Just 1 NTA point can have an average worth of anywhere from $18 to $55 per day. How should you prioritize your search for ICD-10 codes? His claim's principal diagnosis is Parkinson's Disease. (By the way, we created a PDPM Calculator for you to experiment with and get a better understanding of how PDPM works. 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 Rehab and Nursing staff should complete the Section GG on the MDS form for indicated ADL tasks on Day 1-3 of admission with the admission date as Day 1. Once you have identified the condition/extensive service on the MDS or claim, the points associated with each comorbidity are added up for a total NTA score which is associated with 1 of the 6 case-mix groups shown below. 5!!!!!May!be!used!by!permission!only!Proactive!Medical!Review,!LLC!!!!!www.proactivemedicalreview.com!!!! 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. Remember, the CMS list is authoritative, mine is only for your convenience. 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PDF Comorbidities Included in NTA Comorbidity Score and Assigned Points 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. 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. 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. His I0020B Primary Diagnosis and his claim's Principal Diagnosis is now the aftercare of the hip fracture. Each component has its case mix index to determine the component rate. 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. A long-term care facility provides custodial care requiring supervised, minimal or total dependence in the performance of the activities of daily living (ADLs) such has bed mobility, transfers in and out of bed, walking in the room, walking in the corridor, locomotion on unit peripheral to the patients room, locomotion off unit which involves areas farther from the patients room such as dining areas, rehabilitation rooms, activity rooms and other administrative offices, toileting, eating, personal hygiene and bathing. 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. As mentioned earlier, these NTA comorbidities are reported (coded) throughout the MDS. 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. HU]o0}G?G< m*-$R5k'EC(K@!BE`;s 2I2,[fy@770&05 Bal[|# f1 `j[>,Uf[OrGUXore:qVKP2T(r`~F& +g80qjM8#)A{)@c}A,F^Ec{HN"!l!]_J3? Research indicated that for those SNF patients with AIDS, NTA costs per day were 151% higher and wage-weighted nursing staff time was 18% greater than for other patients. This could be a difference of $29.23 per day for Urban and $27.93 per day for a Rural facility. How often will the items on this list be available to you when you are doing the 5 day assessment? And so, you will need to determine how your facility will obtain the initial Diagnosis Identification documentation by the ARD, because it is a "look back" period. Patient Driven Payment Model (PDPM) - Everything You Need to Know - Relias (Nursing, Social Services, Dietary and Activity Staff). (10 items fit). 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 . Not having the correct codes can have a domino effect and result in missed reimbursement, or claim inaccuracies. . hVmk#7+xG{ZMaMu{vB{[ciF3Viee2!VpIbDAy_X%_A0,R99Kb! Remember that on the therapy plan of care the Treatment Diagnoses should be directly linked the Medical Diagnoses. PDF Classroom Walkthrough Checklist b!+XQ{ +LgOIYe/Q6RVpYY_N/.~iMu1fY*eR}W_E[,7vrR!XSF};qZW&e"S5!CW}3GU|muc?_X`dcg7(zRU8k? 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. 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. The provider will report on the Minimum Data Set (MDS) each of the comorbidities that a person has. For example, Mr. Steve is a long term care resident due to Parkinson's Disease. "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? 