It more accurately accounts for expenses and isnt overshadowed by therapy. The higher the total point value, the greater the payment (CMI). 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. Securely download your document with other editable templates, any time, with PDFfiller. This problem isnt new either but now it will drive reimbursement. (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. 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. 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. A SANE nurse is an RN who has been trained to examine and assess clients who have a reported a sexual assault. Now let's discuss the I0020B Primary Diagnosis and the Claim's Principal Diagnosis. Focuses on clinically relevant factors rather than volume-based services or RUG levels. 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. Basic versions of many 2019 AHCA PDPM Academy copyrighted document resources and webinars are available to . 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. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. It will be imperative that the coding is accurate on the MDS for the NTA conditions. PDPM Goes Beyond Therapy: Finding the Hidden - Skilled Nursing News 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. 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. endstream
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Stay tuned. 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). 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. 0000001405 00000 n
Refer to the CMS PDPM ICD-10 NTA Comorbidity Crosswalk for I8000-derived comorbidities with acceptable ICD-10 codes that map to the NTA component and the NTA item listing for a complete list of NTA conditions/services. When the variable per diem adjustment is applied, the increase NTA component goes up 3x; in the example above, the daily rate for days 1-3 would increase by $87.70 for Urban and $83.78 for Rural. PDPM, Non-Therapy Ancillaries & MDS Section I As under the previous RUGIV model, the presence of an AIDS diagnosis continues to be identified through the . 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). Which codes are you most likely to actually see in the wild? MDS Item Field rows in tan represent MDS item groups identified in CMS PDPM documentation and do not have data entry fields. xref
Evansville, IN 47711, Phone: (812) 471-7777 SNF Reimbursement - TRICARE West (I did abbreviate a few of the names for sanity.) Hopefully I dont lose my blogging privileges, but I looked at a years worth of Part A admissions to every SNF in the country and found, gasp, not all codes occur that often. Other codes can still be listed in I8000. It's easy to get to those 50, but the tricky part is understanding which ICD-10 codes match to the comorbidities. The NTA looks at conditions and extensive services that are associated with significant increase in costs for a skilled nursing facility. For RUGs IV PPS, the payment is based on a per diem rate that is constant for the entire length of stay. For example, if a resident admits and the dietitian notes the BMI is over 40, query the physician to confirm a morbid obesity diagnosis. 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. 0
The PDPM diagnosis list determines the reimbursements for a Medicare Part A stay. Contact us now and sign up to receive our newsletters here. Incorporate NTA identification into the daily clinical meeting as it is ever important to identify when a change in condition or services takes place. PDPM (Patient-Driven Payment Model): Outcomes Matter! - MatrixCare Try it out!). 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. 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. If you have an idea lets discuss! 0000000016 00000 n
These conditions may warrant completion of an Interim Payment Assessment (IPA) thus increasing the NTA component score and potentially the total per diem. 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. Not having the correct codes can have a domino effect and result in missed reimbursement, or claim inaccuracies. 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. (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. The NTA comorbidity score is a weighted count of certain comorbidities that a SNF patient has, which is then used to classify the patient into an NTA component payment group. .com NTA Diagnosis Tool CMS identified a list of 50 conditions and extensive services associated with increases in NTA costs. Observation services are not covered as part of the inpatient stay. There are a lot of items from section I8000. (2019). Remember, a diagnosis has to be active and documented by a physician or nonphysician extender to qualify as an NTA item. PDPM: 15 Quick Tips - LinkedIn ENSURE TO CAPTURE EVERYTHING PRIOR TO COMPLETION OF THE 5-DAY MDS ASSESSMENT! First, it corrects an issue where diagnosis codes were mapped to NTA comorbidities as 1 to 1 mappings where 1 to 2 mappings were intended from the PDPM_ICD10_Mappings_FY20XX Excel sheet. z@~. 463 0 obj
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:1&[+cZhqhU;IKBU We earn 1 NTA point and qualify for Nursing Category Special Care Low for a Stage IV Pressure Ulcer when coded in M0300. You can also zoom in to see detail. Center for Medicare and Medicaid Services. Patients are assigned a clinical category based on the primary diagnosis for SNF stay. Fax: (812) 471-7802 Item I0020 and I0020B: Item I0020 (primary medical condition category that best describes the primary reason for admission lists several options. 0000009034 00000 n
Below is a summary of the determinants of payment and which section on the MDS assessment form they are derived from. 2207 Morgan Ave, Suite D If the 25% is exceeded, a non-fatal warning will appear on the final validation report during the MDS submission process. Remember that after the 3 day interrupted stay he is considered a new admission for purposes of Part A PDPM. 0000009611 00000 n
