,: >i*S7O=X8ZA'ic2+(!olVz`zz_"K@I 0000190726 00000 n Custodial care does not require the assistance of a licensed staff. Involve the Interdisciplinary Team. This isnt exactly a new problem, but it didnt drive reimbursement before. 0000003793 00000 n Just 1 NTA point can have an average worth of anywhere from $18 to $55 per day. endstream endobj 1696 0 obj <>stream 437 27 0000001690 00000 n For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. PDF FINAL PDPM Triple Check Checklist For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. (Note that this map is showing ONLY the NTA rate. endstream endobj 1695 0 obj <>stream However, if a provider chooses to ignore the importance of this MDS item, it will cost them 1 NTA point which could possibly impact their Case Mix Group's CMI. ~,/-I\!/JfB. To find out if you're leaving any money on the table email MDS Consultants for a PDPM review at info@mds-consultants.com, Find the PDPM ICD-10 Mapping tool at: https://mds-consultants.com/helpful-cms-info/, PDPM step-by-step scoring guide at https://mds-consultants.com/mds-tools/, https://mds-consultants.com/helpful-cms-info/, Coding N2001 N2005: Part A Drug Regimen Review, The Struggle with Antipsychotic Reduction . You are never alone in this field and resources are available in seminars, webinars, the CMS website, MDS manual, etc. PDF PATIENT DRIVEN PAYMENT MODEL - Centers for Medicare & Medicaid Services PDF Skilled Nursing Facility PPS Final Rule for FY 2022 1694 0 obj <>stream Often overlooked, Non-Therapy Ancillaries or NTAs will be more important than ever in PDPM. Luckily, code diving is a lot of fun, right? |Pa(E8BNJA!-tUiX%:h~GJ?J.H% kZ*qyXjBy@C(zHhzQhhlL2cO`.$p6_[3R^IrHrr6#eq7**2uWytb$HyZi[F2_ GBM*.`k@/9cO9R*^fo_MOK6_xg,eM'jv}5E|SWNH0$z|.WL7y9 ;4H*h;H8H"*RW l? Copyright LW Consulting, Inc 2022. PDPM Series Part 4: Non-Therapy Ancillaries Case Mix Groups. Hover over a facility to see the name, NTA Rate, NTA case-mix index and whether the facility is urban or rural. Joint Entrance Examination (Main) | India PDPM, Secret Lists, and New Rules: The Top Skilled Nursing Stories of Remember, a diagnosis has to be active and documented by a physician or nonphysician extender to qualify as an NTA item. Verify coding, dont assume. PDPM Non-Therapy Ancillary Pay - Broad River Rehabilitation When expanded it provides a list of search options that will switch the search inputs to match the current selection. 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. I would really like to see how item I8000 changes on a resident from the 5 day to later assessments. yid T[KaEev0D/wRDQhDB['QgDTBEB)2"xt"Xn2 QN[%=> FhzdBI^8/HD 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. PDPM includes a new pay category, the non-therapy ancillary or NTA. The FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. D0AD3F24-D6BD-4273-B139-8FCA97487E6A.jpeg - @ Homework It will be imperative that the coding is accurate on the MDS for the NTA conditions. CMS identified 50 conditions and services that were related to an increased cost for skilled nursing facilities. Coding of these areas will affect the Speech Case Mix Index. Educate yourself on the. pdpm nta list horse heaven hills road conditions %%EOF Complete a blank sample electronically to save yourself time and money. With postpartum preeclampsia, patients are now not seeing a health care provider by NCC News and Content Team | Jan 24, 2023 | Specialties. - Corrected typo in minimum point value thresholds used to ify patients into groups "NA" and "NB" under the NTA component. We earn 1 NTA point for second or third degree burn coded in M1040F. 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. 6/23/22 Capturing Non-Therapy Ancillary (NTA) in PDPM - GEM Health Care PDF Non-Therapy Ancillary (NTA) Services - At a Glance - Aegis Therapies Adjustments to the PDPM rates include: 2.3% reduction in FY 2023. additional 2.3% decrease in FY 2024. Some didnt occur at all. The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. PDPM - Focus on NTA - YouTube Below is the full listing of conditions and services used for NTA classification and the associated number of points for that comorbidity. 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. We know now that every diagnosis and condition counts. Now let's discuss the I0020B Primary Diagnosis and the Claim's Principal Diagnosis. View fullsize PDF Patient Driven Payment Model - Missouri Long-Term Care Information Update The NTA looks at conditions and extensive services that are associated with significant increase in costs for a skilled nursing facility. SAMPLE Task List for the Nurse Assessment Coordinator (NAC) November 23, 2022. 