The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. (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. 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. 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 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 (. Re-calculate expected daily rate based on the completed Rehab and Nursing Functional Scores and re-review principal diagnosis. These skilled services are for a medical condition that is a hospital-related medical condition treated during the three-day qualifying inpatient hospital stay (not including the day of discharge from the hospital). We must also understand all the aspects of PDPM coding from every single angle, the relationship between each facet of the components, and the impact on care and revenue. Below is the full listing of conditions and services used for NTA classification and the associated number of points for that comorbidity. Patients are assigned a clinical category based on the primary diagnosis for SNF stay. In this post Im going to take a deeper look at it and calculate the average NTA payment by state and facility. Continuous training is the key and implementation of what was learned in coordination with the facility team members will ensure success in providing skilled care for the patients and maximizing facility reimbursement. 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. Incorporate NTA identification into the daily clinical meeting as it is ever important to identify when a change in condition or services takes place. Lastly, lets look a little more closely at rural versus urban. If you have an idea lets discuss! hWmo6+( Some sources even noting companies are finding losses of $500 to just over $1500 due to missed diagnoses, of both malnutrition and obesity, throughout total admissions spans of residents 2. ;iHIBK = >N]Y}dZ}HvtZ04D8YV4r4Od^/NJ x/i"9WirMdy2d*{E^lEu}Jg t@C`[aNOGgg0?bd'r EVm@Av;*%f?Wp :1&[+cZhqhU;IKBU The PDPM Rate is derived from the sum of all the PDPM component rates: PT base rate x PT case mix index (CMI) x VPD adjustment factor, OT base rate x OT CMI x VPD adjustment factor, NTA base rate x NTA CMI x VPD adjustment factor, Nursing base rate x Nursing CMI x 18% Nursing adjustment factor (only for AIDS patients). The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. startxref Points (1-8) are assigned to specific conditions. It is not clear why this would be the case. It is highly advisable for MDS nurses to review each assessment to ensure that all skilled services are captured during the assessment period to maximize reimbursement rate for the facility based on the patients diagnosis and acuity. The five CMGs then convert to a corresponding case mix index (CMI), which is a multiplier to the base rate for a particular CMG. h4Pj0^z[ 8 >BRA$+Vfa 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. These conditions may warrant completion of an Interim Payment Assessment (IPA) thus increasing the NTA component score and potentially the total per diem. Payment is based on services provided by five disciplines: physical therapy, occupational therapy, speech language pathology, nursing, and non-therapy ancillary (NTA). We earn. Custodial care does not require the assistance of a licensed staff. Remember that after the 3 day interrupted stay he is considered a new admission for purposes of Part A PDPM. It is critical that all coded conditions are accurate AND supported by nursing and physician documentation. 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. Identification of NTA conditions and services should start even before the SNF admission. Section I has a lot of items that can effect NTA pay. For example, if the MDS Coordinator counts only two of the three comorbidities that a patient has, the CMI for NTA would be 0.96 instead of 1.34. Base rates are either rural or urban as determined by geographic location. The southwest of the US, Michigan, Ohio and West Virginia would have the highest NTA rates. <<50FFC127310FCF468ABFE4B7414A5B70>]/Prev 423154>> Seek advice from experts, trainers and other MDS nurses when needed to clarify any areas in the MDS assessment or PDPM calculation. or privately paid by the patient if he/she does not qualify under the Medi-Cal program. Do not be apprehensive to query the physician if a diagnosis is not clear or is suspected and not documented. Welcome to Gravity healthcare Consulting & Online Education You only need one SLP co-morbidity (either in one of those check boxes or listed in I8000) to meet that SLP co-morbidity qualifier. 437 0 obj <> endobj Basic versions of many 2019 AHCA PDPM Academy copyrighted document resources and webinars are available to . The idea is that the facility should be paid for the care they are delivering, based on the patients characteristics. MDS Item Field rows in tan represent MDS item groups identified in CMS PDPM documentation and do not have data entry fields. In this post, we going to look at one important piece of the NTA puzzle, section I. The score determines NTA payment groups and indices. }|YAxz .diS\]0}3sfowMm@ Learn why in this video from Aegis Therapies. 