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Under PDPM there are 161 Minimum Data Set (MDS) item fields. PDPM | Caretrac How can a facility ensure that they are not leaving money on the table due to under-coded NTAs? The Patient-Driven Payment Model focuses on the patients unique characteristics and needs based on diagnosis which arise during inpatient hospital stay. or privately paid by the patient if he/she does not qualify under the Medi-Cal program. A frequent question: "If the mapping file lists a code as "return to provider", can I still use it on the MDS?". The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. Actually, were going to limit our scope to only I8000 items. hWmo6+( NON-THERAPY ANCILLARY & PDPM - Concept Rehab What Dietitians Need To Know About PDPM PDF Comorbidities Included in NTA Comorbidity Score and Assigned Points Refer to RAI pages J37-J38 for more on coding J2100. (This isnt going to work well on mobile devices, FYI.). (At this point, I can feel the cold stares from our MDS Experts. 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. IV medications provided as a resident and coded in Section O would also qualify for NTA points. (Note that this map is showing ONLY the NTA rate. 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. 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. The Patient-Driven Payment Model focuses on the patients unique characteristics and needs based on diagnosis which arise during inpatient hospital stay. 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. Remember, the CMS list is authoritative, mine is only for your convenience. Points are scored if the condition or service is present. The visualization is interactive. AHCA Free PDPM Archive Library of Resources for All Provider Members PDPM Chart Audit Simple and Easy: Winning in PDPM Payment and Regulatory Strategies . Remember that on the therapy plan of care the Treatment Diagnoses should be directly linked the Medical Diagnoses. These residents may have a significant number of inaccurate or resolved diagnoses if a facility doesnt have a process for ongoing diagnosis reconciliation. The Patient-Driven Payment Model (PDPM), is fast approaching with implementation set for October 2019. Physician Job in Akron, OH - AmeriWound | CareerBuilder.com Ill also compare urban versus rural facilities when it comes to NTA case-mix. 0000190726 00000 n
The Centers for Medicare and Medicaid Services (CMS) introduced the Patient Driven Payment Model (PDPM) in the FY 2019 Proposed and Final Rule process in 2018. 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. 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. Coding of these areas will affect the Speech Case Mix Index. You can view either rural, urban or both. With several big changes ahead, the margin for error slim for most providers. How should you prioritize your search for ICD-10 codes? %PDF-1.4
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Primary Diagnosis - List I0020B Surgical Procedures - List J2100/J2300-J5000 Aphasia I4300 Cerebrovascular Accident . With this component being paid at a 3x rate for 1st 3 days of . 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. We know now that every diagnosis and condition counts. For the Non-Therapy Ancillary Component, each diagnosis has a corresponding score which is multiplied to the federal NTA case mix index. CMS identified 50 conditions and services that were related to an increased cost for skilled nursing facilities. Based on that, I have made you an extreme cheat sheet, that you should use with extreme caution. PDF Non-Therapy Ancillary Services Conditions/Extensive Services - SimpleLTC (difference of NE-NF and NA-NB). Luckily, code diving is a lot of fun, right? 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 (. PDPM - Focus on NTA - YouTube Do not be apprehensive to query the physician if a diagnosis is not clear or is suspected and not documented. The PDPM Clinical Categories are discussed below. 0000011153 00000 n
and the grouper software will pick it up from I8000. PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. 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. Identification of NTA conditions and services should start even before the SNF admission. NAC Resources for Post-Acute Care Nurses - AAPACN Other diagnoses will affect the Non-therapy Ancillary (NTA) component. Medicare Skilled Nursing Facility PPS SNF PPS Payment Model Research With every dollar spent on nutrition screening and interventions, the Academy of Nutrition and Dietetics has reported savings of $3.25 3. The skilled services are provided by a Medicare-certified SNF. To further understand the difference between long-term care facilities and skilled nursing/rehabilitation facilities, we will focus on the services they offer. The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation. you could miss something. The Primary Diagnosis in I0020B and the Principal Diagnosis should match. Notice there is a big pocket of low NTA rates that covers most of Iowa. When reviewing the CMI components driving PDPM reimbursement its important to consider the critical role of the Non-Therapy Ancillary (NTA) score. 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. As a result, client facilities realize improved wound healing results, improved survey scores and NTA reimbursement under PDPM. View fullsize Copyright LW Consulting, Inc 2022. Welcome to Gravity healthcare Consulting & Online Education On any device & OS. Just 1 NTA point can have an average worth of anywhere from $18 to $55 per day. Was there a need for an IV? The table below shows how the sum of the NTA points converts to an NTA Case Mix Group and a corresponding NTA CMI. Suctioning? Non-Therapy Ancillary (NTA) classification in PDPM is determined by the presence of certain conditions or the use of certain extensive services that were found to be correlated with increases in NTA costs for SNF patients. |Pa(E8BNJA!-tUiX%:h~GJ?J.H%
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GBM*.`k@/9cO9R*^fo_MOK6_xg,eM'jv}5E|SWNH0$z|.WL7y9 ;4H*h;H8H"*RW l? No paper. The resulting sum is the NTA comorbidity score, which is used to classify each resident into an NTA case-mix group. MDS 3.0 Section I Thats a lot of white space. endstream
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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. 0000003037 00000 n
The more comorbidities a patient has, the more medications he or she probably requires. 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 . 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". ,: >i*S7O=X8ZA'ic2+(!olVz`zz_"K@I
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). How often will the items on this list be available to you when you are doing the 5 day assessment?