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Items on this list could change at any time with new legislative and This has been a key consideration in designing the various elements of the new model. For example, Mr. Steve is a long term care resident due to Parkinson's Disease. The administration of IV fluids may qualify for the Parenteral/IV Feeding - High or Parenteral/IV Feeding - low NTA points. The southwest of the US, Michigan, Ohio and West Virginia would have the highest NTA rates. This NTA CMI is added to the other components to calculate the total reimbursement for the patient. There are two look back periods that must be met when coding conditions on the MDS: #1 Diagnosis Identification - Documented by the physician or physician extender within the last 60 days. Yes, I am aware that ICD-10 codes do change occasionally. Everyone I've talked to agrees the NTA payment is a good idea. The Patient-Driven Payment Model focuses on the patients unique characteristics and needs based on diagnosis which arise during inpatient hospital stay. 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. Remember that after the 3 day interrupted stay he is considered a new admission for purposes of Part A PDPM. 0000005276 00000 n 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. (Right). Primary Diagnosis - List I0020B Surgical Procedures - List J2100/J2300-J5000 Aphasia I4300 Cerebrovascular Accident . Learn More Resource PDPM Series Part 5: Assessment Requirements. Formulate a PDPM group to review the chart and come up with the residents primary or principal diagnosis and do the ICD-10 clinical category mapping. Points are scored if the condition or service is present. Far more items than would actually fit on the MDS 3.0 Instrument. For the Non-Therapy Ancillary Component, each diagnosis has a corresponding score which is multiplied to the federal NTA case mix index. 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. 1=BY)#CT 'a7bA(XdHE ? Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). 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 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. endstream endobj 1696 0 obj <>stream View D0AD3F24-D6BD-4273-B139-8FCA97487E6A.jpeg from NURSING MISC at St. Clair County Community College. 0000009034 00000 n ordered by the patients attending physician in the facility. Group therapy now allows for as few as 2 residents and as many as 6 residents. (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. 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). Given that CMS has released the distribution of case-mix groups for NTA for all skilled nursing facilities, we can calculate an average case-mix index for everyone. 0 DetI Rloh,mJLEo(DA"pd#Se.e)6d;[+I=R^2rcZ'F6C"x=*!J&[KL~^ogN3#)LNb}:QOd 0}pE` )S CMS identified 50 conditions and services that were related to an increased cost for skilled nursing facilities. 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 . As under the previous RUGIV model, the presence of an AIDS diagnosis continues to be identified through the . 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. Adjustments to the PDPM rates include: 2.3% reduction in FY 2023. additional 2.3% decrease in FY 2024. F You can also zoom in to see detail. 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. It is for this type of services they offer which also categorize them as skilled nursing and rehabilitation facilities becoming a step-down facility from an acute hospital stay. HUO0~^iq3N&@-0*Si$L9)-ziwg';q_}(Ak"CwKi "@~|iA`!c The general method for calculation of any NTA category is as follows: 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. A good first resource is the PDPM NTA Comorbidity Mapping spreadsheet. More than half of them come from I8000 and many of these have multiple qualifying ICD-10 diagnosis codes. All Rights Reserved. How often will the items on this list be available to you when you are doing the 5 day assessment? $HJ0!$j-g#W d9bEi0~og$.J8-Lb =lZ.SSz|'!`%/ to The higher the total point value, the greater the payment (CMI). Start (and continue) the conversation. They cant all be equally likely, right? If your therapist are doing Group therapy, remind them that there must be supportive documentation regarding the benefit to the resident when participating in a larger group. endstream endobj 452 0 obj <>stream 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. 0000002742 00000 n With the transition from Resource Utilization Group Version IV (, ) to the Patient-Driven Payment Model (PDPM) on October 1, 2019, the. (Note that this map is showing ONLY the NTA rate. Highlights: 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. We earn 1 NTA point for second or third degree burn coded in M1040F. For RUGs IV PPS, the payment is based on a per diem rate that is constant for the entire length of stay. Based on that, we can calculate the rate. Under PDPM there are 161 Minimum Data Set (MDS) item fields. a" I54043lquizzes/446951 (Question 2 5 / 5 pts The The visualization is interactive. To ease some of this burden, AAPACN developed the Sample Task List for the Nurse Assessment Coordinator tool . Under PDPM, 50 conditions and extensive services are considered for NTA classification. No software installation. 0000002280 00000 n Other diagnoses will affect the Non-therapy Ancillary (NTA) component. All PDPM components are assigned an appropriate score to multiply to the federally assigned case mix index group. 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. Five of the six are case-mix adjusted. The FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. The map below shows every SNF in the US that accepted Medicare Part A patients in 2017. These nurses are also trained to complete a full All Rights Reserved By Nursingcecentral 2022 |. 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. 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. endstream endobj 453 0 obj <>stream 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 . NTA component receives 300% of the base per-diem rate for days 1-3 of a stay. 463 0 obj <>stream ! The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. PDPM includes a new pay category, the non-therapy ancillary or NTA. ANOVA Rural versus Urban NTA case-mix (click to enlarge). I wish I could be in your training the 29th. SNF FY 2022 Proposed Rule Learn the Facts Behind the Headlines Part 3: How is My Rate Calculated, Regulatory Reminder! 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. 