The non-therapy ancillary (NTA) classification of PDPM reinforces why ICD-10 coding plays a key role under PDPM. Lets breakdown the PDPM model to better understand how reimbursement is determined. When expanded it provides a list of search options that will switch the search inputs to match the current selection. 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. "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? 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. Do whatever you want with a SKILLED: fill, sign, print and send online instantly. 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. Re-calculate expected daily rate based on the completed Rehab and Nursing Functional Scores and re-review principal diagnosis. Five of the six are case-mix adjusted. The PDPM diagnosis list determines the reimbursements for a Medicare Part A stay. 0 Determinant for payment is based on the number of therapy minutes provided regardless of residents acuity, diagnosis and other skilled nursing services provided. (Right). Complete a blank sample electronically to save yourself time and money. 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. We know now that every diagnosis and condition counts. Our wound certified educators train, educate, and guide our providers and client facilities on the most efficacious wound care treatments and follow up. NTA component receives 300% of the base per-diem rate for days 1-3 of a stay. PDPM Chart Audit Simple and Easy: Winning in PDPM Payment and Regulatory Strategies . The long-term care facilities have emerged not only as a permanent home for the elderly during their retirement or post-retirement years but as respite and recuperative facilities even for the younger patients. SNF FY 2022 Proposed Rule Learn the Facts Behind the Headlines Part 3: How is My Rate Calculated, Regulatory Reminder! Section I has a lot of items that can effect NTA pay. Everyone I've talked to agrees the NTA payment is a good idea. The Ministry of Education (MoE), Government of India (GoI) has established the National Testing Agency (NTA) as an independent, autonomous, and self-sustained premier testing organization under the Societies Registration Act (1860) for conducting efficient, transparent, and international standardized tests in order to assess the competency of candidates for admission to premier . Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. Remember this is using 2017 data so it assumes that providers make no adjustments which is not realistic. For example, IV medications (5 points) coded in MDS item O0100H2 or isolation (1 point) coded in O0100M2. 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. It's easy to get to those 50, but the tricky part is understanding which ICD-10 codes match to the comorbidities. 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. Refer to RAI pages J37-J38 for more on coding J2100. requires an analytical mind and financial knowledge to determine the highest allowable reimbursement for the facility. The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation. With PDPM payment method, the determinants of payment are categorized into the following case-mix adjusted components: The PDPM rate is adjusted over the course of facility stay by the inclusion of a variable per diem (VPD) adjustment on the following three components: PT, OT and NTA. (I did abbreviate a few of the names for sanity.) 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. 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). THURSDAY JUNE 23, 2022 2 PM EASTERN - 90 MINUTES, OHIO HEALTH CARE ASSOCIATION- Virtual Webinar, COST $35 FOR OHCA MEMBERS, $90 FOR NON-MEMBERS, https://webinars.ohca.org/?pg=semwebCatalog&panel=showLive&seminarid=16339, 6/23/22 Capturing Non-Therapy Ancillary (NTA) in PDPM. The NTA looks at conditions and extensive services that are associated with significant increase in costs for a skilled nursing facility. With the transition from Resource Utilization Group Version IV (, ) to the Patient-Driven Payment Model (PDPM) on October 1, 2019, the. 0000189184 00000 n yid T[KaEev0D/wRDQhDB['QgDTBEB)2"xt"Xn2 QN[%=> FhzdBI^8/HD No software installation. A SANE nurse is an RN who has been trained to examine and assess clients who have a reported a sexual assault. endstream endobj 447 0 obj <> endobj 448 0 obj <> endobj 449 0 obj [278 0 0 0 0 889 0 0 333 333 0 0 278 333 0 278 556 556 556 556 556 556 556 556 556 556 278 0 0 584 0 0 0 667 667 722 722 667 611 778 722 278 500 667 556 833 722 778 667 0 722 667 611 722 667 944 0 667 0 0 0 0 0 0 0 556 556 500 556 556 278 556 556 222 222 500 222 833 556 556 556 0 333 500 278 556 500 722 500 500 500] endobj 450 0 obj <>stream Learn More Resource PDPM Series Part 5: Assessment Requirements. HU]o0}G?G< m*-$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? To ease some of this burden, AAPACN developed the Sample Task List for the Nurse Assessment Coordinator tool . SANE is an acronym that stands for Sexual Assault Nurse Examiner. - Corrected typo in minimum point value thresholds used to ify patients into groups "NA" and "NB" under the NTA component. 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 . Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). endstream endobj 1697 0 obj <>stream More than half of them come from I8000 and many of these have multiple qualifying ICD-10 diagnosis codes. . last. His claim's principal diagnosis is Parkinson's Disease. The score determines NTA payment groups and indices. This could be a difference of $29.23 per day for Urban and $27.93 per day for a Rural facility. 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. 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. 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. Explain the impact of the variable per diem rate in the NTA component and how it impacts PDPM payment. The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. 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. Request for labs, imaging studies and surgical reports whichever is applicable. Under PDPM, there are six payment components. There is also the impact of the Variable Per Diem Adjustment Factor that is applied to the NTA Component. We earn 1 NTA point for second or third degree burn coded in M1040F. It especially packs a heavy punch when considering that the NTA per diem rate is tripled for the first three days of the stay. It is critical that all coded conditions are accurate AND supported by nursing and physician documentation. There must be a reason for it, right? It is not clear why this would be the case. 