With postpartum preeclampsia, patients are now not seeing a health care provider by NCC News and Content Team | Jan 24, 2023 | Specialties. CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. They cant all be equally likely, right? trailer The general method for calculation of any NTA category is as follows: The Fiscal Year (FY) 2021 PDPM ICD-10-CM Mappings file includes the NTA Comorbidity to ICD-10-CM Mapping, which maps comorbidities in the NTA component captured in item I8000 to allowable ICD-10 codes. Whats in it for me? Securely download your document with other editable templates, any time, with PDFfiller. Some didnt occur at all. 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. (Nursing, Social Services, Dietary and Activity Staff). Retrieved from: https://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html, Center for Medicare and Medicaid Services. The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. A good first resource is the PDPM NTA Comorbidity Mapping spreadsheet. 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. Luckily, code diving is a lot of fun, right? Everyone I've talked to agrees the NTA payment is a good idea. Admittedly, thats a lot to look through. The required MDS data would be entered in the sub-items listed below the item group identifier. endstream endobj 452 0 obj <>stream (2019). PDPM Chart Audit Simple and Easy: Winning in PDPM Payment and Regulatory Strategies . Stay tuned. For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. 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. 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). or service for purposes of classification under the PDPM's NTA component. This isnt exactly a new problem, but it didnt drive reimbursement before. 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. 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. On day 4 it goes back to the rate shown. Skilled nursing services are covered under the Federal Governments. This does not include conditions that are resolved. Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. You can view either rural, urban or both. 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. Refer to the PDPM Calculation Worksheet for more information. For example, IV medications (5 points) coded in MDS item O0100H2 or isolation (1 point) coded in O0100M2. Other diagnoses will affect the Non-therapy Ancillary (NTA) component. 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. View fullsize 0000000836 00000 n We know now that every diagnosis and condition counts. [|Qc\0aXjK@ EdO4&_? @.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; 0000009611 00000 n Basic versions of many 2019 AHCA PDPM Academy copyrighted document resources and webinars are available to . 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 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. With such a close relationship to payment, it is critical the staff member(s) responsible for ICD-10 coding are knowledgeable in this area. RUG Classification Groups based on the volume and intensity of therapy provided to patient: Determinants of Payment for PDPM are summarized below. by NCC News and Content Team | Mar 1, 2023 | Hospitals, Specialties. A Knowledgeable and Compassionate partner. 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 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". Patients are assigned a clinical category based on the primary diagnosis for SNF stay. MDS 3.0 Section I Thats a lot of white space. 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. The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. It is highly advisable for MDS nurses to review each assessment to ensure that all skilled services are captured during the assessment period to maximize reimbursement rate for the facility based on the patients diagnosis and acuity. See the table below. Under PDPM there are 161 Minimum Data Set (MDS) item fields. Reimbursement, LW Consulting, Inc.5925 Stevenson Avenue, Suite GHarrisburg, PA 17112, Ph:800-320-5401Local Ph: 717-233-6100Fx:717-233-4633. (At this point, I can feel the cold stares from our MDS Experts. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. The Patient-Driven Payment Model (PDPM), is fast approaching with implementation set for October 2019. Comorbidities are assigned points based on the cost in care associated with the condition or service, with points ranging from 1 to 8. Note that for the first 3 days of the stay you get 3 times the rate shown on the map. PDPM Series Part 4: Non-Therapy Ancillaries Case Mix Groups. To find out if you're leaving any money on the table email MDS Consultants for a PDPM review at info@mds-consultants.com, Find the PDPM ICD-10 Mapping tool at: https://mds-consultants.com/helpful-cms-info/, PDPM step-by-step scoring guide at https://mds-consultants.com/mds-tools/, https://mds-consultants.com/helpful-cms-info/, Coding N2001 N2005: Part A Drug Regimen Review, The Struggle with Antipsychotic Reduction . 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 (NTA). Item I0020 and I0020B: Item I0020 (primary medical condition category that best describes the primary reason for admission lists several options. The MDS nurse should be alert to these changes to ensure timely completion of the required MDS assessment. The FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. 