As a result, client facilities realize improved wound healing results, improved survey scores and NTA reimbursement under PDPM. This simply shows you a starting point. hb```b``ia`e`ff@ a(meU=r%::@`uH@V01:000x1p`5`gy4AuG/Dg* ZF:&'[-@ >` t!R With the transition from Resource Utilization Group Version IV (RUG-IV) to the Patient-Driven Payment Model (PDPM) on October 1, 2019, the MDS nurse requires an analytical mind and financial knowledge to determine the highest allowable reimbursement for the facility. %PDF-1.4 % What do I need to know? Group therapy now allows for as few as 2 residents and as many as 6 residents. ^(:eOCQ'SM7(Rmnvr/+eO.)hicZjz.,vO&u. 0000006001 00000 n 1=BY)#CT 'a7bA(XdHE ? 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. (difference of NE-NF and NA-NB). Your NTA payment is driven by the presence of a number of conditions and/or extensive services. Under PDPM, an adjustment is applied to certain PDPM components that varies the per diem payment over the course of the stay. 0000002491 00000 n Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). Fax: (812) 471-7802 oYyTQb`y{y;..nI^vY5[3?O%5;5E8_kT}m}02|E}}q4:>9=6 /W=.8,w,8m_?Y\Y\v &0,/}["JO=>?]"y;?P'WY4[;of}7gh.RF)# `,J Z5FXMM:&Dh,A*hJtiL."%oKt . CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. 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. No software installation. Welcome to Gravity healthcare Consulting & Online Education Contact us now and sign up to receive our newsletters here. 0000004207 00000 n "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? Basic versions of many 2019 AHCA PDPM Academy copyrighted document resources and webinars are available to . 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. @ Homework - Chapter 31: HlTT x + . (10 items fit). endstream endobj 454 0 obj <>stream 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. The idea is that the facility should be paid for the care they are delivering, based on the patients characteristics. Which codes are the most important? Patient classification system where patients are grouped according to their care and resource needs. In this article, we discuss the non-therapy ancillary (NTA) component. Specialties What Is a SANE Nurse? The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. 0 DetI Rloh,mJLEo(DA"pd#Se.e)6d;[+I=R^2rcZ'F6C"x=*!J&[KL~^ogN3#)LNb}:QOd 0}pE` )S 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. Was there a need for an IV? Focuses on clinically relevant factors rather than volume-based services or RUG levels. 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. pdpm nta listhorse heaven hills road conditionshorse heaven hills road conditions 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. 0000003037 00000 n The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. What do I need to know? Hoo0Gw7I18J+-+hLC&QI$[3iB:s]:?\GqA ATc#(R2:nl/?e. ` 0!RJ3t f{ WN"Y@L1+;HXZL@\uB*4c*fi$1( )}hciksm2hn 1cU(YTS46ye&? &JHyBIQ fF List the 3 MDS items that qualify a resident for the Extensive Nursing Service group. MDS 3.0 RAI Manual. Understanding the Value of the MDS Nurse Under PDPM, Psoriatic Arthropathy & Systemic Sclerosis, Myelodysplastic Syndromes and Myelofibrosis. 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). Points (1-8) are assigned to specific conditions. The new nurse assessment coordinator (NAC) may be overwhelmed with the numerous tasks required of the position. For the NTA component, the CMI is multiplied against the applicable per diem adjustment factor and is then applied to determine the case-mix adjusted payment associated with each of these payment components for each utilization day under PDPM. A year later, he falls and sustains a hip fracture. How should you prioritize your search for ICD-10 codes? Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing components. $HJ0!$j-g#W d9bEi0~og$.J8-Lb =lZ.SSz|'!`%/ Previous articles in this series outlined the physical and occupational therapy component and the speech language pathology component. This isnt exactly a new problem, but it didnt drive reimbursement before. The MDS software programs such as PointClick Care, Matrix, Net Solutions, to name just a few, automatically calculate the PDPM rates once the MDS assessment is completed. Evansville, IN 47711, Phone: (812) 471-7777 mapping to one of the clinical categories: Orthopedic Surgery (Except Major Joint Replacement or Spinal Surgery, Non-orthopedic Surgery and Acute Neurologic, Other Orthopedic (non-surgical orthopedics and musculoskeletal), Medical Management (medical management, acute infections, cancer, pulmonary, cardiovascular/coagulation, acute neurologic), The patients functional score which is coded on. Seek advice from experts, trainers and other MDS nurses when needed to clarify any areas in the MDS assessment or PDPM calculation. 0000009611 00000 n Ive done that for urban and rural for every state. This information is essential. Far more items than would actually fit on the MDS 3.0 Instrument. The provider will report on the Minimum Data Set (MDS) each of the comorbidities that a person has. background-color: #2c4a88; PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. 