Any delay in getting this information is going to be problematic. CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. 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. 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? Just 1 NTA point can have an average worth of anywhere from $18 to $55 per day. Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). 18% of the Nursing adjustment factor is multiplied to the Nursing rate only patients with diagnosis of AIDS. 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. How often will the items on this list be available to you when you are doing the 5 day assessment? I am sure we'll continue to understand even more as the months go by. List the 3 MDS items that qualify a resident for the Extensive Nursing Service group. Copyright LW Consulting, Inc 2022. Your NTA payment is driven by the presence of a number of conditions and/or extensive services. 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. Everyone Ive talked to agrees the NTA payment is a good idea. Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing components. &)` R #V? U? The score determines NTA payment groups and indices. When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. 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. As under the previous RUGIV model, the presence of an AIDS diagnosis continues to be identified through the . 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. Base rates are either rural or urban as determined by geographic location. 437 27 Lastly, lets look a little more closely at rural versus urban. We earn 1 NTA point for second or third degree burn coded in M1040F. 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. Anyone involved with ICD-10 coding should have ready access to the coding guidelines. 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. This is especially important for those residents who are long-term and later qualify for skilled care. 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 (Nursing, Social Services, Dietary and Activity Staff). Variable Per Diem Adjustment Factors and ScheduleNTA. The idea is that the facility should be paid for the care they are delivering, based on the patients characteristics. Love what you read? Le^#N"TaAKTt The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. hWmo6+( Everyone I've talked to agrees the NTA payment is a good idea. 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. Preparedness for coding changes will be the key to a smooth transition. Of importance to note is the condition of HIV/AIDS under the NTA component. startxref ~,/-I\!/JfB. Wound Care? An NTA comorbidity score of 12 = a CMI of 3.24. The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation to ensure 100% accuracy. Primary reason for SNF care or PDPM diagnosis coded on Section I00200B (ICD-10 code) of the MDS assessment, Functional status coded on Section GG of the MDS assessment, Cognitive Status: BIMS score coded on the Section C of the MDS assessment, presence of a swallowing disorder or mechanically altered diet coded on Section K of the MDS assessment, other SLP-related comorbidities coded on Section I of the MDS assessment, Extensive services received coded on Section of the MDS assessment such as Tracheostomy, Ventilator, and Isolation, Presence of Depression coded on Section D: PHQ9 on the MDS assessment, Restorative nursing services coded on Section O of the MDS assessment, Comorbidities present coded on Section I of the MDS assessment, Extensive services received coded on Section O of the MDS assessment: Tracheostomy, Ventilator and Isolation. This problem isnt new either but now it will drive reimbursement. Incorporate NTA identification into the daily clinical meeting as it is ever important to identify when a change in condition or services takes place. 0000003961 00000 n If you have an idea lets discuss! 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. 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 We earn 1 NTA point when Other Skin Problems (foot ulcers/lesions) is coded in MDS item M1040A (infection of the foot such as cellulitis or purulent drainage), M1040B (diabetic foot ulcer), or M1040C (other open lesion of foot). The Patient-Driven Payment Model focuses on the patients unique characteristics and needs based on diagnosis which arise during inpatient hospital stay. 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. ,: >i*S7O=X8ZA'ic2+(!olVz`zz_"K@I Remember, the CMS list is authoritative, mine is only for your convenience. 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. ;iHIBK = >N]Y}dZ}HvtZ04D8YV4r4Od^/NJ x/i"9WirMdy2d*{E^lEu}Jg t@C`[aNOGgg0?bd'r EVm@Av;*%f?Wp :1&[+cZhqhU;IKBU 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. But toward the end of January, reporter Maggie Flynn poked holes in the idea that ICD-10 mastery was a necessity. The Non-Therapy Ancillary Services (NTA) component is a total score of all listed conditions and/or extensive services that apply to the resident. } #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. 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. 