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 patients NTA comorbidity score is the sum of the points associated with each relevant comorbidity. PDPM includes a new pay category, the non-therapy ancillary or NTA. %PDF-1.6 % The PDPM program has six payment components. (Ui7A7dR;5|jDM\sEamJFK3O.C[=vBD:]'N+T_ rhc_ex>mHR&o6Bfr*W0zG3KWmxK6P46n=Jt0Pn'OGC~&S};& Dt];vwj+E0R"^T 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. 0000003961 00000 n PDPM ICD10 Consulting Confidential 2019 A Native American-Owned business Page . Remember that after the 3 day interrupted stay he is considered a new admission for purposes of Part A PDPM. Was there a need for an IV? Either way, you must still also code the I0020B primary condition I0010 through I8000. The Primary Diagnosis in I0020B and the Principal Diagnosis should match. A frequent question: "If the mapping file lists a code as "return to provider", can I still use it on the MDS?". 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. Your NTA payment is driven by the presence of a number of conditions and/or extensive services. Good talk. If you have an idea lets discuss! As we prepare for the transition to the Patient-Driven Payment Model (PDPM), which is expected to occur on October 1, 2019, we have been reviewing the primary components that make up the Case Mix Index (CMI) for reimbursement. (2019) Fact Sheet: PDPM Payments for SNF Patients with HIV/AIDS https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/PDPM_Fact_Sheet_AIDS_v3_508.pdf. Any delay in getting this information is going to be problematic. hb```b``ia`e`ff@ a(meU=r%::@`uH@V01:000x1p`5`gy4AuG/Dg* ZF:&'[-@ >` t!R The skilled services are provided by a Medicare-certified SNF. 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. xref Items on this list could change at any time with new legislative and PDPM HIPPS Coding Crosswalk In order to accommodate the new payment groups, the PDPM HIPPS algorithm is . With this component being paid at a 3x rate for 1st 3 days of . Anyone involved with ICD-10 coding should have ready access to the coding guidelines. Below is the full listing of conditions and services used for NTA classification and the associated number of points for that comorbidity. 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. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. 0000001085 00000 n How can a facility ensure that they are not leaving money on the table due to under-coded NTAs? SANE is an acronym that stands for Sexual Assault Nurse Examiner. It is not clear why this would be the case. I wish I could be in your training the 29th. 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. Sometimes the code may be a qualifier for other PDPM components, sometimes it won't be. 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. 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. Think about this A resident with a Stage IV pressure ulcer has physician orders and Registered Dietician recommendations for a protein supplement. 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). Involve the Interdisciplinary Team. endstream endobj 438 0 obj <>/Metadata 434 0 R/OutputIntents[<>]/Pages 433 0 R/StructTreeRoot 3 0 R/Type/Catalog>> endobj 439 0 obj <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Type/Page>> endobj 440 0 obj <> endobj 441 0 obj <> endobj 442 0 obj <> endobj 443 0 obj [226 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 606 0 529 0 0 0 0 0 0 0 0 0 0 659 0 0 0 0 0 495 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 503 0 0 0 0 0 0 0 813 537 538 537 0 0 0 347] endobj 444 0 obj <> endobj 445 0 obj [278 0 0 0 0 0 0 0 0 0 0 584 0 333 278 278 556 556 556 556 556 556 556 556 556 556 0 0 0 0 0 0 0 722 722 722 722 667 611 778 0 278 0 0 0 833 722 0 667 0 0 667 611 0 0 0 0 0 0 0 0 0 0 0 0 556 611 556 611 556 333 611 0 278 0 0 278 889 611 611 611 0 389 556 333 611 556 0 556 556] endobj 446 0 obj <>stream 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. 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. 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. 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. PDPM MDS Items ! 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. Also, there is a 25% combined limit on concurrent and/or group therapy. 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. As under the previous RUGIV model, the presence of an AIDS diagnosis continues to be identified through the . }|YAxz .diS\]0}3sfowMm@ The presence of these conditions and extensive services is reported by providers . 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. But toward the end of January, reporter Maggie Flynn poked holes in the idea that ICD-10 mastery was a necessity. Under PDPM, an adjustment is applied to certain PDPM components that varies the per diem payment over the course of the stay. (difference of NE-NF and NA-NB). 