:&Dh,A*hJtiL."%oKt Custodial care does not require the assistance of a licensed staff. Two Big PDPM Changes in FY 2023 and 3 Tools to Address Them This does not include conditions that are resolved. MDS 3.0 RAI Manual. 0000002742 00000 n
The PDPM classification system is based on support of the patients characteristics. 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 (. List the 3 MDS items that qualify a resident for the Extensive Nursing Service group. PDPM payments will be based on six groupsone non-case mix group (CMG) and five specific CMGs: PT, OT, SLP, NTA and nursing. This list of options is not used for PDPM payment, but is used as risk adjustments for some of the QRP Quality Measures. Report the diagnosis code that provides an 18% add-on to the nursing component when coded on the UB-04 even when not coded on the MDS. Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. Everyone Ive talked to agrees the NTA payment is a good idea. Patients are assigned a clinical category based on the primary diagnosis for SNF stay. PDPM: Calculating your NTA comorbidity score - SimpleLTC Facilities must ensure efficient processes are in place when selecting the primary diagnosis. Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). What do I need to know? The patients NTA comorbidity score is the sum of the points associated with each relevant comorbidity. Perhaps the most "transformative" component relates to Non-Therapy Ancillary (NTA) Services. 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. The resulting sum is the NTA comorbidity score, which is used to classify each resident into an NTA case-mix group. info@proactivemedicalreview.com, 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. Skilled nursing services are covered under the Federal Governments. The new nurse assessment coordinator (NAC) may be overwhelmed with the numerous tasks required of the position. 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. This button displays the currently selected search type. h4Pj0^z[ 8 >BRA$+Vfa Skilled nursing services are covered under the Federal Governments Medicare program for a limited time or on a short-time basis and must meet the following requirements: The role of the Minimum Data Set (MDS) nurses has evolved all these years from being a clinician to a financial analytical nurse because the MDS assessments have become the basis for facility reimbursement by the Medicare program. These groups and indices, combined with other components of the payment system, provide a total reimbursement process that 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. See the table below. Non-Therapy Ancillary (NTA) Services - At a Glance The Patient-Driven Payment Model (PDPM) takes effect on October 1, 2019 and represents a significantly different approach to reimbursement for care in Skilled Nursing Facilities (SNFs). Refer to RAI pages J37-J38 for more on coding J2100. PDPM: 15 Quick Tips - LinkedIn Remember this is using 2017 data so it assumes that providers make no adjustments which is not realistic. Understanding the Value of the MDS Nurse Under PDPM, Psoriatic Arthropathy & Systemic Sclerosis, Myelodysplastic Syndromes and Myelofibrosis. 0000000836 00000 n
Patient classification system where patients are grouped according to their care and resource needs. The general method for calculation of any NTA category is as follows: PDPM Non-Therapy Ancillary Pay - Broad River Rehabilitation The patients functional score which is coded on Section GG 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. With several big changes ahead, the margin for error slim for most providers. xref
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. In the past, we only checked this box even if the resident was a diabetic and also had retinopathy. PDF Non-Therapy Ancillary Services Conditions/Extensive Services - SimpleLTC Not all NTAs are ICD-10 codes, some are MDS items. Which codes are the most important? 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. For example, if the MDS Coordinator counts only two of the three comorbidities that a patient has, the CMI for NTA would be 0.96 instead of 1.34. You can rely on us. PDF PATIENT-DRIVEN PAYMENT MODEL: FREQUENTLY ASKED QUESTIONS (FAQs) o NTA = All NTA items identified with a value of two or more points on the NTA table. Determinant for payment is based on the number of therapy minutes provided regardless of residents acuity, diagnosis and other skilled nursing services provided. 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 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. &)` R #V? U? Other diagnoses will affect the Non-therapy Ancillary (NTA) component. This is especially important for those residents who are long-term and later qualify for skilled care. The Patient Driven Payment Model (PDPM) - FHCA Pulse NAC Resources for Post-Acute Care Nurses - AAPACN h2430Q0P0430S0 ! The map below shows every SNF in the US that accepted Medicare Part A patients in 2017. We know now that every diagnosis and condition counts. Notice there is a big pocket of low NTA rates that covers most of Iowa. 1694 0 obj
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Try Now! 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.