26 11.4 Will section I0020B override section I0020, 1-13 for the primary reason for SNF admission since There are a total of five rates that make up your pay under PDPM.) Yes, Im aware that if you dont look at every. comorbidities used under PDPM for NTA classification is assigned a certain number of points, between one and eight, based on its relative costliness. His claim's principal diagnosis is Parkinson's Disease. Retrieved from: https://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html, Center for Medicare and Medicaid Services. To ease some of this burden, AAPACN developed the Sample Task List for the Nurse Assessment Coordinator tool . %PDF-1.6 % It is for this type of services they offer which also categorize them as skilled nursing and rehabilitation facilities becoming a, A long-term care facility provides custodial care requiring supervised, minimal or total dependence in the performance of the activities of daily living (. ) 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. I would really like to see how item I8000 changes on a resident from the 5 day to later assessments. 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. the design of the PDPM case-mix system implemented in FY 2020. The PDPM Clinical Categories are discussed below. CMS 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. } 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. 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. It more accurately accounts for expenses and isnt overshadowed by therapy. The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. 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. 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. Request for labs, imaging studies and surgical reports whichever is applicable. CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. Suctioning? They are assisted by certified nursing assistants (. @.dFo8L.3.#V0 F6Qa)bJ3oR/-5F=8tJ7r8*o{ VFh6Em4~qLh8Km,nLjwjW'm,|w>cy?^UKqZ`TU$7h"M9D*;XYi@ YhZ|453}R;|/F>!KLd{mQ*z7-.r|T_]Y^]K42Ca1g_AVYJo1ox/,e*M'LM ThY^SC w{i0[y0j|[1;hfD$;qp4UgNurGg2gKE)dtA6g!kJ|wpl; Yes, I am aware that ICD-10 codes do change occasionally. Custodial care does not require the assistance of a licensed staff. Reimbursement for these services is covered under the State of Californias Medi-Cal program or privately paid by the patient if he/she does not qualify under the Medi-Cal program. 1=BY)#CT 'a7bA(XdHE ? 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. After a qualifying hospital stay, he has returned to the SNF for aftercare of the hip fracture. 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. This information is essential. Variable Per Diem Adjustment Factors and ScheduleNTA. Learn More Resource PDPM Series Part 5: Assessment Requirements. 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. What do I need to know? 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. You can view either rural, urban or both. 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. Some didnt occur at all. 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 has been a key consideration in designing the various elements of the new model. This isnt exactly a new problem, but it didnt drive reimbursement before. This problem isnt new either but now it will drive reimbursement. For example, Mr. Steve is a long term care resident due to Parkinson's Disease. 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). Not all NTAs are ICD-10 codes, some are MDS items. 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. 0000002742 00000 n The list includes diagnosis codes, which will be recorded in the I8000 section of the MDS. 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. Items on this list could change at any time with new legislative and Under PDPM there are 161 Minimum Data Set (MDS) item fields. 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. In the absence of specific documentation, you may use positive tests, procedures, hospitalization for symptoms). 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. Title: Microsoft Word - FINAL PDPM Triple Check Checklist.docx Author: jleatherbarrow Created Date: 1/29/2020 4:19:17 PM In order to determine the patients NTA comorbidity score accurately, providers must identify all comorbidities for which a resident would qualify, then total the points. The skilled services are provided by a Medicare-certified SNF. 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. 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. IV medications provided as a resident and coded in Section O would also qualify for NTA points. The Centers for Medicare and Medicaid Services (CMS) have provided the SNFs with a list of ICD-10-CM codes mapping to one of the clinical categories: These clinical categories are used as the Primary PDPM diagnosis giving weight to the calculation of PDPM rates for PT, OT, SLP and Nursing components. 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). #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. 0000000836 00000 n Which codes are the most important? CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. You can read more about this in the Official ICD10 Guidelines for Coding and Reporting FY2020, Section II, Subsection K. For example: The definition of Group Therapy has changed. 