The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation. For example, Mr. Steve is a long term care resident due to Parkinson's Disease. (Click either image to enlarge.). Anyone involved with ICD-10 coding should have ready access to the coding guidelines. In this post, we going to look at one important piece of the NTA puzzle, section I. Yes, I get that is bad. View D0AD3F24-D6BD-4273-B139-8FCA97487E6A.jpeg from NURSING MISC at St. Clair County Community College. 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. ordered by the patients attending physician in the facility. endstream endobj 451 0 obj <>stream "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? I would really like to see how item I8000 changes on a resident from the 5 day to later assessments. 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. Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). 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. Do whatever you want with a SKILLED: fill, sign, print and send online instantly. 0000009611 00000 n The MDS nurse should be alert to these changes to ensure timely completion of the required MDS assessment. (By the way, we created a PDPM Calculator for you to experiment with and get a better understanding of how PDPM works. This isnt exactly a new problem, but it didnt drive reimbursement before. 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. For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. the design of the PDPM case-mix system implemented in FY 2020. 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. 0000007482 00000 n Wound Care? startxref 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 (. Think about this A resident with a Stage IV pressure ulcer has physician orders and Registered Dietician recommendations for a protein supplement. Stay tuned. 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. %%EOF Group therapy now allows for as few as 2 residents and as many as 6 residents. Zi@Ym"l?]L?*;YaRxwFhSGkhSFRQJIp.V4v!fbN91GE]Y:+s It especially packs a heavy punch when considering that the NTA per diem rate is tripled for the first three days of the stay. The presence of these conditions and extensive services is reported by providers . 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. PDPM payments will be based on six groupsone non-case mix group (CMG) and five specific CMGs: PT, OT, SLP, NTA and nursing. Suctioning? 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. 18% of the Nursing adjustment factor is multiplied to the Nursing rate only patients with diagnosis of AIDS. A SANE nurse is an RN who has been trained to examine and assess clients who have a reported a sexual assault. 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. Just 1 NTA point can have an average worth of anywhere from $18 to $55 per day. SANE is an acronym that stands for Sexual Assault Nurse Examiner. 437 0 obj <> endobj For RUGs IV PPS, the payment is based on a per diem rate that is constant for the entire length of stay. (This isnt going to work well on mobile devices, FYI.). |Pa(E8BNJA!-tUiX%:h~GJ?J.H% kZ*qyXjBy@C(zHhzQhhlL2cO`.$p6_[3R^IrHrr6#eq7**2uWytb$HyZi[F2_ GBM*.`k@/9cO9R*^fo_MOK6_xg,eM'jv}5E|SWNH0$z|.WL7y9 ;4H*h;H8H"*RW l? Now let's discuss the I0020B Primary Diagnosis and the Claim's Principal Diagnosis. Admittedly, thats a lot to look through. Whats in it for me? Non-Therapy Ancillary (NTA) Services - At a Glance The Patient-Driven Payment Model (PDPM) takes effect on October 1, 2019 and represents a significantly different approach to reimbursement for care in Skilled Nursing Facilities (SNFs). 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. 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. What do I need to know? His claim's principal diagnosis is Parkinson's Disease. Lets breakdown the PDPM model to better understand how reimbursement is determined. Identification of NTA conditions and services should start even before the SNF admission. Under PDPM, 50 conditions and extensive services are considered for NTA classification. As outlined in the SNF PDPM technical report, CMS was looking for the new reimbursement plan to account accurately and appropriately for the increased costs associated with caring for patients with AIDS. 0000005276 00000 n Patient classification system where patients are grouped according to their care and resource needs. Primary Diagnosis - List I0020B Surgical Procedures - List J2100/J2300-J5000 Aphasia I4300 Cerebrovascular Accident . CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. Adjustments to the PDPM rates include: 2.3% reduction in FY 2023. additional 2.3% decrease in FY 2024. These maps look significantly different from a lot of the others weve seen. 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 These conditions may warrant completion of an Interim Payment Assessment (IPA) thus increasing the NTA component score and potentially the total per diem. 463 0 obj <>stream Diligent review of the medical history and clinical record is essential. Based on that, I have made you an extreme cheat sheet, that you should use with extreme caution. Learn More Resource PDPM Series Part 5: Assessment Requirements. 26 11.4 Will section I0020B override section I0020, 1-13 for the primary reason for SNF admission since This is especially important for those residents who are long-term and later qualify for skilled care. ~,/-I\!/JfB. requires an analytical mind and financial knowledge to determine the highest allowable reimbursement for the facility. hb```b``ia`e`ff@ a(meU=r%::@`uH@V01:000x1p`5`gy4AuG/Dg* ZF:&'[-@ >` t!R You can also zoom in to see detail. SAMPLE Task List for the Nurse Assessment Coordinator (NAC) November 23, 2022. 