0000190726 00000 n For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. PDPM Chart Audit Simple and Easy: Winning in PDPM Payment and Regulatory Strategies . Points are added together for all conditions. HUO0~^iq3N&@-0*Si$L9)-ziwg';q_}(Ak"CwKi "@~|iA`!c Coding of these areas will affect the Speech Case Mix Index. As mentioned earlier, these NTA comorbidities are reported (coded) throughout the MDS. 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. PDPM HIPPS Coding Crosswalk In order to accommodate the new payment groups, the PDPM HIPPS algorithm is . (By the way, we created a PDPM Calculator for you to experiment with and get a better understanding of how PDPM works. Understanding the Value of the MDS Nurse Under PDPM, Psoriatic Arthropathy & Systemic Sclerosis, Myelodysplastic Syndromes and Myelofibrosis. Request for labs, imaging studies and surgical reports whichever is applicable. F 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 0000004207 00000 n The list includes diagnosis codes, which will be recorded in the I8000 section of the MDS. 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. Focuses on clinically relevant factors rather than volume-based services or RUG levels. Stay tuned. On day 4 it goes back to the rate shown. 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). 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. Also notice there are very few facilities with low NTA rates in the Appalachians. and the grouper software will pick it up from I8000. The PDPM Clinical Categories are discussed below. The functional scoring is based on residents performance in. 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. I wish I could be in your training the 29th. NTA component receives 300% of the base per-diem rate for days 1-3 of a stay. MDS 3.0 RAI Manual. It may also include a condition that started while the patient was getting care in the SNF for a hospital-related medical condition such as antibiotic medications via intravenous (IV) route to treat infections even if it was not the reason the patient was admitted to the acute hospital. In it, youll find the 1,612 codes that map to the different comorbidities. A list of these specific retinopathy codes are in the SLP mapping file from CMS. 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. 0000002742 00000 n 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. hb```b``ia`e`ff@ a(meU=r%::@`uH@V01:000x1p`5`gy4AuG/Dg* ZF:&'[-@ >` t!R 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. %PDF-1.6 % CMS identified a . Which codes are you most likely to actually see in the wild? [|Qc\0aXjK@ EdO4&_? We earn 1 NTA point for second or third degree burn coded in M1040F. 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. var divElement = document.getElementById('viz1528375166404'); var vizElement = divElement.getElementsByTagName('object')[0]; vizElement.style.width='100%';vizElement.style.height=(divElement.offsetWidth*0.75)+'px'; var scriptElement = document.createElement('script'); scriptElement.src = 'https://public.tableau.com/javascripts/api/viz_v1.js'; vizElement.parentNode.insertBefore(scriptElement, vizElement); Use the rate filter to show only the highest or lowest NTA rates. The saying, haste makes waste applies in the completion of MDS assessments and calculation of the maximized PDPM rate for the patient. Re-calculate expected daily rate based on the completed Rehab and Nursing Functional Scores and re-review principal diagnosis. tr:nth-child(even) {background-color: #f2f2f2;} 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. The PDPM program has six payment components. 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 correct coding for NTA will require a team effort and diligent review of coding and supporting documentation. The NTA component, together with the nursing and non-case mix components, make up the total reimbursement for a patient day under Medicare Part A. NTA classification is based on the presence of certain comorbidities or use of certain extensive services. endstream endobj 453 0 obj <>stream Custodial care does not require the assistance of a licensed staff. ENSURE TO CAPTURE EVERYTHING PRIOR TO COMPLETION OF THE 5-DAY MDS ASSESSMENT! 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 . 0000001405 00000 n But now, if the resident also happens to have diabetic retinopathy, we can earn an extra NTA point if we also include the specific Diabetic Retinopathy code in I8000. CMS identified 50 conditions and services that were related to an increased cost for skilled nursing facilities. A Knowledgeable and Compassionate partner. The functional scoring is based on residents performance in 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. NF is the lowest grouper with a score of 0, while NA is highest with a score of 12+. Comorbidities are assigned points based on the cost in care associated with the condition or service, with points ranging from 1 to 8. 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). 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. Coding of these areas will affect the, Postpartum Preeclampsia Diagnosis and Management, Hyperemesis Gravidarum: More Than Just Morning Sickness. Refer to the CMS PDPM ICD-10 NTA Comorbidity Crosswalk for I8000-derived comorbidities with acceptable ICD-10 codes that map to the NTA component and the NTA item listing for a complete list of NTA conditions/services. The resulting sum is the NTA comorbidity score, which is used to classify each resident into an NTA case-mix group. Primary Diagnosis - List I0020B Surgical Procedures - List J2100/J2300-J5000 Aphasia I4300 Cerebrovascular Accident . You can filter by NTA rate. 