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. The Non-Therapy Ancillary Services (NTA) component is a total score of all listed conditions and/or extensive services that apply to the resident. Ensure you have staff who are trained in ICD-10 coding. These nurses are also trained to complete a full All Rights Reserved By Nursingcecentral 2022 |. 3HFDRkse$:stHqPJoHK-qL_sh|Kg?unioWAsfH8[^9{'~-? 8cq1o22#|Bm1il,4iw&C|E^F+oq:>_|M\v+iTOigWJ:dCa$Qv_n/q|wCuukk+e';iJB2C &!Ar8c _~r ANOVA Rural versus Urban NTA case-mix (click to enlarge). The NTA component, together with the nursing and non-case mix components, make up the total reimbursement for a patient day under Medicare Part A. NTA classification is based on the presence of certain comorbidities or use of certain extensive services. 0000004207 00000 n Prior to October 1, 2019, all SNFs which participate under the Medicare program are paid under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) based primarily on the type and intensity of therapy services provided to the patients regardless of their acuity, unique characteristics, specific needs, or goals. Involve the Interdisciplinary Team. Hoo0Gw7I18J+-+hLC&QI$[3iB:s]:?\GqA ATc#(R2:nl/?e. ` 0!RJ3t f{ WN"Y@L1+;HXZL@\uB*4c*fi$1( )}hciksm2hn 1cU(YTS46ye&? &JHyBIQ fF Yes, you can, just not in I0020B. The non-therapy ancillary (NTA) classification of PDPM reinforces why ICD-10 coding plays a key role under PDPM. Remember, the CMS list is authoritative, mine is only for your convenience. by NCC News and Content Team | Mar 1, 2023 | Hospitals, Specialties. The more comorbidities a patient has, the more medications he or she probably requires. Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). When reviewing the CMI components driving PDPM reimbursement it's important to consider the critical role of the Non-Therapy Ancillary (NTA) score. Verify coding, dont assume. SAMPLE Task List for the Nurse Assessment Coordinator (NAC) November 23, 2022. Lets breakdown the PDPM model to better understand how reimbursement is determined. 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 The Primary Diagnosis in I0020B and the Principal Diagnosis should match. CMS identified a . Le^#N"TaAKTt Speaking of individual facilities, lets take a look at that as well. This list of options is not used for PDPM payment, but is used as risk adjustments for some of the QRP Quality Measures. The patients functional score which is coded on Section GG 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. 18% of the Nursing adjustment factor is multiplied to the Nursing rate only patients with diagnosis of AIDS. Hopefully I dont lose my blogging privileges, but I looked at a years worth of Part A admissions to every SNF in the country and found, gasp, not all codes occur that often. Adjustments to the PDPM rates include: 2.3% reduction in FY 2023. additional 2.3% decrease in FY 2024. You are never alone in this field and resources are available in seminars, webinars, the CMS website, MDS manual, etc. Note that for the first 3 days of the stay you get 3 times the rate shown on the map. These groups and indices, combined with other components of the payment system, provide a total reimbursement process that 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. hbspt.cta._relativeUrls=true;hbspt.cta.load(2297384, '30c35813-92d3-4fa1-bc3f-6b232de017b1', {"useNewLoader":"true","region":"na1"}); Topics: Whats in it for me? 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. 0000190726 00000 n Diligent review of the medical history and clinical record is essential. 463 0 obj <>stream The PDPM program has six payment components. 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. Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). 0000189184 00000 n Understanding the Value of the MDS Nurse Under PDPM, Psoriatic Arthropathy & Systemic Sclerosis, Myelodysplastic Syndromes and Myelofibrosis. } The AHCA Patient Driven Payment Model (PDPM) Resource Center provides AHCA provider members with a suite of original content, tools, and training options and resources to assist providers in how to be successful in implementing the new Medicare Part A PDPM SNF PPS, effective October 2019. ENSURE TO CAPTURE EVERYTHING PRIOR TO COMPLETION OF THE 5-DAY MDS ASSESSMENT! z@~. The most up to date guidelines are available at. Yes, I get that is bad. Daily Medicare charting should focus on all possible nursing clinical categories, special care high, special care low, clinically complex, behavioral symptoms and cognitive performance, and reduced physical function. SANE is an acronym that stands for Sexual Assault Nurse Examiner. hb```b``ia`e`ff@ a(meU=r%::@`uH@V01:000x1p`5`gy4AuG/Dg* ZF:&'[-@ >` t!R Far more items than would actually fit on the MDS 3.0 Instrument. Try it out!). 0000007482 00000 n MDS 3.0 RAI Manual. 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. You can filter by NTA rate. You should understand those things too, reader.). When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. I0020 is also a gateway to the I0020B Primary Diagnosis code. 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.
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