0000002491 00000 n Ill also compare urban versus rural facilities when it comes to NTA case-mix. The saying, haste makes waste applies in the completion of MDS assessments and calculation of the maximized PDPM rate for the patient. HU]o0}G?G< m*-$R5k'EC(K@!BE`;s 2I2,[fy@770&05 Bal[|# f1 `j[>,Uf[OrGUXore:qVKP2T(r`~F& +g80qjM8#)A{)@c}A,F^Ec{HN"!l!]_J3? At first, it took me longer to get used to making calculations in determining the highest allowable rate for the patient. We also qualify for Special Care Low in the Nursing Category when there is an application of a dressing to the foot with the ulcer. The NTA looks at conditions and extensive services that are associated with significant increase in costs for a skilled nursing facility. <<50FFC127310FCF468ABFE4B7414A5B70>]/Prev 423154>> To ease some of this burden, AAPACN developed the Sample Task List for the Nurse Assessment Coordinator tool . [|Qc\0aXjK@ EdO4&_? When reviewing the CMI components driving PDPM reimbursement it's important to consider the critical role of the Non-Therapy Ancillary (NTA) score. Under PDPM there are 161 Minimum Data Set (MDS) item fields. The Patient-Driven Payment Model (PDPM), is fast approaching with implementation set for October 2019. A} 2?d`aYW!3,8h|J/K\J:s&Ve>1|9WiixusVo\sGP8saBT!+(z$lYnAZZp@6Y1m`[ jKeMQ5i.7HCGIC1iGIc' Yes, you can, just not in I0020B. HUMk@(h; ! Often overlooked, Non-Therapy Ancillaries or NTAs will be more important than ever in PDPM. This gives you enough time to prepare for their implementation of any changes as MDS assessments are time sensitive. 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. 0000003037 00000 n Either way, you must still also code the I0020B primary condition I0010 through I8000. It more accurately accounts for expenses and isnt overshadowed by therapy. 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. 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. HVmo0)>bbJS:i>h4B6u~>!bB8lr lk4-M~V CIExej[_@{wpuCm/8yU\mqpC1!Ll%5##P:a,Orh[a%zDUd V#~RLXP9BZ,/Y798(|&a"#.G. A good first resource is the PDPM NTA Comorbidity Mapping spreadsheet. 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. As mentioned earlier, these NTA comorbidities are reported (coded) throughout the MDS. 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. 0000001690 00000 n 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. But if discharged on 10/01/19, it must be included on the claim. 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. 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. You can view either rural, urban or both. When reviewing the CMI components driving PDPM reimbursement its important to consider the critical role of the Non-Therapy Ancillary (NTA) score. The provider will report on the Minimum Data Set (MDS) each of the comorbidities that a person has. yid T[KaEev0D/wRDQhDB['QgDTBEB)2"xt"Xn2 QN[%=> FhzdBI^8/HD All PDPM components are assigned an appropriate score to multiply to the federally assigned case mix index group. 0000006001 00000 n Explain the impact of the variable per diem rate in the NTA component and how it impacts PDPM payment. You should understand those things too, reader.). 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 . Items on this list could change at any time with new legislative and It is not clear why this would be the case. The patients NTA comorbidity score is the sum of the points associated with each relevant comorbidity. How can a facility ensure that they are not leaving money on the table due to under-coded NTAs? Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. 1694 0 obj <>stream tr:nth-child(even) {background-color: #f2f2f2;} This button displays the currently selected search type. 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. 0000000016 00000 n When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. Below is a summary of the determinants of payment and which section on the MDS assessment form they are derived from. Remember that after the 3 day interrupted stay he is considered a new admission for purposes of Part A PDPM. (Note that this map is showing ONLY the NTA rate. by NCC News and Content Team | Mar 1, 2023 | Hospitals, Specialties. Yes, I am aware that ICD-10 codes do change occasionally. 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. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. 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. (Nursing, Social Services, Dietary and Activity Staff). 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. 0000002280 00000 n With the transition from Resource Utilization Group Version IV (, ) to the Patient-Driven Payment Model (PDPM) on October 1, 2019, the. 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. All Rights Reserved. I am sure we'll continue to understand even more as the months go by. h4Pj0^z[ 8 >BRA$+Vfa 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. The required MDS data would be entered in the sub-items listed below the item group identifier. 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. 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. Ive done that for urban and rural for every state. If you have an idea lets discuss! 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. you could miss something. 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 wish I could be in your training the 29th. The higher the score, the higher the NTA rate. Do not be apprehensive to query the physician if a diagnosis is not clear or is suspected and not documented. Refer to RAI pages J37-J38 for more on coding J2100. 66y% Each patient has a different reimbursement rate as compared to the RUG-IV PPS rate in the past. 5!!!!!May!be!used!by!permission!only!Proactive!Medical!Review,!LLC!!!!!www.proactivemedicalreview.com!!!! We know now that every diagnosis and condition counts. Learn more about Jessica, Eleisha, and the rest of the Proactive team. The visualization is interactive. The Patient-Driven Payment Model focuses on the patients unique characteristics and needs based on diagnosis which arise during inpatient hospital stay. 