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. This information is essential. With postpartum preeclampsia, patients are now not seeing a health care provider by NCC News and Content Team | Jan 24, 2023 | Specialties. PDF Skilled Nursing Facility PPS Final Rule for FY 2022 Its important to comprehend more than just the basics of PDPM. Patient classification system where patients are grouped according to their care and resource needs. o NTA = All NTA items identified with a value of two or more points on the NTA table. PDPM Goes Beyond Therapy: Finding the Hidden - Skilled Nursing News &)` R #V? U? 0000000016 00000 n Highlights: The NTA Component of PDPM: Best Practices for Accurate Scoring Two Big PDPM Changes in FY 2023 and 3 Tools to Address Them #2 Diagnosis Status - The diagnosis must have a direct relationship to the resident's current functional status, cognitive status, mood or behavior status, medical treatments, nursing monitoring, or risk of death during the 7-day look-back period. One can see from the table above that if comorbidities are missed, the facility could possibly miss out on reimbursement. Below is a summary of the determinants of payment and which section on the MDS assessment form they are derived from. 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. This simply shows you a starting point. 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. 0000190726 00000 n Comorbidities associated with higher increases in NTA costs are grouped into higher point tiers, while those that are associated with lower increases in NTA costs are grouped into lower point tiers. 0 The resulting sum is the NTA comorbidity score, which is used to classify each resident into an NTA case-mix group. A SANE nurse is an RN who has been trained to examine and assess clients who have a reported a sexual assault. When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. hb```b``ia`e`ff@ a(meU=r%::@`uH@V01:000x1p`5`gy4AuG/Dg* ZF:&'[-@ >` t!R (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 2207 Morgan Ave, Suite D 0000002491 00000 n Was there a need for an IV? .center {text-align: center;}, Foot Code, Except Diabetic Foot Ulcer Code, Once we have totaled the score from the table above, we use it to map to a case-mix group and case-mix index. 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. Remember this is using 2017 data so it assumes that providers make no adjustments which is not realistic. Just 1 NTA point can have an average worth of anywhere from $18 to $55 per day. $HJ0!$j-g#W d9bEi0~og$.J8-Lb =lZ.SSz|'!`%/ SAMPLE Task List for the Nurse Assessment Coordinator (NAC) November 23, 2022. A Knowledgeable and Compassionate partner. The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation to ensure 100% accuracy. We earn 1 NTA point for second or third degree burn coded in M1040F. 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. INTRODUCTION. To further understand the difference between long-term care facilities and skilled nursing/rehabilitation facilities, we will focus on the services they offer. You can filter by NTA rate. Under PDPM there are 161 Minimum Data Set (MDS) item fields. Admittedly, thats a lot to look through. 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 These nurses are also trained to complete a full All Rights Reserved By Nursingcecentral 2022 |. 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. The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. (Right). Nursing and NTA Components of PDPM - Hansen Hunter & Co. P.C. The Financial Impact of Malnutrition and PDPM 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. ordered by the patients attending physician in the facility. (I did abbreviate a few of the names for sanity.) Verify coding, dont assume. %PDF-1.6 % Coding of these areas will affect the, Postpartum Preeclampsia Diagnosis and Management, Hyperemesis Gravidarum: More Than Just Morning Sickness. As a result, client facilities realize improved wound healing results, improved survey scores and NTA reimbursement under PDPM. What do I need to know? How can a facility ensure that they are not leaving money on the table due to under-coded NTAs? Variable Per Diem Adjustment Factors and ScheduleNTA. 0000005276 00000 n A good first resource is the PDPM NTA Comorbidity Mapping spreadsheet. hbspt.cta._relativeUrls=true;hbspt.cta.load(2297384, '30c35813-92d3-4fa1-bc3f-6b232de017b1', {"useNewLoader":"true","region":"na1"}); Topics: [|Qc\0aXjK@ EdO4&_? Conduct interview assessments for the Brief Interview for Mental Status (BIMS), and Mood ON ASSESSMENT REFERENCE DATE (ARD) OR A DAY PRIOR TO ARD. F Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation. You can also zoom in to see detail. Group therapy now allows for as few as 2 residents and as many as 6 residents. 