table, th, td { Yes, Im aware that if you dont look at every. Perhaps the most "transformative" component relates to Non-Therapy Ancillary (NTA) Services. 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. 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. View D0AD3F24-D6BD-4273-B139-8FCA97487E6A.jpeg from NURSING MISC at St. Clair County Community College. Evansville, IN 47711, Phone: (812) 471-7777 This does not include conditions that are resolved. Always be on the lookout for new updates which usually happen every year and usually effective by October 1 of each updated year. thead { (difference of NE-NF and NA-NB). We earn. Points are scored if the condition or service is present. Previous articles in this series outlined the physical and occupational therapy component and the speech language pathology component. hWmo6+( 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 In the past, we only checked this box even if the resident was a diabetic and also had retinopathy. SNF FY 2022 Proposed Rule Learn the Facts Behind the Headlines Part 3: How is My Rate Calculated, Regulatory Reminder! 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. 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 . 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. Each patient has a different reimbursement rate as compared to the RUG-IV PPS rate in the past. Great info! 8cq1o22#|Bm1il,4iw&C|E^F+oq:>_|M\v+iTOigWJ:dCa$Qv_n/q|wCuukk+e';iJB2C &!Ar8c _~r Suctioning? With supportive documentation, it can be coded in I5600. Admitted in the Skilled nursing facility (SNF) within a short time (generally 30 days) of leaving the hospital and require skilled services related to hospital stay. At the start of 2019, 63% of respondents to SNN's annual outlook survey identified a greater emphasis on coding as a a key PDPM strategy. Reimbursement, LW Consulting, Inc.5925 Stevenson Avenue, Suite GHarrisburg, PA 17112, Ph:800-320-5401Local Ph: 717-233-6100Fx:717-233-4633. With postpartum preeclampsia, patients are now not seeing a health care provider by NCC News and Content Team | Jan 24, 2023 | Specialties. It is important that the completion of an IPA does not reset the VPD. His I0020B Primary Diagnosis and his claim's Principal Diagnosis is now the aftercare of the hip fracture. Speaking of individual facilities, lets take a look at that as well. At first, it took me longer to get used to making calculations in determining the highest allowable rate for the patient. 0000006001 00000 n Other specific items will be recorded in various parts of the MDS including Section K, M, N, and O. As under the previous RUGIV model, the presence of an AIDS diagnosis continues to be identified through the . The score determines NTA payment groups and indices. 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 choice of PDPM diagnosis has become rocket science for MDS nurses as this gives more weight in the calculation of the PDPM rate for the facility. 0000002742 00000 n For example, if a resident admits and the dietitian notes the BMI is over 40, query the physician to confirm a morbid obesity diagnosis. More than half of them come from I8000 and many of these have multiple qualifying ICD-10 diagnosis codes. by Proactive LTC Consulting | Jan 6, 2020 | Audits, Compliance, Education, MDS, Medical Review, PDPM. The PDPM program has six payment components. With several big changes ahead, the margin for error slim for most providers. Not having the correct codes can have a domino effect and result in missed reimbursement, or claim inaccuracies. Also, there is a 25% combined limit on concurrent and/or group therapy. The FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. (10 items fit). .center {text-align: center;}, Foot Code, Except Diabetic Foot Ulcer Code, Once we have totaled the score from the table above, we use it to map to a case-mix group and case-mix index. The administration of IV fluids may qualify for the Parenteral/IV Feeding - High or Parenteral/IV Feeding - low NTA points. 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. HUMk@(h; ! Now let's discuss the I0020B Primary Diagnosis and the Claim's Principal Diagnosis. Remember, a diagnosis has to be active and documented by a physician or nonphysician extender to qualify as an NTA item. %%EOF Specialties Hyperemesis Gravidarum: More Than Just Morning Sickness Pregnancy and nausea are terms used in unison with one another. Think about this A resident with a Stage IV pressure ulcer has physician orders and Registered Dietician recommendations for a protein supplement. you could miss something. PATIENT DRIVEN PAYMENT MODEL |4 . To ease some of this burden, AAPACN developed the Sample Task List for the Nurse Assessment Coordinator tool . mp:U@|8B *zL$#Tk\*SU%mQlTYA Rj&-N _VjWpb[5R8'i, Lastly, lets look a little more closely at rural versus urban. 