0000001865 00000 n A year later, he falls and sustains a hip fracture. %%EOF When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. Learn More Resource PDPM Series Part 5: Assessment Requirements. (Nursing, Social Services, Dietary and Activity Staff). View fullsize We earn 2 NTA points if Diabetes is coded in MDS item I2900. 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. Complete a blank sample electronically to save yourself time and money. 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. 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. or service for purposes of classification under the PDPM's NTA component. endstream endobj 1695 0 obj <>stream by Proactive LTC Consulting | Jan 6, 2020 | Audits, Compliance, Education, MDS, Medical Review, PDPM. . 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. Other diagnoses will affect the Non-therapy Ancillary (NTA) component. The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. A list of these specific retinopathy codes are in the SLP mapping file from CMS. 0000190726 00000 n SANE is an acronym that stands for Sexual Assault Nurse Examiner. 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. 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. 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. When expanded it provides a list of search options that will switch the search inputs to match the current selection. Verify coding, dont assume. Custodial care does not require the assistance of a licensed staff. In the absence of specific documentation, you may use positive tests, procedures, hospitalization for symptoms). AVONA confirms that rural facilities do indeed have lower NTA case-mix. This list of options is not used for PDPM payment, but is used as risk adjustments for some of the QRP Quality Measures. 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. For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. This NTA CMI is added to the other components to calculate the total reimbursement for the patient. The NTA case-mix groups are based on NTA score ranges: 0 (NF), 1 2 (NE), 3 5 (ND), 6 8 (NC), 9 11 (NB), or 12+ (NA), according to table 17, NTA Case-Mix Groups, in chapter 6 of the Long-Term Care Facility Resident Assessment Instrument 3.0 Users Manual. The Non-Therapy Ancillary Services (NTA) component is a total score of all listed conditions and/or extensive services that apply to the resident. endstream endobj 452 0 obj <>stream 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. Documentation by the physician and nursing must also support the skilled nature of the codes that are recorded as NTA conditions. All Rights Reserved. These clinical categories are PT, OT, and SLP. Conduct interview assessments for the Brief Interview for Mental Status (BIMS), and Mood ON ASSESSMENT REFERENCE DATE (ARD) OR A DAY PRIOR TO ARD. 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. Request for labs, imaging studies and surgical reports whichever is applicable. Hoo0#=)HU64*)T%DH!$swwb4fc|i]\/8gr? 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. The table below shows how the sum of the NTA points converts to an NTA Case Mix Group and a corresponding NTA CMI. Suctioning? Our wound certified educators train, educate, and guide our providers and client facilities on the most efficacious wound care treatments and follow up. The patients NTA comorbidity score is the sum of the points associated with each relevant comorbidity. 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 . (This isnt going to work well on mobile devices, FYI.). (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. Next you multiply the case-mix index by the rate, either rural ($74.56) or urban ($78.05). 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. For example, if a resident admits and the dietitian notes the BMI is over 40, query the physician to confirm a morbid obesity diagnosis. 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. 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". or privately paid by the patient if he/she does not qualify under the Medi-Cal program. Le^#N"TaAKTt For example, an NTA comorbidity score of 11 equals a CMI of 2.53. This item also impacts your MDS High Risk Pressure Ulcer QM because it is a high risk qualifier (along with impaired bed mobility impaired transfer, or comatose) for the numerator and denominator of the calculation. It is not clear why this would be the case. In summary, the NTA component is an important component to capture and reimburse the facility for costly medications and supplies that are needed to support patient characteristics. } You can filter by NTA rate. 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. [|Qc\0aXjK@ EdO4&_? Everyone Ive talked to agrees the NTA payment is a good idea. Re-calculate expected daily rate based on the completed Rehab and Nursing Functional Scores and re-review principal diagnosis. HUMk@(h; ! 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. Five are case-mix adjusted to allow for variances in diagnoses, severity of illness and other variables associated with the probability of improvement with treatment: Physical therapy (PT) - includes a variable per diem factor Occupational therapy (OT) - includes a variable per diem factor Classroom Walkthrough Checklist Resource Center K 12 Resources Frontline Education April 18th, 2019 - Broken Arrow Public Schools a large urban suburban district with deep roots in the community serves more than 19 000 students Recognized as one of the top But if discharged on 10/01/19, it must be included on the claim. %PDF-1.6 % They cant all be equally likely, right? Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. 0000002038 00000 n mp:U@|8B *zL$#Tk\*SU%mQlTYA Rj&-N _VjWpb[5R8'i, Specialties Hyperemesis Gravidarum: More Than Just Morning Sickness Pregnancy and nausea are terms used in unison with one another. 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. At first, it took me longer to get used to making calculations in determining the highest allowable rate for the patient. Resolved conditions should not be listed since therapy would not be treated for a resolved condition. 