8cq1o22#|Bm1il,4iw&C|E^F+oq:>_|M\v+iTOigWJ:dCa$Qv_n/q|wCuukk+e';iJB2C &!Ar8c _~r In order to determine the patients NTA comorbidity score accurately, providers must identify all comorbidities for which a resident would qualify, then total the points. The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. background-color: #2c4a88; Points are added together for all conditions. More than half of them come from I8000 and many of these have multiple qualifying ICD-10 diagnosis codes. HUO0~^iq3N&@-0*Si$L9)-ziwg';q_}(Ak"CwKi "@~|iA`!c HUMk@(h; ! PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. The following ICD-10 codes qualify: 41 Body mass index (BMI) 40.0-44.9, adult, 42 Body mass index (BMI) 45.0-49.9, adult, 44 Body mass index (BMI) 60.0-69.9, adult, 45 Body mass index (BMI) 70 or greater, adult, 01 Morbid (severe) obesity due to excess calories, 2 Morbid (severe) obesity with alveolar hypoventilation, Cross-train. Determinants of payment are based on the patients characteristics assigned to six components: Patients are assigned to classification groups known as RUG Classification Groups based on various characteristics of patients and the intensity of therapy services provided. 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. 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. CMS identified a . We earn. Also notice there are very few facilities with low NTA rates in the Appalachians. It more accurately accounts for expenses and isn't overshadowed by therapy. 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. (I did abbreviate a few of the names for sanity.) For example, an NTA comorbidity score of 11 equals a CMI of 2.53. Five of the six are case-mix adjusted. One can see from the table above that if comorbidities are missed, the facility could possibly miss out on reimbursement. endstream endobj 454 0 obj <>stream In this article, we discuss the non-therapy ancillary (NTA) component. Request for labs, imaging studies and surgical reports whichever is applicable. Its important to comprehend more than just the basics of PDPM. hWmo6+( Payment is based on services provided by five disciplines: physical therapy, occupational therapy, speech language pathology, nursing, and non-therapy ancillary (NTA). It will be imperative that the coding is accurate on the MDS for the NTA conditions. SNF FY 2022 Proposed Rule Learn the Facts Behind the Headlines Part 3: How is My Rate Calculated, Regulatory Reminder! 0 . For the NTA, an adjustment factor of 3.0 is applied to the total NTA CMI for days 1-3. Q: Our EMR system will calculate the BMI. 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. $HJ0!$j-g#W d9bEi0~og$.J8-Lb =lZ.SSz|'!`%/ @ Homework - Chapter 31: HlTT x + . endstream endobj 1697 0 obj <>stream Remember this is using 2017 data so it assumes that providers make no adjustments which is not realistic. Reimbursement for these services is covered under the. 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. 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. Below is a summary of the determinants of payment and which section on the MDS assessment form they are derived from. This information is essential. and the grouper software will pick it up from I8000. As mentioned earlier, these NTA comorbidities are reported (coded) throughout the MDS. 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. 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. Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing components. On any device & OS. 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 (. ) 0000002280 00000 n AVONA confirms that rural facilities do indeed have lower NTA case-mix. I am sure we'll continue to understand even more as the months go by. The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. These conditions may warrant completion of an Interim Payment Assessment (IPA) thus increasing the NTA component score and potentially the total per diem. 5!!!!!May!be!used!by!permission!only!Proactive!Medical!Review,!LLC!!!!!www.proactivemedicalreview.com!!!! The five CMGs then convert to a corresponding case mix index (CMI), which is a multiplier to the base rate for a particular CMG. List the 3 MDS items that qualify a resident for the Extensive Nursing Service group. 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. If the 25% is exceeded, a non-fatal warning will appear on the final validation report during the MDS submission process. Patients rely on you. The PT and OT payment would be based on: primary reason for SNF care and functional status at admission The sum of the lowest per diem rate under each PDPM component, plus the non-case-mix component is the: default code Which of the following is NOT a case-level adjustment for a MS-LTC-DRG long term stay outlier Love what you read? Variable Per Diem Adjustment Factors and ScheduleNTA. 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. last. F The visualization is interactive. I0020 is also a gateway to the I0020B Primary Diagnosis code. endstream endobj 1695 0 obj <>stream 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. 0 DetI Rloh,mJLEo(DA"pd#Se.e)6d;[+I=R^2rcZ'F6C"x=*!J&[KL~^ogN3#)LNb}:QOd 0}pE` )S Our wound certified educators train, educate, and guide our providers and client facilities on the most efficacious wound care treatments and follow up. View D0AD3F24-D6BD-4273-B139-8FCA97487E6A.jpeg from NURSING MISC at St. Clair County Community College. This has been a key consideration in designing the various elements of the new model. To assist stakeholders in understanding the potential impacts of the proposed PDPM, we are providing a provider-specific impact analysis file, which details the estimated . The saying, haste makes waste applies in the completion of MDS assessments and calculation of the maximized PDPM rate for the patient. These nurses are also trained to complete a full All Rights Reserved By Nursingcecentral 2022 |.