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. MDS Item Field rows in tan represent MDS item groups identified in CMS PDPM documentation and do not have data entry fields. These maps look significantly different from a lot of the others weve seen. Perhaps the most "transformative" component relates to Non-Therapy Ancillary (NTA) Services. With several big changes ahead, the margin for error slim for most providers. Hoo0#=)HU64*)T%DH!$swwb4fc|i]\/8gr? F Remember that after the 3 day interrupted stay he is considered a new admission for purposes of Part A PDPM. The PDPM Rate is derived from the sum of all the PDPM component rates: PT base rate x PT case mix index (CMI) x VPD adjustment factor, OT base rate x OT CMI x VPD adjustment factor, NTA base rate x NTA CMI x VPD adjustment factor, Nursing base rate x Nursing CMI x 18% Nursing adjustment factor (only for AIDS patients). hWmo6+( Not all NTAs are ICD-10 codes, some are MDS items. I0020 is also a gateway to the I0020B Primary Diagnosis code. When also coded in I8000, I69.091 will also contribute again to the case mix group because it is on the SLP comorbidity list. 463 0 obj <>stream Whats in it for me? How should you prioritize your search for ICD-10 codes? (At this point, I can feel the cold stares from our MDS Experts. Yes, Im aware that if you dont look at every. 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. CMS identified a . There are a total of five rates that make up your pay under PDPM.) Welcome to Gravity healthcare Consulting & Online Education The FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. NF is the lowest grouper with a score of 0, while NA is highest with a score of 12+. After a qualifying hospital stay, he has returned to the SNF for aftercare of the hip fracture. HUO0~^iq3N&@-0*Si$L9)-ziwg';q_}(Ak"CwKi "@~|iA`!c ,: >i*S7O=X8ZA'ic2+(!olVz`zz_"K@I Refer to the PDPM Calculation Worksheet for more information. A frequent question: "If the mapping file lists a code as "return to provider", can I still use it on the MDS?". All disciplines should complete all their assessments ON TIME to CAPTURE all skilled services and accurately calculate residents daily rate PRIOR TO completion and transmission of the MDS 5-day assessment. 1694 0 obj <>stream 0000006770 00000 n 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. %%EOF 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. No paper. by Proactive LTC Consulting | Jan 6, 2020 | Audits, Compliance, Education, MDS, Medical Review, PDPM. xref %PDF-1.6 % CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. 0000001865 00000 n If a resident is admitted into a Part A stay within 30 days after major surgical procedure (as a hospital inpatient) that carried some degree of risk to life or had the potential for severe disability, then J2100 (recent surgery requiring active SNF care) is checked "yes". Ive done that for urban and rural for every state. 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 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. (By the way, we created a PDPM Calculator for you to experiment with and get a better understanding of how PDPM works. 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. To assist in ensuring that you can capture all diagnoses and pertinent information to maximize facility reimbursement, I suggest doing the following (which most MDS nurses I am sure are already doing): Request for Hospital History & Physical, Progress Notes, and consults. 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. AVONA confirms that rural facilities do indeed have lower NTA case-mix. Base rates are either rural or urban as determined by geographic location. PDPM Series Part 4: Non-Therapy Ancillaries Case Mix Groups. You are never alone in this field and resources are available in seminars, webinars, the CMS website, MDS manual, etc. Under PDPM, 50 conditions and extensive services are considered for NTA classification. Try it out!). 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 b!+XQ{ +LgOIYe/Q6RVpYY_N/.~iMu1fY*eR}W_E[,7vrR!XSF};qZW&e"S5!CW}3GU|muc?_X`dcg7(zRU8k? (difference of NE-NF and NA-NB). What do I need to know? Whats in it for me? I wish I could be in your training the 29th. 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. 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. This does not include conditions that are resolved. PDPM MDS Items ! This is an important financial consideration that facilities will not be able to afford to miss out on because of sloppy documentation or review of the records. RUG Classification Groups based on the volume and intensity of therapy provided to patient: Determinants of Payment for PDPM are summarized below. PDPM ICD10 Consulting Confidential 2019 A Native American-Owned business Page . NTA Componenet NTA Component NTA Comorbidity Score NTA Case Mix Group CMI 12+ NA 3.25 9-11 NB 2.53 6-8 NC 1.85 3-5 ND 1.34 1-2 NE 0.96 0 NF 0.72 Presumption of Coverage Comorbidities Included in NTA Comorbidity Score and Assigned Points Condition/Extensive Service MDS Item Points HIV/AIDS SNF Claim ICD-10 B20 8 Parenteral IV Feeding: Level High 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 isnt exactly a new problem, but it didnt drive reimbursement before. This item includes diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. 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. Just 1 NTA point can have an average worth of anywhere from $18 to $55 per day. What if we could limit those codes down to just those ICD-10 codes that are likely to occur. the design of the PDPM case-mix system implemented in FY 2020. 2207 Morgan Ave, Suite D Report the diagnosis code that provides an 18% add-on to the nursing component when coded on the UB-04 even when not coded on the MDS. 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. } 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. 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. pdpm nta listhorse heaven hills road conditionshorse heaven hills road conditions Each component has its case mix index to determine the component rate. As mentioned earlier, these NTA comorbidities are reported (coded) throughout the MDS. z@~. The southwest of the US, Michigan, Ohio and West Virginia would have the highest NTA rates. PATIENT DRIVEN PAYMENT MODEL |4 . 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. 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.