endstream endobj 1696 0 obj <>stream Welcome to Gravity healthcare Consulting & Online Education 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. (Right). Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. 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. It will be imperative that the coding is accurate on the MDS for the NTA conditions. 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. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. 0000001085 00000 n The provider will report on the Minimum Data Set (MDS) each of the comorbidities that a person has. 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. There must be a reason for it, right? Remember this is using 2017 data so it assumes that providers make no adjustments which is not realistic. These components for classification and payment include: Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST), Non-therapy Ancillary (NTA) as well as Nursing. SAMPLE Task List for the Nurse Assessment Coordinator (NAC) November 23, 2022. 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". @.dFo8L.3.#V0 F6Qa)bJ3oR/-5F=8tJ7r8*o{ VFh6Em4~qLh8Km,nLjwjW'm,|w>cy?^UKqZ`TU$7h"M9D*;XYi@ YhZ|453}R;|/F>!KLd{mQ*z7-.r|T_]Y^]K42Ca1g_AVYJo1ox/,e*M'LM ThY^SC w{i0[y0j|[1;hfD$;qp4UgNurGg2gKE)dtA6g!kJ|wpl; Anyone involved with ICD-10 coding should have ready access to the coding guidelines. 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. (Nursing, Social Services, Dietary and Activity Staff). Click the comorbidity and see the ICD-10 codes that are most likely to occur. The PDPM classification system is based on support of the patients characteristics. This NTA CMI is added to the other components to calculate the total reimbursement for the patient. 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. 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 Everyone I've talked to agrees the NTA payment is a good idea. 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. Refer to the PDPM Calculation Worksheet for more information. Group therapy now allows for as few as 2 residents and as many as 6 residents. ENSURE TO CAPTURE EVERYTHING PRIOR TO COMPLETION OF THE 5-DAY MDS ASSESSMENT! The individual NTA conditions have points ranging from 1 to 8. 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. startxref Fax: (812) 471-7802 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 absence of specific documentation, you may use positive tests, procedures, hospitalization for symptoms). The list includes diagnosis codes, which will be recorded in the I8000 section of the MDS. Whats in it for me? CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. 0 (By the way, we created a PDPM Calculator for you to experiment with and get a better understanding of how PDPM works. Inappropriate Schizophrenia Diagnosis/Coding and Survey Citation Posting, Regulatory Reminders: Consolidated Billing Update 2023, Osteomyelitis of vertebra, site unspecified, Other acute osteomyelitis, unspecified ankle and foot, Staphylococcal arthritis, unspecified knee, Other acute osteomyelitis, unspecified site, Pneumococcal arthritis, unspecified joint, Other chronic osteomyelitis, unspecified ankle and foot, Other acute osteomyelitis, unspecified tibia and fibula, Other chronic osteomyelitis, unspecified site, Direct infection of unspecified joint in infectious and parasitic diseases classified elsewhere, Staphylococcal arthritis, unspecified hip, Direct infection of unspecified knee in infectious and parasitic diseases classified elsewhere, Staphylococcal arthritis, unspecified shoulder, Other chronic osteomyelitis, unspecified tibia and fibula, Other acute osteomyelitis, unspecified femur, Direct infection of vertebrae in infectious and parasitic diseases classified elsewhere, Other chronic osteomyelitis, unspecified thigh, Direct infection of multiple joints in infectious and parasitic diseases classified elsewhere, Other acute osteomyelitis, multiple sites, Staphylococcal arthritis, unspecified ankle and foot, Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission, Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, Infection and inflammatory reaction due to unspecified internal joint prosthesis, initial encounter, Embolism due to internal orthopedic prosthetic devices, implants and grafts, initial encounter, Embolism due to vascular prosthetic devices, implants and grafts, initial encounter, Other mechanical complication of unspecified internal joint prosthesis, initial encounter, Dislocation of unspecified internal joint prosthesis, initial encounter, Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, initial encounter, Infection and inflammatory reaction due to internal fixation device of unspecified site, initial encounter, Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter, Other mechanical complication of aortic (bifurcation) graft (replacement), initial encounter, Other mechanical complication of other internal orthopedic devices, implants and grafts, initial encounter, Breakdown (mechanical) of internal fixation device of unspecified bone of limb, initial encounter, Infection and inflammatory reaction due to cardiac valve prosthesis, initial encounter, Mechanical loosening of unspecified internal prosthetic joint, initial encounter, Broken internal joint prosthesis, unspecified site, initial encounter, Embolism due to genitourinary prosthetic devices, implants and grafts, initial encounter, Secondary esophageal varices without bleeding, Secondary esophageal varices with bleeding, Alcoholic cirrhosis of liver without ascites, Antineoplastic chemotherapy induced pancytopenia, Agranulocytosis secondary to cancer chemotherapy, Acute respiratory failure, unspecified whether with hypoxia or hypercapnia, Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia, Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia, Acute and chronic postprocedural respiratory failure, Acute pulmonary insufficiency following thoracic surgery, Acute and subacute infective endocarditis, Acute and subacute endocarditis, unspecified, Endocarditis and heart valve disorders in diseases classified elsewhere, Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus, Epilepsy, unspecified, intractable, with status epilepticus, Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus, Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus, Respiratory