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. As a result, client facilities realize improved wound healing results, improved survey scores and NTA reimbursement under PDPM. Once completing his Part A stay, the hip fracture will no longer appear on his claim, and Parkinson's Disease now returns as the Principal Diagnosis. Updates the ICD-10 mapping used to classify patients under the PDPM framework. .com NTA Diagnosis Tool CMS identified a list of 50 conditions and extensive services associated with increases in NTA costs. 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). Start (and continue) the conversation. 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. 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. We also qualify for Special Care Low in the Nursing Category when there is an application of a dressing to the foot with the ulcer. The decision to change the definition was because CMS believes that therapists, using their clinical judgment, will allow for more flexibility and that residents often benefit from the psychosocial aspects of group therapy. All PDPM components are assigned an appropriate score to multiply to the federally assigned case mix index group. While the SNF certs and the Therapy Certs may contain this documentation, they are often not signed or approved until after the ARD. The NTA component is an important component to capture and reimburse the facility for costly medications, services, and supplies needed to care for residents. This article was originally published in February 2019, and has been updated in October 2019 with several more tips. 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. Ill also compare urban versus rural facilities when it comes to NTA case-mix. 0000000836 00000 n Great info! Think about this A resident with a Stage IV pressure ulcer has physician orders and Registered Dietician recommendations for a protein supplement. 0000008175 00000 n z@~. . In this article, we discuss the non-therapy ancillary (NTA) component. Under PDPM, an adjustment is applied to certain PDPM components that varies the per diem payment over the course of the stay. (difference of NE-NF and NA-NB). Zi@Ym"l?]L?*;YaRxwFhSGkhSFRQJIp.V4v!fbN91GE]Y:+s Luckily, code diving is a lot of fun, right? If the 25% is exceeded, a non-fatal warning will appear on the final validation report during the MDS submission process. 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. 8cq1o22#|Bm1il,4iw&C|E^F+oq:>_|M\v+iTOigWJ:dCa$Qv_n/q|wCuukk+e';iJB2C &!Ar8c _~r Payment is based on services provided by five disciplines: physical therapy, occupational therapy, speech language pathology, nursing, and non-therapy ancillary (NTA). 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 (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. 0000001690 00000 n 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 (. 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 0000000016 00000 n This simply shows you a starting point. background-color: #2c4a88; Welcome to Gravity healthcare Consulting & Online Education Our wound certified educators train, educate, and guide our providers and client facilities on the most efficacious wound care treatments and follow up. mp:U@|8B *zL$#Tk\*SU%mQlTYA Rj&-N _VjWpb[5R8'i, 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. Now let's discuss the I0020B Primary Diagnosis and the Claim's Principal Diagnosis. 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. xref It especially packs a heavy punch when considering that the NTA per diem rate is tripled for the first three days of the stay. Hover over a facility to see the name, NTA Rate, NTA case-mix index and whether the facility is urban or rural. These components for classification and payment include: Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST), Non-therapy Ancillary (NTA) as well as Nursing. With several big changes ahead, the margin for error slim for most providers. Section I has a lot of items that can effect NTA pay. ordered by the patients attending physician in the facility. 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. 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. code. A frequent question: "If the mapping file lists a code as "return to provider", can I still use it on the MDS?". As a result, client facilities realize improved wound healing results, improved survey scores and NTA reimbursement under PDPM. 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. The individual NTA conditions have points ranging from 1 to 8. When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. 0 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. Next you multiply the case-mix index by the rate, either rural ($74.56) or urban ($78.05). When reviewing the CMI components driving PDPM reimbursement it's important to consider the critical role of the Non-Therapy Ancillary (NTA) score. Custodial care does not require the assistance of a licensed staff. (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.

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