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Below is a summary of the determinants of payment and which section on the MDS assessment form they are derived from. For example, IV medications (5 points) coded in MDS item O0100H2 or isolation (1 point) coded in O0100M2. 0000002280 00000 n You can also zoom in to see detail. color: white; THURSDAY JUNE 23, 2022 2 PM EASTERN - 90 MINUTES, OHIO HEALTH CARE ASSOCIATION- Virtual Webinar, COST $35 FOR OHCA MEMBERS, $90 FOR NON-MEMBERS, https://webinars.ohca.org/?pg=semwebCatalog&panel=showLive&seminarid=16339, 6/23/22 Capturing Non-Therapy Ancillary (NTA) in PDPM. Once you have identified the condition/extensive service on the MDS or claim, the points associated with each comorbidity are added up for a total NTA score which is associated with 1 of the 6 case-mix groups shown below. How often will the items on this list be available to you when you are doing the 5 day assessment? This PDPM model aims to utilize the individual patients characteristics and needs based on diagnosis as opposed to the RUG-IV system relying on volume of services. (At this point, I can feel the cold stares from our MDS Experts. These nurses are also trained to complete a full All Rights Reserved By Nursingcecentral 2022 |. This PDPM model aims to utilize the individual patient's characteristics and needs based on diagnosis as opposed to the RUG-IV system relying on volume of services. - Corrected typo in minimum point value thresholds used to ify patients into groups "NA" and "NB" under the NTA component. hl o NTA = All NTA items identified with a value of two or more points on the NTA table. We earn 2 NTA points if Diabetes is coded in MDS item I2900. mapping to one of the clinical categories: Orthopedic Surgery (Except Major Joint Replacement or Spinal Surgery, Non-orthopedic Surgery and Acute Neurologic, Other Orthopedic (non-surgical orthopedics and musculoskeletal), Medical Management (medical management, acute infections, cancer, pulmonary, cardiovascular/coagulation, acute neurologic), The patients functional score which is coded on. In this article, we discuss the non-therapy ancillary (NTA) component. Copyright LW Consulting, Inc 2022. The Patient-Driven Payment Model (PDPM), is fast approaching with implementation set for October 2019. In this post Im going to take a deeper look at it and calculate the average NTA payment by state and facility. 3HFDRkse$:stHqPJoHK-qL_sh|Kg?unioWAsfH8[^9{'~-? The NTA looks at conditions and extensive services that are associated with significant increase in costs for a skilled nursing facility. 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. Under PDPM, there are six payment components. 0000004542 00000 n Points (1-8) are assigned to specific conditions. 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. 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. Lets breakdown the PDPM model to better understand how reimbursement is determined. Yes, you can, just not in I0020B. For example, if a resident admits and the dietitian notes the BMI is over 40, query the physician to confirm a morbid obesity diagnosis. You can view either rural, urban or both. 0000011153 00000 n PDPM HIPPS Coding Crosswalk In order to accommodate the new payment groups, the PDPM HIPPS algorithm is . 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. Under PDPM, Section GG drives PT and OT, and nursing which affects reimbursement. What if we could limit those codes down to just those ICD-10 codes that are likely to occur. Patient classification system where patients are grouped according to their care and resource needs. When reviewing the CMI components driving PDPM reimbursement its important to consider the critical role of the Non-Therapy Ancillary (NTA) score. Notice there is a big pocket of low NTA rates that covers most of Iowa. a" I54043lquizzes/446951 (Question 2 5 / 5 pts The ;iHIBK = >N]Y}dZ}HvtZ04D8YV4r4Od^/NJ x/i"9WirMdy2d*{E^lEu}Jg t@C`[aNOGgg0?bd'r EVm@Av;*%f?Wp :1&[+cZhqhU;IKBU table, th, td { In this post, we going to look at one important piece of the NTA puzzle, section I. IV medications provided as a resident and coded in Section O would also qualify for NTA points. 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. The functional scoring is based on residents performance in. 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. These maps look significantly different from a lot of the others weve seen. 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 No paper. While the SNF certs and the Therapy Certs may contain this documentation, they are often not signed or approved until after the ARD. Next you multiply the case-mix index by the rate, either rural ($74.56) or urban ($78.05). The PT and OT payment would be based on: primary reason for SNF care and functional status at admission The sum of the lowest per diem rate under each PDPM component, plus the non-case-mix component is the: default code Which of the following is NOT a case-level adjustment for a MS-LTC-DRG long term stay outlier Recently, a provider stated that its not that important because the QM high risk determination includes impaired mobility and transfer, which most of their residents with pressure ulcers already have, so that already qualifies them for high risk even if I5600 is not coded. h4Pj0^z[ 8 >BRA$+Vfa 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". 