bronchiolitis interstitial lung disease, Respiratory disorders in diseases classified elsewhere, Other alveolar and parieto-alveolar conditions, Idiopathic interstitial pneumonia, not otherwise specified, Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema, Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema, Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema, Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema, Morbid (severe) obesity due to excess calories, Morbid (severe) obesity with alveolar hypoventilation, Body mass index (BMI) 70 or greater, adult, Ulcerative colitis, unspecified, without complications, Crohns disease, unspecified, without complications, Other ulcerative colitis without complications, Ulcerative (chronic) pancolitis without complications, Ulcerative (chronic) proctitis without complications, Crohns disease of small intestine without complications, Crohns disease of large intestine without complications, Idiopathic aseptic necrosis of unspecified femur, Idiopathic aseptic necrosis of unspecified bone, Idiopathic aseptic necrosis of bone, other site, Systemic lupus erythematosus, organ or system involvement unspecified, Ankylosing spondylitis of unspecified sites in spine, Wegeners granulomatosis without renal involvement, Polymyositis, organ involvement unspecified, Dermatopolymyositis, unspecified, organ involvement unspecified, Systemic involvement of connective tissue, unspecified, Unspecified inflammatory spondylopathy, site unspecified, Refractory anemia without ring sideroblasts, so stated, Other specified disorders involving the immune mechanism, not elsewhere classified, Disorder involving the immune mechanism, unspecified. PDPM Chart Audit Simple and Easy: Winning in PDPM Payment and Regulatory Strategies . The more comorbidities a patient has, the more medications he or she probably requires. Documentation by the physician and nursing must also support the skilled nature of the codes that are recorded as NTA conditions. If the 25% is exceeded, a non-fatal warning will appear on the final validation report during the MDS submission process. or privately paid by the patient if he/she does not qualify under the Medi-Cal program. With several big changes ahead, the margin for error slim for most providers. This item includes diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. Notice there is a big pocket of low NTA rates that covers most of Iowa. 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. What do I need to know? hb```b``ia`e`ff@ a(meU=r%::@`uH@V01:000x1p`5`gy4AuG/Dg* ZF:&'[-@ >` t!R 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). Patients rely on you. 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 (. ) Custodial care does not require the assistance of a licensed staff. This article was originally published in February 2019, and has been updated in October 2019 with several more tips. mp:U@|8B *zL$#Tk\*SU%mQlTYA Rj&-N _VjWpb[5R8'i, 0000009611 00000 n Learn More Resource PDPM Series Part 5: Assessment Requirements. %PDF-1.6 % 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. The administration of IV fluids may qualify for the Parenteral/IV Feeding - High or Parenteral/IV Feeding - low NTA points. (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. 0000006001 00000 n Based on that, I have made you an extreme cheat sheet, that you should use with extreme caution. 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. Below is a summary of the determinants of payment and which section on the MDS assessment form they are derived from. For example, an NTA comorbidity score of 11 equals a CMI of 2.53. 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 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 The Centers for Medicare & Medicaid Services (CMS) realizes that the cost impact of medications, at the time of admission, is extensive. Which codes are the most important? 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. 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. Skilled nursing services are covered under the Federal Governments. 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. This problem isnt new either but now it will drive reimbursement. In this post, we going to look at one important piece of the NTA puzzle, section I. 5!!!!!May!be!used!by!permission!only!Proactive!Medical!Review,!LLC!!!!!www.proactivemedicalreview.com!!!! 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. Which codes are you most likely to actually see in the wild? Highlights: Under PDPM, long-term care facilities will receive reimbursement based on services that each resident receives. You can also zoom in to see detail. The FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. Primary Diagnosis - List I0020B Surgical Procedures - List J2100/J2300-J5000 Aphasia I4300 Cerebrovascular Accident . 1694 0 obj <>stream 0000007482 00000 n You are never alone in this field and resources are available in seminars, webinars, the CMS website, MDS manual, etc. The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. 0000002742 00000 n View fullsize The idea is that the facility should be paid for the care they are delivering, based on the patients characteristics. 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. 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. } The Patient-Driven Payment Model focuses on the patients unique characteristics and needs based on diagnosis which arise during inpatient hospital stay. Explain the impact of the variable per diem rate in the NTA component and how it impacts PDPM payment. What do I need to know? 437 27 Identification of NTA conditions and services should start even before the SNF admission. These groups and indices, combined with other components of the payment system, provide a total reimbursement process that PDPM includes a new pay category, the non-therapy ancillary or NTA. Other diagnoses will affect the Non-therapy Ancillary (NTA) component. 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. 0000005276 00000 n Speaking of individual facilities, lets take a look at that as well. 66y% The Primary Diagnosis in I0020B and the Principal Diagnosis should match. 2207 Morgan Ave, Suite D These maps look significantly different from a lot of the others weve seen. 