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. Complete a blank sample electronically to save yourself time and money. Under the PDPM structure, there are no rules regarding when nursing home staff can perform an IPA, McCarthy noted, and even slight changes to a resident's care plan could result in additional NTA points that could bring in extra per-day reimbursement dollars. The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. The five CMGs then convert to a corresponding case mix index (CMI), which is a multiplier to the base rate for a particular CMG. The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. The southwest of the US, Michigan, Ohio and West Virginia would have the highest NTA rates. 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. 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 . The idea is that the facility should be paid for the care they are delivering, based on the patients characteristics. This could be a difference of $29.23 per day for Urban and $27.93 per day for a Rural facility. At the direction of the attending physician, a patient needs skilled care from and/or under the supervision of a skilled nursing or therapy staff daily. z@~. The FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. by Proactive LTC Consulting | Jan 6, 2020 | Audits, Compliance, Education, MDS, Medical Review, PDPM. Conduct interview assessments for the Brief Interview for Mental Status (BIMS), and Mood ON ASSESSMENT REFERENCE DATE (ARD) OR A DAY PRIOR TO ARD. 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. 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 INTRODUCTION. ;iHIBK = >N]Y}dZ}HvtZ04D8YV4r4Od^/NJ x/i"9WirMdy2d*{E^lEu}Jg t@C`[aNOGgg0?bd'r EVm@Av;*%f?Wp :1&[+cZhqhU;IKBU There are a lot of items from section I8000. They are assisted by certified nursing assistants (. 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. info@proactivemedicalreview.com, Blog by Jessica Cairns, RN, RAC-CT, CMAC, and Eleisha Wilkes, RN, RAC-CTA, Click to share on LinkedIn (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Twitter (Opens in new window), Deep Dive into Federal Regulations in a Year, Mission Possible: SNF Department Head Briefing, https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2020-Coding-Guidelines.pdf, https://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/PDPM_Fact_Sheet_NTAComorbidityScoring_v2_508.pdf, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/PDPM_Fact_Sheet_AIDS_v3_508.pdf, Special Treatments/Programs: Intravenous Medication Post-admit Code, Special Treatments/Programs: Ventilator or Respirator Post-admit Code, Special Treatments/Programs: Transfusion Post-admit Code, Major Organ Transplant Status, Except Lung, Active Diagnoses: Multiple Sclerosis Code, Active Diagnoses: Asthma COPD Chronic Lung Disease Code, Bone/Joint/Muscle Infections/Necrosis Except: Aseptic Necrosis of Bone, Active Diagnoses: Diabetes Mellitus (DM) Code, Other Foot Skin Problems: Diabetic Foot Ulcer Code, Special Treatments/Programs: Tracheostomy Care Post-admit Code, Active Diagnoses: Multi-Drug Resistant Organism (MDRO) Code, Special Treatments/Programs: Isolation Post-admit Code, Specified Hereditary Metabolic/Immune Disorders, Special Treatments/Programs: Radiation Post-admit Code, Stage 4 Unhealed Pressure Ulcer Currently present, Psoriatic Arthropathy and Systemic Sclerosis, Proliferative Diabetic Retinopathy and Vitreous Hemorrhage, Other Foot Skin Problems: Foot Infection Code, Other Open Lesion on Foot Code, Except Diabetic Foot Ulcer Code, Complications of Specified Implanted Device or Graft, Bladder and Bowel Appliances: Intermittent catheterization, Special Treatments/Programs: Suctioning Post-admit Code, Myelodysplastic Syndromes and Myelofibrosis, Systemic Lupus Erythematosus, Other Connective Tissue Disorders, and Inflammatory Spondylopathies, Diabetic Retinopathy Except: Proliferative Diabetic Retinopathy and Vitreous Hemorrhage, Nutritional Approaches While a Resident: Feeding Tube, Disorders of Immunity Except: RxCC97: Immune Disorders, Pulmonary Fibrosis and Other Chronic Lung Disorders. $HJ0!$j-g#W d9bEi0~og$.J8-Lb =lZ.SSz|'!`%/ Good talk. All about coding rehabilitation for joint replacements: Its important to know the reason for the joint replacement since coding a joint replacement due to a fracture is different than when a joint replacement is due to an elective surgery. 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. To find out if you're leaving any money on the table email MDS Consultants for a PDPM review at info@mds-consultants.com, Find the PDPM ICD-10 Mapping tool at: https://mds-consultants.com/helpful-cms-info/, PDPM step-by-step scoring guide at https://mds-consultants.com/mds-tools/, https://mds-consultants.com/helpful-cms-info/, Coding N2001 N2005: Part A Drug Regimen Review, The Struggle with Antipsychotic Reduction . ! 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. (2019). ,: >i*S7O=X8ZA'ic2+(!olVz`zz_"K@I In preparation we listened to every webinar we could find, we attended all the training we could, we visited the on-line discussion groups, we dreamed about it, had nightmares about it, we Googled it, and we read all the articles we could find hoping to comprehend all facets of PDPM. Welcome to Gravity healthcare Consulting & Online Education The PDPM clinical categories represent groups of similar diagnosis codes, which are used as part of the resident's classification under the PT, OT, and . The non-therapy ancillary (NTA) classification of PDPM reinforces why ICD-10 coding plays a key role under PDPM. xref Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). Some didnt occur at all. background-color: #2c4a88; 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.
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