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. Under PDPM, Section GG drives PT and OT, and nursing which affects reimbursement. Reimbursement, LW Consulting, Inc.5925 Stevenson Avenue, Suite GHarrisburg, PA 17112, Ph:800-320-5401Local Ph: 717-233-6100Fx:717-233-4633. The non-therapy ancillary (NTA) classification of PDPM reinforces why ICD-10 coding plays a key role under PDPM. 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. 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. Speaking of individual facilities, lets take a look at that as well. When also coded in I8000, I69.091 will also contribute again to the case mix group because it is on the SLP comorbidity list. The presence of these conditions and extensive services is reported by providers . I would really like to see how item I8000 changes on a resident from the 5 day to later assessments. 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. 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. Recently, a provider stated that its not that important because the QM high risk determination includes impaired mobility and transfer, which most of their residents with pressure ulcers already have, so that already qualifies them for high risk even if I5600 is not coded. Under PDPM, there are six payment components. Try it out!). 0000001405 00000 n You can rely on us. ^(:eOCQ'SM7(Rmnvr/+eO.)hicZjz.,vO&u. For example, an NTA comorbidity score of 11 equals a CMI of 2.53. Incorporate NTA identification into the daily clinical meeting as it is ever important to identify when a change in condition or services takes place. 0000004542 00000 n 0000002491 00000 n The new nurse assessment coordinator (NAC) may be overwhelmed with the numerous tasks required of the position. Patients rely on you. Learn why in this video from Aegis Therapies. This can be revised if there is a change in a patients condition which requires additional skilled services such as IV medications which were not administered initially. 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. Whats in it for me? The PDPM Clinical Categories are discussed below. ;iHIBK = >N]Y}dZ}HvtZ04D8YV4r4Od^/NJ x/i"9WirMdy2d*{E^lEu}Jg t@C`[aNOGgg0?bd'r EVm@Av;*%f?Wp :1&[+cZhqhU;IKBU 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. the design of the PDPM case-mix system implemented in FY 2020. (By the way, we created a PDPM Calculator for you to experiment with and get a better understanding of how PDPM works. 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. The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation. endstream endobj 451 0 obj <>stream A list of these specific retinopathy codes are in the SLP mapping file from CMS. Remember that on the therapy plan of care the Treatment Diagnoses should be directly linked the Medical Diagnoses. 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. border: 1px solid black; 0000011153 00000 n A Knowledgeable and Compassionate partner. thead { When reviewing the CMI components driving PDPM reimbursement it's important to consider the critical role of the Non-Therapy Ancillary (NTA) score. 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 RUG-IV vs Patient-Driven Payment Model (PDPM), Prior to October 1, 2019, all SNFs which participate under the Medicare program are paid under the Skilled Nursing Facility (SNF). The Centers for Medicare & Medicaid Services (CMS) realizes that the cost impact of medications, at the time of admission, is extensive. These conditions may warrant completion of an Interim Payment Assessment (IPA) thus increasing the NTA component score and potentially the total per diem. endstream endobj 1697 0 obj <>stream This simply shows you a starting point. Comorbidities are assigned points based on the cost in care associated with the condition or service, with points ranging from 1 to 8. This article was originally published in February 2019, and has been updated in October 2019 with several more tips. 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 FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. ENSURE TO CAPTURE EVERYTHING PRIOR TO COMPLETION OF THE 5-DAY MDS ASSESSMENT! The resulting sum is the NTA comorbidity score, which is used to classify each resident into an NTA case-mix group. Other codes can still be listed in I8000. It is not clear why this would be the case. } (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 Preparedness for coding changes will be the key to a smooth transition. <<50FFC127310FCF468ABFE4B7414A5B70>]/Prev 423154>> The NTA looks at conditions and extensive services that are associated with significant increase in costs for a skilled nursing facility. CMS stated in the final rule for FY 2023 that they intend to take a more cautious approach to mitigate the potential negative impacts on the nursing home industry with this parity adjustment by spreading it across a two-year period. The Non-Therapy Ancillary Services (NTA) component is a total score of all listed conditions and/or extensive services that apply to the resident. PDPM payments will be based on six groupsone non-case mix group (CMG) and five specific CMGs: PT, OT, SLP, NTA and nursing. background-color: #2c4a88; 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. After the PDPM rate for each component is determined, the sum of the PDPM component rates is added to the fixed non-case mix rate which will be the final reimbursement rate for the patient for the entire skilled nursing facility stay. The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. Inappropriate Schizophrenia Diagnosis/Coding and Survey Citation Posting, Regulatory Reminders: Consolidated Billing Update 2023. Great info! Fax: (812) 471-7802 SAMPLE Task List for the Nurse Assessment Coordinator (NAC) November 23, 2022. by Proactive LTC Consulting | Jan 6, 2020 | Audits, Compliance, Education, MDS, Medical Review, PDPM. Lastly, lets look a little more closely at rural versus urban. This item includes diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. Patients are assigned a clinical category based on the primary diagnosis for SNF stay. Of importance to note is the condition of HIV/AIDS under the NTA component. 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. 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. The skilled services are provided by a Medicare-certified SNF. The higher the score, the higher the NTA rate. Refer to RAI pages J37-J38 for more on coding J2100. Which codes are you most likely to actually see in the wild? 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 $83.78 for Rural. h4Pj0^z[ 8 >BRA$+Vfa Explain the impact of the variable per diem rate in the NTA component and how it impacts PDPM payment. Hoo0#=)HU64*)T%DH!$swwb4fc|i]\/8gr? 5!!!!!May!be!used!by!permission!only!Proactive!Medical!Review,!LLC!!!!!www.proactivemedicalreview.com!!!!