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. As mentioned earlier, these NTA comorbidities are reported (coded) throughout the MDS. !on!$ Q7ER}x;:lRcP%?9w_ mm ' 3HFDRkse$:stHqPJoHK-qL_sh|Kg?unioWAsfH8[^9{'~-? Other SLP co-morbidities picked up from the grouper software include the checkboxes for I4300 (aphasia), I4500 (stroke/CVA/TIA), I4900 (hemiplegia/hemiparesis), I5500 (traumatic brain injury), O0100E2 (tracheostomy while a resident), and O0100F2 (ventilator/respirator while a resident). For example, IV medications (5 points) coded in MDS item O0100H2 or isolation (1 point) coded in O0100M2. 0000004542 00000 n Complete a blank sample electronically to save yourself time and money. 1=BY)#CT 'a7bA(XdHE ? At the start of 2019, 63% of respondents to SNN's annual outlook survey identified a greater emphasis on coding as a a key PDPM strategy. Click here to visit our shop. ANOVA Rural versus Urban NTA case-mix (click to enlarge). The NTA looks at conditions and extensive services that are associated with significant increase in costs for a skilled nursing facility. The non-therapy ancillary (NTA) part of the patient driven payment model (PDPM) is considered by most people Ive talked to as being better than what were currently doing. h4Pj0^z[ 8 >BRA$+Vfa 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. a" I54043lquizzes/446951 (Question 2 5 / 5 pts The Involve the Interdisciplinary Team. Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing components. 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. 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. In this fourth webinar of our six part series, learn which items on the MDS or Medicare claim will be used to determine the NTA score and its impact on payment. 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. 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. Below is the full listing of conditions and services used for NTA classification and the associated number of points for that comorbidity. Updates the ICD-10 mapping used to classify patients under the PDPM framework. Our wound certified educators train, educate, and guide our providers and client facilities on the most efficacious wound care treatments and follow up. Under PDPM there are 161 Minimum Data Set (MDS) item fields. 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. Resolved conditions should not be listed since therapy would not be treated for a resolved condition. You can see in the histogram that not only are there a lot fewer rural facilities, but they also appear to have lower average case-mix. This isnt exactly a new problem, but it didnt drive reimbursement before. 0000011153 00000 n CMS The table below shows how the sum of the NTA points converts to an NTA Case Mix Group and a corresponding NTA CMI. It more accurately accounts for expenses and isnt overshadowed by therapy. border: 1px solid black; It especially packs a heavy punch when considering that the NTA per diem rate is tripled for the first three days of the stay. When reviewing the CMI components driving PDPM reimbursement its important to consider the critical role of the Non-Therapy Ancillary (NTA) score. [|Qc\0aXjK@ EdO4&_? NF is the lowest grouper with a score of 0, while NA is highest with a score of 12+. It is important that the completion of an IPA does not reset the VPD. The PDPM Clinical Categories are discussed below. Items on this list could change at any time with new legislative and 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). NTA component receives 300% of the base per-diem rate for days 1-3 of a stay. The southwest of the US, Michigan, Ohio and West Virginia would have the highest NTA rates. Title: Microsoft Word - FINAL PDPM Triple Check Checklist.docx Author: jleatherbarrow Created Date: 1/29/2020 4:19:17 PM 0000006770 00000 n 18% of the Nursing adjustment factor is multiplied to the Nursing rate only patients with diagnosis of AIDS. If the resident went from the hospital directly to a LTCH first, then to your SNF, you can code the surgery because an LTCH is a post-acute long term care hospital, not an acute care hospital. Under PDPM, Section GG drives PT and OT, and nursing which affects reimbursement. "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? The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. The score determines NTA payment groups and indices. The five CMGs then convert to a corresponding case mix index (CMI), which is a multiplier to the base rate for a particular CMG. 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. 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 Retrieved from: https://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html, Center for Medicare and Medicaid Services. The visualization is interactive. Actually, were going to limit our scope to only I8000 items. 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. The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation. 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. Coding of these areas will affect the, Postpartum Preeclampsia Diagnosis and Management, Hyperemesis Gravidarum: More Than Just Morning Sickness. 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. code. 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 ! Start (and continue) the conversation. yid T[KaEev0D/wRDQhDB['QgDTBEB)2"xt"Xn2 QN[%=> FhzdBI^8/HD CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. Do whatever you want with a SKILLED: fill, sign, print and send online instantly. Five of the six are case-mix adjusted. What if we could limit those codes down to just those ICD-10 codes that are likely to occur. The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation to ensure 100% accuracy. RUG Classification Groups based on the volume and intensity of therapy provided to patient: Determinants of Payment for PDPM are summarized below. Previous articles in this series outlined the physical and occupational therapy component and the speech language pathology component. 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. A frequent question: "If the mapping file lists a code as "return to provider", can I still use it on the MDS?". Do not be apprehensive to query the physician if a diagnosis is not clear or is suspected and not documented. Under PDPM, there are six payment components.
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