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. Actually, were going to limit our scope to only I8000 items. 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. 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 After a qualifying hospital stay, he has returned to the SNF for aftercare of the hip fracture. 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 . With every dollar spent on nutrition screening and interventions, the Academy of Nutrition and Dietetics has reported savings of $3.25 3. In the past, we only checked this box even if the resident was a diabetic and also had retinopathy. For the Non-Therapy Ancillary Component, each diagnosis has a corresponding score which is multiplied to the federal NTA case mix index. 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. 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 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). 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. The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. endstream endobj 453 0 obj <>stream This is especially important for those residents who are long-term and later qualify for skilled care. If you have an idea lets discuss! The PDPM program has six payment components. 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. His I0020B Primary Diagnosis and his claim's Principal Diagnosis is now the aftercare of the hip fracture. PDPM Chart Audit Simple and Easy: Winning in PDPM Payment and Regulatory Strategies . The most up to date guidelines are available at. Specialties What Is a SANE Nurse? xref No software installation. 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. It especially packs a heavy punch when considering that the NTA per diem rate is tripled for the first three days of the stay. PDPM includes a new pay category, the non-therapy ancillary or NTA. 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. 437 0 obj <> endobj Item I0020 and I0020B: Item I0020 (primary medical condition category that best describes the primary reason for admission lists several options. (I did abbreviate a few of the names for sanity.) Patients rely on you. 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. NTA has been separated as an independent component, and NTA classification 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. endstream endobj 1696 0 obj <>stream 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 (. ) There are two look back periods that must be met when coding conditions on the MDS: #1 Diagnosis Identification - Documented by the physician or physician extender within the last 60 days. With several big changes ahead, the margin for error slim for most providers. For RUGs IV PPS, the payment is based on a per diem rate that is constant for the entire length of stay. The five CMGs then convert to a corresponding case mix index (CMI), which is a multiplier to the base rate for a particular CMG. 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. Preparedness for coding changes will be the key to a smooth transition. Other specific items will be recorded in various parts of the MDS including Section K, M, N, and O. Therefore, the code in I0020B must be directly related to the I0020 Primary Medical Condition. The saying, haste makes waste applies in the completion of MDS assessments and calculation of the maximized PDPM rate for the patient. It is highly recommended for the MDS nurse to make calculations which can determine the highest acceptable reimbursement rate for the facility. If the 25% is exceeded, a non-fatal warning will appear on the final validation report during the MDS submission process. Skilled nursing services are covered under the Federal Governments. Speaking of individual facilities, lets take a look at that as well. Ill also compare urban versus rural facilities when it comes to NTA case-mix. 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. 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. Everyone Ive talked to agrees the NTA payment is a good idea. 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 new nurse assessment coordinator (NAC) may be overwhelmed with the numerous tasks required of the position. Admittedly, thats a lot to look through. Other codes can still be listed in I8000. With such a close relationship to payment, it is critical the staff member(s) responsible for ICD-10 coding are knowledgeable in this area. It will be imperative that the coding is accurate on the MDS for the NTA conditions. CMS 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.