NTA component receives 300% of the base per-diem rate for days 1-3 of a stay. Patients rely on you. Patients are assigned a clinical category based on the primary diagnosis for SNF stay. This information is essential. These components for classification and payment include: Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST), Non-therapy Ancillary (NTA) as well as Nursing. It is not clear why this would be the case. %%EOF With several big changes ahead, the margin for error slim for most providers. by Proactive LTC Consulting | Jan 6, 2020 | Audits, Compliance, Education, MDS, Medical Review, PDPM. Learn More Resource PDPM Series Part 5: Assessment Requirements. Items on this list could change at any time with new legislative and To find out if you're leaving any money on the table email MDS Consultants for a PDPM review at [email protected], 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 . PDPM includes a new pay category, the non-therapy ancillary or NTA. The non-therapy ancillary (NTA) classification of PDPM reinforces why ICD-10 coding plays a key role under PDPM. Focuses on clinically relevant factors rather than volume-based services or RUG levels. ENSURE TO CAPTURE EVERYTHING PRIOR TO COMPLETION OF THE 5-DAY MDS ASSESSMENT! 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. 18% of the Nursing adjustment factor is multiplied to the Nursing rate only patients with diagnosis of AIDS. 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. 0000009034 00000 n ;iHIBK = >N]Y}dZ}HvtZ04D8YV4r4Od^/NJ x/i"9WirMdy2d*{E^lEu}Jg t@C`[aNOGgg0?bd'r EVm@Av;*%f?Wp :1&[+cZhqhU;IKBU In the past, we only checked this box even if the resident was a diabetic and also had retinopathy. 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. The resulting sum is the NTA comorbidity score, which is used to classify each resident into an NTA case-mix group. you could miss something. endstream endobj 1698 0 obj <>stream Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). 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. Contact us now and sign up to receive our newsletters here. A Knowledgeable and Compassionate partner. 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 (. ) Patient classification system where patients are grouped according to their care and resource needs. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. Educate yourself on the. 0000009611 00000 n Le^#N"TaAKTt Try Now! Skilled nursing services are covered under the Federal Governments. 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. background-color: #2c4a88; Everyone Ive talked to agrees the NTA payment is a good idea. endstream endobj 451 0 obj <>stream (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. 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. table, th, td { A frequent question: "If the mapping file lists a code as "return to provider", can I still use it on the MDS?". The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation. No paper. endstream endobj 1695 0 obj <>stream Sometimes the code may be a qualifier for other PDPM components, sometimes it won't be. The saying, haste makes waste applies in the completion of MDS assessments and calculation of the maximized PDPM rate for the patient. - Corrected typo in minimum point value thresholds used to ify patients into groups "NA" and "NB" under the NTA component. With such a close relationship to payment, it is critical the staff member(s) responsible for ICD-10 coding are knowledgeable in this area. Basic versions of many 2019 AHCA PDPM Academy copyrighted document resources and webinars are available to . startxref 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. h2430Q0P0430S0 (10 items fit). The PDPM program has six payment components. How should you prioritize your search for ICD-10 codes? For the NTA, an adjustment factor of 3.0 is applied to the total NTA CMI for days 1-3. When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. CMS identified a . One can see from the table above that if comorbidities are missed, the facility could possibly miss out on reimbursement. Diligent review of the medical history and clinical record is essential. It's easy to get to those 50, but the tricky part is understanding which ICD-10 codes match to the comorbidities. SNF FY 2022 Proposed Rule Learn the Facts Behind the Headlines Part 3: How is My Rate Calculated, Regulatory Reminder! z@~. Luckily, code diving is a lot of fun, right? 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. The Patient-Driven Payment Model focuses on the patients unique characteristics and needs based on diagnosis which arise during inpatient hospital stay. 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. 2207 Morgan Ave, Suite D or service for purposes of classification under the PDPM's NTA component. Determinant for payment is based on the number of therapy minutes provided regardless of residents acuity, diagnosis and other skilled nursing services provided. The more comorbidities a patient has, the more medications he or she probably requires. 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. What if we could limit those codes down to just those ICD-10 codes that are likely to occur. 