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. Ill also compare urban versus rural facilities when it comes to NTA case-mix. The PDPM classification system is based on support of the patients characteristics. endstream endobj 1698 0 obj <>stream Re-calculate expected daily rate based on the completed Rehab and Nursing Functional Scores and re-review principal diagnosis. 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. Good talk. Dietitians are classified in the NTA discipline. The list includes diagnosis codes, which will be recorded in the I8000 section of the MDS. Determinant for payment is based on the number of therapy minutes provided regardless of residents acuity, diagnosis and other skilled nursing services provided. Diligent review of the medical history and clinical record is essential. 0000001865 00000 n 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. CMS identified 50 conditions and services that were related to an increased cost for skilled nursing facilities. 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. Learn more about Jessica, Eleisha, and the rest of the Proactive team. Based on that, I have made you an extreme cheat sheet, that you should use with extreme caution. As under the previous RUG-IV model, the presence of an AIDS diagnosis continues to be identified through the SNFs entry of ICD-10-CM code B20 on the claim. With such a close relationship to payment, it is critical the staff member(s) responsible for ICD-10 coding are knowledgeable in this area. Comorbidities are assigned points based on the cost in care associated with the condition or service, with points ranging from 1 to 8. Medical records department should already code and map for the clinical category to be able to determine principal diagnosis code and calculate expected daily rate for the facility using either the manual PDPM worksheet or software-generated calculation. } A list of these specific retinopathy codes are in the SLP mapping file from CMS. The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation to ensure 100% accuracy. More than half of them come from I8000 and many of these have multiple qualifying ICD-10 diagnosis codes. ,: >i*S7O=X8ZA'ic2+(!olVz`zz_"K@I 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 (, Behavioral Symptoms and Cognitive Performance Problems, The Centers for Medicare and Medicaid Services (. 3HFDRkse$:stHqPJoHK-qL_sh|Kg?unioWAsfH8[^9{'~-? Patients are assigned a clinical category based on the primary diagnosis for SNF stay. The non-therapy ancillary (NTA) classification of PDPM reinforces why ICD-10 coding plays a key role under PDPM. For example, if a resident admits and the dietitian notes the BMI is over 40, query the physician to confirm a morbid obesity diagnosis. CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. SNF FY 2022 Proposed Rule Learn the Facts Behind the Headlines Part 3: How is My Rate Calculated, Regulatory Reminder! 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. SANE is an acronym that stands for Sexual Assault Nurse Examiner. Item I0020 and I0020B: Item I0020 (primary medical condition category that best describes the primary reason for admission lists several options. 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. Try Now! Wound Care? trailer The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. 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. The MDS nurse should be alert to these changes to ensure timely completion of the required MDS assessment. Below is a summary of the determinants of payment and which section on the MDS assessment form they are derived from. The administration of IV fluids may qualify for the Parenteral/IV Feeding - High or Parenteral/IV Feeding - low NTA points. INTRODUCTION. 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 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. 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. 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 Determinants of Payment on MDS Assessment, Section GG Rehab and Nursing Functional Score, Interdisciplinary Team Members Documentation, Nursing, Social Services, Dietary and Activity Staff), Conduct interview assessments for the Brief Interview for Mental Status (, indicating if resident has a swallowing disorder especially if on a mechanically altered diet (Puree or mechanical soft diet). requires an analytical mind and financial knowledge to determine the highest allowable reimbursement for the facility. It is not clear why this would be the case. The higher the score, the higher the NTA rate. 2207 Morgan Ave, Suite D 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 Facilities that work to establish these best practices associated with the NTA component will increase revenue and see other benefits such as improved Quality Measures, reduced readmission rates, and improve skilled documentation.