18% of the Nursing adjustment factor is multiplied to the Nursing rate only patients with diagnosis of AIDS. If your facility has a low NTA rate, it may just mean you have work to do, documentation-wise. 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. 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. Click here to visit our shop. Custodial care does not require the assistance of a licensed staff. CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. Click the comorbidity and see the ICD-10 codes that are most likely to occur. (This isnt going to work well on mobile devices, FYI.). 0000002038 00000 n Copyright LW Consulting, Inc 2022. PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. 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. Often overlooked, Non-Therapy Ancillaries or NTAs will be more important than ever in 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. Learn More Resource PDPM Series Part 5: Assessment Requirements. 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. There are a total of five rates that make up your pay under PDPM.) 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 correct coding for NTA will require a team effort and diligent review of coding and supporting documentation to ensure 100% accuracy. Intermittent Catheterization? 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. We earn 2 NTA points if Diabetes is coded in MDS item I2900. 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. 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. 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 (Note that this map is showing ONLY the NTA rate. Seek advice from experts, trainers and other MDS nurses when needed to clarify any areas in the MDS assessment or PDPM calculation. 463 0 obj <>stream What do I need to know? These groups and indices, combined with other components of the payment system, provide a total reimbursement process that Q: Our EMR system will calculate the BMI. Love what you read? In the absence of specific documentation, you may use positive tests, procedures, hospitalization for symptoms). startxref (2019). Points are added together for all conditions. But, since its new, were going to have to work on understanding how its supposed to work, and how we can most easily and efficiently complete the assessment with accurate information. [|Qc\0aXjK@ EdO4&_? 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). Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. As mentioned earlier, these NTA comorbidities are reported (coded) throughout the MDS. There must be a reason for it, right? 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. @.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; If you have an idea lets discuss! The individual NTA conditions have points ranging from 1 to 8. The NTA comorbidity score is a weighted count of certain comorbidities that a SNF patient has, which is then used to classify the patient into an NTA component payment group. 1=BY)#CT 'a7bA(XdHE ? (By the way, we created a PDPM Calculator for you to experiment with and get a better understanding of how PDPM works. 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. ,: >i*S7O=X8ZA'ic2+(!olVz`zz_"K@I This article was originally published in February 2019, and has been updated in October 2019 with several more tips. (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. 0000190726 00000 n 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. As far as treating for late effects, such as weakness after an episode of pneumonia, you should obtain documentation from the physician or physician extender linking the late effects of the unsteady gait and weakness directly to the episode of pneumonia and that the pneumonia has a direct relationship to the current functional status and treatment. Involve the Interdisciplinary Team. (Right). endstream endobj 1698 0 obj <>stream Under PDPM, an adjustment is applied to certain PDPM components that varies the per diem payment over the course of the stay. With such a close relationship to payment, it is critical the staff member(s) responsible for ICD-10 coding are knowledgeable in this area. Share our insider knowledge and tips! ^(:eOCQ'SM7(Rmnvr/+eO.)hicZjz.,vO&u. Request for labs, imaging studies and surgical reports whichever is applicable. A list of these specific retinopathy codes are in the SLP mapping file from CMS. For the Non-Therapy Ancillary Component, each diagnosis has a corresponding score which is multiplied to the federal NTA case mix index. $HJ0!$j-g#W d9bEi0~og$.J8-Lb =lZ.SSz|'!