There must be a reason for it, right? For example, IV medications (5 points) coded in MDS item O0100H2 or isolation (1 point) coded in O0100M2. border: 1px solid black; For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. %%EOF
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The PDPM diagnosis list determines the reimbursements for a Medicare Part A stay. A SANE nurse is an RN who has been trained to examine and assess clients who have a reported a sexual assault. On day 4 it goes back to the rate shown. This problem isnt new either but now it will drive reimbursement. Lets breakdown the PDPM model to better understand how reimbursement is determined. Below is the full listing of conditions and services used for NTA classification and the associated number of points for that comorbidity. 0000011153 00000 n
(Nursing, Social Services, Dietary and Activity Staff). It's easy to get to those 50, but the tricky part is understanding which ICD-10 codes match to the comorbidities. NTA component receives 300% of the base per-diem rate for days 1-3 of a stay. Stay tuned. Welcome to Gravity healthcare Consulting & Online Education An NTA comorbidity score of 12 = a CMI of 3.24. 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. 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. 0000009611 00000 n
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It is not clear why this would be the case. You can filter by NTA rate. 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. If the Primary Diagnosis you listed in I0020B also happens to be a SLP Comorbidity qualifier from the SLP Comorbidity list, the grouper software will pick it up as a comorbidity from I8000. 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. At the direction of the attending physician, a patient needs skilled care from and/or under the supervision of a skilled nursing or therapy staff daily. A Knowledgeable and Compassionate partner. To ease some of this burden, AAPACN developed the Sample Task List for the Nurse Assessment Coordinator tool . Was there a need for an IV? 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. 0000190726 00000 n
Click here to visit our shop. No software installation. Remember this is using 2017 data so it assumes that providers make no adjustments which is not realistic. Ive done that for urban and rural for every state. 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. On any device & OS. 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. 0000001405 00000 n
Condition/Extensive Service Source Points Aseptic Necrosis of Bone MDS Item I8000 1 Asthma COPD Chronic Lung Disease MDS Item I6200 2 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 Suctioning? 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. Diligent review of the medical history and clinical record is essential. We earn 1 NTA point if we code Protein or Calorie Malnutrition/At Risk for Protein or Calorie Malnutrition in MDS item I5600. RUG Classification Groups based on the volume and intensity of therapy provided to patient: Determinants of Payment for PDPM are summarized below. The required MDS data would be entered in the sub-items listed below the item group identifier. Custodial care does not require the assistance of a licensed staff. pdpm nta listhorse heaven hills road conditionshorse heaven hills road conditions Remember, the CMS list is authoritative, mine is only for your convenience. 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. Base rates are either rural or urban as determined by geographic location. 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. PATIENT DRIVEN PAYMENT MODEL |4 . HUMk@(h;
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(At this point, I can feel the cold stares from our MDS Experts. How can a facility ensure that they are not leaving money on the table due to under-coded NTAs? The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. [|Qc\0aXjK@ EdO4&_? and the grouper software will pick it up from I8000. The Primary Diagnosis in I0020B and the Principal Diagnosis should match. While the SNF certs and the Therapy Certs may contain this documentation, they are often not signed or approved until after the ARD. 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. comorbidities used under PDPM for NTA classification is assigned a certain number of points, between one and eight, based on its relative costliness. }|YAxz .diS\]0}3sfowMm@ Refer to RAI pages J37-J38 for more on coding J2100. Also, there is a 25% combined limit on concurrent and/or group therapy. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation to ensure 100% accuracy. 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. 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 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. Which codes are you most likely to actually see in the wild? The administration of IV fluids may qualify for the Parenteral/IV Feeding - High or Parenteral/IV Feeding - low NTA points. 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. It is critical that all coded conditions are accurate AND supported by nursing and physician documentation. (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 Variable Per Diem Adjustment Factors and ScheduleNTA. 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). This has been a key consideration in designing the various elements of the new model. Ill also compare urban versus rural facilities when it comes to NTA case-mix. ^(:eOCQ'SM7(Rmnvr/+eO.)hicZjz.,vO&u. Explain the impact of the variable per diem rate in the NTA component and how it impacts PDPM payment. The table below shows how the sum of the NTA points converts to an NTA Case Mix Group and a corresponding NTA CMI. (This isnt going to work well on mobile devices, FYI.). Basic versions of many 2019 AHCA PDPM Academy copyrighted document resources and webinars are available to . 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. The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. background-color: #2c4a88; Whats in it for me? 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). (difference of NE-NF and NA-NB). Not having the correct codes can have a domino effect and result in missed reimbursement, or claim inaccuracies. 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. Some didnt occur at all. startxref
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. A good first resource is the PDPM NTA Comorbidity Mapping spreadsheet. .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. Perhaps the most "transformative" component relates to Non-Therapy Ancillary (NTA) Services. Adjustments to the PDPM rates include: 2.3% reduction in FY 2023. additional 2.3% decrease in FY 2024. If a resident is admitted into a Part A stay within 30 days after major surgical procedure (as a hospital inpatient) that carried some degree of risk to life or had the potential for severe disability, then J2100 (recent surgery requiring active SNF care) is checked "yes". Hoo0#=)HU64*)T%DH!$swwb4fc|i]\/8gr? Patient has at least three qualifying inpatient days in an acute hospital. There are a total of five rates that make up your pay under PDPM.) Securely download your document with other editable templates, any time, with PDFfiller. Each component has its case mix index to determine the component rate. Any delay in getting this information is going to be problematic. As mentioned earlier, these NTA comorbidities are reported (coded) throughout the MDS. 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 . 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. or service for purposes of classification under the PDPM's NTA component. 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. Visit www.TrainingInMotion.org for more details of how we can help you achieve your PDPM goals. Start (and continue) the conversation. This is especially important for those residents who are long-term and later qualify for skilled care. Under PDPM, if a facility completes an IPA, and more points are achieved in the NTA component, the first 3 payment days of the IPA will NOT have the adjustment factor of 3% like it would at the start of the Medicare stay. The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. 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. 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 more comorbidities a patient has, the more medications he or she probably requires. 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. 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. Either way, you must still also code the I0020B primary condition I0010 through I8000. Observation services are not covered as part of the inpatient stay. last. 0
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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. PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. List the 3 MDS items that qualify a resident for the Extensive Nursing Service group. mp:U@|8B
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_VjWpb[5R8'i, CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. The NTA component, together with the nursing and non-case mix components, make up the total reimbursement for a patient day under Medicare Part A. NTA classification is based on the presence of certain comorbidities or use of certain extensive services. 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.
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