0000277284 00000 n Understanding PDPM and the NTA Component - LW Consult Understanding the Value of the MDS Nurse Under PDPM, Psoriatic Arthropathy & Systemic Sclerosis, Myelodysplastic Syndromes and Myelofibrosis. The higher the score, the higher the NTA rate. To ease some of this burden, AAPACN developed the Sample Task List for the Nurse Assessment Coordinator tool . MDS 3.0 RAI Manual. - Corrected typo in minimum point value thresholds used to ify patients into groups "NA" and "NB" under the NTA component. yid T[KaEev0D/wRDQhDB['QgDTBEB)2"xt"Xn2 QN[%=> FhzdBI^8/HD 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). CMS It is highly recommended for the MDS nurse to make calculations which can determine the highest acceptable reimbursement rate for the facility. 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. 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). Speaking of individual facilities, lets take a look at that as well. Other codes can still be listed in I8000. The Patient-Driven Payment Model focuses on the patients unique characteristics and needs based on diagnosis which arise during inpatient hospital stay. |Pa(E8BNJA!-tUiX%:h~GJ?J.H% kZ*qyXjBy@C(zHhzQhhlL2cO`.$p6_[3R^IrHrr6#eq7**2uWytb$HyZi[F2_ GBM*.`k@/9cO9R*^fo_MOK6_xg,eM'jv}5E|SWNH0$z|.WL7y9 ;4H*h;H8H"*RW l? (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. Hoo0#=)HU64*)T%DH!$swwb4fc|i]\/8gr? An NTA comorbidity score of 12 = a CMI of 3.24. or privately paid by the patient if he/she does not qualify under the Medi-Cal program. %%EOF (Ui7A7dR;5|jDM\sEamJFK3O.C[=vBD:]'N+T_ rhc_ex>mHR&o6Bfr*W0zG3KWmxK6P46n=Jt0Pn'OGC~&S};& Dt];vwj+E0R"^T 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. All PDPM components are assigned an appropriate score to multiply to the federally assigned case mix index group. 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. PDPM NTA Case Mix Classification Groups NTA Score Range NTA Case Mix Group NTA Case Mix Index NTA HIPPS Character 12+ NA 3.24 A 9-11 NB 2.53 B 6-8 NC 1.84 C 3-5 ND 1.33 D 1-2 NE 0.96 E 0 NF 0.72 F . 0000004207 00000 n As a result, patients with AIDS are assigned the highest point value (8 points) of any condition or service for purposes of classification under the PDPMs NTA component, and they also receive a special 18% add-on to the nursing component of the payment. Any delay in getting this information is going to be problematic. 6/23/22 Capturing Non-Therapy Ancillary (NTA) in PDPM - GEM Health Care In the absence of specific documentation, you may use positive tests, procedures, hospitalization for symptoms). Complete a blank sample electronically to save yourself time and money. PDF PDPM Component Variable Per-Diem and RUG-IV Rate Reference Tables Updates the ICD-10 mapping used to classify patients under the PDPM framework. This list of options is not used for PDPM payment, but is used as risk adjustments for some of the QRP Quality Measures. ! 0000003793 00000 n Under PDPM, 50 conditions and extensive services are considered for NTA classification. 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. and the grouper software will pick it up from I8000. PDPM (Patient-Driven Payment Model): Outcomes Matter! - MatrixCare For example, an NTA comorbidity score of 11 equals a CMI of 2.53. PDPM Series Part 4: Non-Therapy Ancillaries Case Mix Groups. PDF PATIENT-DRIVEN PAYMENT MODEL: FREQUENTLY ASKED QUESTIONS (FAQs) Always be on the lookout for new updates which usually happen every year and usually effective by October 1 of each updated year. Fillable Online SKILLED Fax Email Print - pdfFiller PDPM: Calculating your NTA comorbidity score - SimpleLTC ;iHIBK = >N]Y}dZ}HvtZ04D8YV4r4Od^/NJ x/i"9WirMdy2d*{E^lEu}Jg t@C`[aNOGgg0?bd'r EVm@Av;*%f?Wp :1&[+cZhqhU;IKBU 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. When reviewing the CMI components driving PDPM reimbursement it's important to consider the critical role of the Non-Therapy Ancillary (NTA) score. 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. You can rely on us. With the transition from Resource Utilization Group Version IV (, ) to the Patient-Driven Payment Model (PDPM) on October 1, 2019, the. Good talk. endstream endobj 454 0 obj <>stream Stay tuned. Based on that, we can calculate the rate.
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