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. Do whatever you want with a SKILLED: fill, sign, print and send online instantly. ,: >i*S7O=X8ZA'ic2+(!olVz`zz_"K@I Consider adding the list of NTAs to current pre-admission screening forms or otherwise creating a way to identify and communicate potential conditions and services that may continue during the SNF stay. endstream endobj 1696 0 obj <>stream I would really like to see how item I8000 changes on a resident from the 5 day to later assessments. This update addresses two issues with the NTA comorbidities mapping. 26 11.4 Will section I0020B override section I0020, 1-13 for the primary reason for SNF admission since 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. 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. A Knowledgeable and Compassionate partner. Not all NTAs are ICD-10 codes, some are MDS items. Start (and continue) the conversation. 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. 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 The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. We earn 1 NTA point for second or third degree burn coded in M1040F. 437 27 The new nurse assessment coordinator (NAC) may be overwhelmed with the numerous tasks required of the position. Some didnt occur at all. Comorbidities are assigned points based on the cost in care associated with the condition or service, with points ranging from 1 to 8. The higher the score, the higher the NTA rate. Each component has its case mix index to determine the component rate. Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing components. h4Pj0^z[ 8 >BRA$+Vfa First, it corrects an issue where diagnosis codes were mapped to NTA comorbidities as 1 to 1 mappings where 1 to 2 mappings were intended from the PDPM_ICD10_Mappings_FY20XX Excel sheet. A SANE nurse is an RN who has been trained to examine and assess clients who have a reported a sexual assault. PDPM consists of five case-mix adjusted components: Physical therapy (PT) Occupational therapy (OT) Speech-language pathology (SLP) Nursing Non-therapy ancillary (NTA) PDPM also includes a variable per diem (VPD) adjustment that adjusts the per diem rate to reflect varying costs throughout a patient's stay. And so, you will need to determine how your facility will obtain the initial Diagnosis Identification documentation by the ARD, because it is a "look back" period. Custodial care does not require the assistance of a licensed staff. These conditions may warrant completion of an Interim Payment Assessment (IPA) thus increasing the NTA component score and potentially the total per diem. Share our insider knowledge and tips! Updates the ICD-10 mapping used to classify patients under the PDPM framework. The score determines NTA payment groups and indices. Note that for the first 3 days of the stay you get 3 times the rate shown on the map. And lastly, an update on therapy revenue codes and the claim CMS Transmittal 2270 from March 13, 2019 states that beginning October 1, 2019, the Medicare contractor will no longer require therapy services to be present on SNF or Swing Bed claims. 8cq1o22#|Bm1il,4iw&C|E^F+oq:>_|M\v+iTOigWJ:dCa$Qv_n/q|wCuukk+e';iJB2C &!Ar8c _~r This information is essential. Either way, you must still also code the I0020B primary condition I0010 through I8000. 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. 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. 0000004542 00000 n 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. This simply shows you a starting point. z@~. 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. What do I need to know? Lastly, lets look a little more closely at rural versus urban. ENSURE TO CAPTURE EVERYTHING PRIOR TO COMPLETION OF THE 5-DAY MDS ASSESSMENT! 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. 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. 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. With supportive documentation, it can be coded in I5600. Often overlooked, Non-Therapy Ancillaries or NTAs will be more important than ever in PDPM. $HJ0!$j-g#W d9bEi0~og$.J8-Lb =lZ.SSz|'!`%/ With such a close relationship to payment, it is critical the staff member(s) responsible for ICD-10 coding are knowledgeable in this area. One can see from the table above that if comorbidities are missed, the facility could possibly miss out on reimbursement. It especially packs a heavy punch when considering that the NTA per diem rate is tripled for the first three days of the stay. (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. background-color: #2c4a88; 66y% Great info! Remember, the CMS list is authoritative, mine is only for your convenience. No software installation. 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. The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation. Click here to visit our shop. 5!!!!!May!be!used!by!permission!only!Proactive!Medical!Review,!LLC!!!!!www.proactivemedicalreview.com!!!! PDPM payments will be based on six groupsone non-case mix group (CMG) and five specific CMGs: PT, OT, SLP, NTA and nursing. Which codes are you most likely to actually see in the wild? The five CMGs then convert to a corresponding case mix index (CMI), which is a multiplier to the base rate for a particular CMG. On day 4 it goes back to the rate shown. It more accurately accounts for expenses and isnt overshadowed by therapy. h2430Q0P0430S0 ;iHIBK = >N]Y}dZ}HvtZ04D8YV4r4Od^/NJ x/i"9WirMdy2d*{E^lEu}Jg t@C`[aNOGgg0?bd'r EVm@Av;*%f?Wp :1&[+cZhqhU;IKBU 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". endstream endobj 454 0 obj <>stream 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. (Click either image to enlarge.). thead { 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. Also notice there are very few facilities with low NTA rates in the Appalachians. Below is the full listing of conditions and services used for NTA classification and the associated number of points for that comorbidity. Coding of these areas will affect the, Postpartum Preeclampsia Diagnosis and Management, Hyperemesis Gravidarum: More Than Just Morning Sickness. 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. Overview In July 2018, CMS finalized a new case-mix classification model, the Patient Driven Payment Model (PDPM), that, effective beginning October 1, 2019, will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay.
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