`%/ Either way, you must still also code the I0020B primary condition I0010 through I8000. endstream endobj 1695 0 obj <>stream You are never alone in this field and resources are available in seminars, webinars, the CMS website, MDS manual, etc. In 2019, CMS has further revised and finalized the version of PDPM that will go into effect October 1, 2019. Dietitians are classified in the NTA discipline. ENSURE TO CAPTURE EVERYTHING PRIOR TO COMPLETION OF THE 5-DAY MDS ASSESSMENT! Under PDPM, long-term care facilities will receive reimbursement based on services that each resident receives. Under PDPM, 50 conditions and extensive services are considered for NTA classification. HU]o0}G?G< m*-$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? 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. Far more items than would actually fit on the MDS 3.0 Instrument. The PDPM Clinical Categories are discussed below. 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). 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). the design of the PDPM case-mix system implemented in FY 2020. 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. 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. Five of the six are case-mix adjusted. 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. In it, youll find the 1,612 codes that map to the different comorbidities. This list of options is not used for PDPM payment, but is used as risk adjustments for some of the QRP Quality Measures. NF is the lowest grouper with a score of 0, while NA is highest with a score of 12+. Payment is based on services provided by five disciplines: physical therapy, occupational therapy, speech language pathology, nursing, and non-therapy ancillary (NTA). The higher the score, the higher the NTA rate. 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. 0000009034 00000 n Start (and continue) the conversation. When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. We earn 1 NTA point for second or third degree burn coded in M1040F. (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. The list includes diagnosis codes, which will be recorded in the I8000 section of the MDS. Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). If a resident is admitted into a Part A stay within 30 days after major surgical procedure (as a hospital inpatient) that carried some degree of risk to life or had the potential for severe disability, then J2100 (recent surgery requiring active SNF care) is checked "yes". Educate yourself on the. 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). Comorbidities are assigned points based on the cost in care associated with the condition or service, with points ranging from 1 to 8. ANOVA Rural versus Urban NTA case-mix (click to enlarge). 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. The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. xref Reimbursement for these services is covered under the. Its important to comprehend more than just the basics of PDPM. Learn more about Jessica, Eleisha, and the rest of the Proactive team. With the transition from Resource Utilization Group Version IV (, ) to the Patient-Driven Payment Model (PDPM) on October 1, 2019, the. 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. When also coded in I8000, I69.091 will also contribute again to the case mix group because it is on the SLP comorbidity list. Remember this is using 2017 data so it assumes that providers make no adjustments which is not realistic. 3HFDRkse$:stHqPJoHK-qL_sh|Kg?unioWAsfH8[^9{'~-? Which codes are the most important? 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. 0000278826 00000 n It more accurately accounts for expenses and isn't overshadowed by therapy. SAMPLE Task List for the Nurse Assessment Coordinator (NAC) November 23, 2022. All PDPM components are assigned an appropriate score to multiply to the federally assigned case mix index group. hl Incorporate NTA identification into the daily clinical meeting as it is ever important to identify when a change in condition or services takes place. What if we could limit those codes down to just those ICD-10 codes that are likely to occur. 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. 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. The Patient-Driven Payment Model (PDPM), is fast approaching with implementation set for October 2019. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. Identification of NTA conditions and services should start even before the SNF admission. A year later, he falls and sustains a hip fracture. Also notice there are very few facilities with low NTA rates in the Appalachians. Inappropriate Schizophrenia Diagnosis/Coding and Survey Citation Posting, Regulatory Reminders: Consolidated Billing Update 2023. The PDPM classification system is based on support of the patients characteristics. Under PDPM, Section GG drives PT and OT, and nursing which affects reimbursement. The categories impact a resident's case-mix classification. (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. Zi@Ym"l?]L?*;YaRxwFhSGkhSFRQJIp.V4v!fbN91GE]Y:+s We earn 1 NTA point and qualify for Nursing Category Special Care Low for a Stage IV Pressure Ulcer when coded in M0300.