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. Ensure you have staff who are trained in ICD-10 coding. If you have an idea lets discuss! The PDPM Clinical Categories are discussed below. 0000002742 00000 n Comorbidities associated with higher increases in NTA costs are grouped into higher point tiers, while those that are associated with lower increases in NTA costs are grouped into lower point tiers. PDPM Chart Audit Simple and Easy: Winning in PDPM Payment and Regulatory Strategies . We earn. ~,/-I\!/JfB. 26 11.4 Will section I0020B override section I0020, 1-13 for the primary reason for SNF admission since These clinical categories are PT, OT, and SLP. Center for Medicare and Medicaid Services. 0000005276 00000 n This NTA CMI is added to the other components to calculate the total reimbursement for the patient. 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. The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. Each component has its case mix index to determine the component rate. How can a facility ensure that they are not leaving money on the table due to under-coded NTAs? 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). Remember that after the 3 day interrupted stay he is considered a new admission for purposes of Part A PDPM. Do whatever you want with a SKILLED: fill, sign, print and send online instantly. 1694 0 obj <>stream Was there a need for an IV? 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. Each patient has a different reimbursement rate as compared to the RUG-IV PPS rate in the past. Below is the full listing of conditions and services used for NTA classification and the associated number of points for that comorbidity. You are never alone in this field and resources are available in seminars, webinars, the CMS website, MDS manual, etc. Under PDPM, Section GG drives PT and OT, and nursing which affects reimbursement. (difference of NE-NF and NA-NB). For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. #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. See the table below. (Ui7A7dR;5|jDM\sEamJFK3O.C[=vBD:]'N+T_ rhc_ex>mHR&o6Bfr*W0zG3KWmxK6P46n=Jt0Pn'OGC~&S};& Dt];vwj+E0R"^T Refer to the PDPM Calculation Worksheet for more information. MDS Item Field rows in tan represent MDS item groups identified in CMS PDPM documentation and do not have data entry fields. |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$z|.WL7y9 ;4H*h;H8H"*RW l? PDPM Series Part 4: Non-Therapy Ancillaries Case Mix Groups. } 0000007482 00000 n } endstream endobj 454 0 obj <>stream There are a lot of items from section I8000. endstream endobj 1696 0 obj <>stream The MDS nurse should be alert to these changes to ensure timely completion of the required MDS assessment. h4Pj0^z[ 8 >BRA$+Vfa or privately paid by the patient if he/she does not qualify under the Medi-Cal program. 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. 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. 437 0 obj <> endobj The new nurse assessment coordinator (NAC) may be overwhelmed with the numerous tasks required of the position. 0000011153 00000 n Think about this A resident with a Stage IV pressure ulcer has physician orders and Registered Dietician recommendations for a protein supplement. SAMPLE Task List for the Nurse Assessment Coordinator (NAC) November 23, 2022. 0000002038 00000 n Facilities must ensure efficient processes are in place when selecting the primary diagnosis. His claim's principal diagnosis is Parkinson's Disease. With this component being paid at a 3x rate for 1st 3 days of . 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. Try it out!). Yes, Im aware that if you dont look at every. endstream endobj 452 0 obj <>stream Patient has at least three qualifying inpatient days in an acute hospital. Notice there is a big pocket of low NTA rates that covers most of Iowa. 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. 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. I believe that this payment method acknowledges not only the skilled rehabilitation services provided to the patient, but also the complexity of skilled nursing services rendered to the patient and appropriately incorporated in the PDPM rate calculation. (Click either image to enlarge.). We know now that every diagnosis and condition counts. 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. These conditions may warrant completion of an Interim Payment Assessment (IPA) thus increasing the NTA component score and potentially the total per diem. 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 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. 1=BY)#CT 'a7bA(XdHE ? The adjusted PT, OT, and NTA per diem rates are then added together with the unadjusted SLP and nursing component rates and the non-case-mix component, as is done under RUG-IV, to determine the full per diem rate for a given resident. With postpartum preeclampsia, patients are now not seeing a health care provider by NCC News and Content Team | Jan 24, 2023 | Specialties. 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.