18% of the Nursing adjustment factor is multiplied to the Nursing rate only patients with diagnosis of AIDS. Not all NTAs are ICD-10 codes, some are MDS items. PDPM consists of five case-mix adjusted components: Physical therapy (PT) Occupational therapy (OT) Speech-language pathology (SLP) Nursing Non-therapy ancillary (NTA) PDPM also includes a variable per diem (VPD) adjustment that adjusts the per diem rate to reflect varying costs throughout a patient's stay. The Non-Therapy Ancillary Services (NTA) component is a total score of all listed conditions and/or extensive services that apply to the resident. 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. (10 items fit). The NTA component is an important component to capture and reimburse the facility for costly medications, services, and supplies needed to care for residents. Of importance to note is the condition of HIV/AIDS under the NTA component. This NTA CMI is added to the other components to calculate the total reimbursement for the patient. Patient classification system where patients are grouped according to their care and resource needs. (Right). Lastly, lets look a little more closely at rural versus urban. mp:U@|8B *zL$#Tk\*SU%mQlTYA Rj&-N _VjWpb[5R8'i, The Primary Diagnosis in I0020B and the Principal Diagnosis should match. With supportive documentation, it can be coded in I5600. Other diagnoses will affect the Non-therapy Ancillary (NTA) component. The Centers for Medicare and Medicaid Services (CMS) introduced the Patient Driven Payment Model (PDPM) in the FY 2019 Proposed and Final Rule process in 2018. 0000006001 00000 n endstream endobj 1698 0 obj <>stream and the grouper software will pick it up from I8000. 437 0 obj <> endobj (Click either image to enlarge.). Preparedness for coding changes will be the key to a smooth transition. The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. When reviewing the CMI components driving PDPM reimbursement it's important to consider the critical role of the Non-Therapy Ancillary (NTA) score. Each component has its case mix index to determine the component rate. Skilled nursing facilities now have more than a year of experience with the Patient-Driven Payment Model (PDPM), the updated case-mix classification system used in the Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS) that includes five case-mix-adjusted payment components: physical therapy (PT), occupational therapy PDF PDPM NTA at a Glance - forvis.com PDPM includes a new pay category, the non-therapy ancillary or NTA. Highlights: Hiring both part-time 2 days/week and full-time 4-5 days/week (benefits for FT only) Hours: Monday-Friday ~7am to 4pm; no evenings, weekends, call, or holidays . <<50FFC127310FCF468ABFE4B7414A5B70>]/Prev 423154>> The Centers for Medicare & Medicaid Services (CMS) realizes that the cost impact of medications, at the time of admission, is extensive. What Dietitians Need To Know About PDPM Its important to comprehend more than just the basics of PDPM. 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. 0000002491 00000 n 0000008175 00000 n CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. 0000000836 00000 n Which codes are you most likely to actually see in the wild? Character 3: Nursing Case Mix Group (NSG CMG) Character 4: NTA Case Mix Group (NTA CMG) Character 5: Assessment Indicator HIPPS Code PT/OT CMG SLP CMG NSG CMG NTA CMG HIPPS Code A TA SA ES3 NA A B TB SB ES2 NB B C TC SC ES1 NC . This article was originally published in February 2019, and has been updated in October 2019 with several more tips. But if discharged on 10/01/19, it must be included on the claim. The most up to date guidelines are available at. PDPM: 15 Quick Tips - LinkedIn 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. Remember, the CMS list is authoritative, mine is only for your convenience. Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). 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. PDPM ICD10 Consulting Confidential 2019 A Native American-Owned business Page . 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. The Patient Driven Payment Model (PDPM) - FHCA Pulse F The higher the score, the higher the NTA rate. 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. To further understand the difference between long-term care facilities and skilled nursing/rehabilitation facilities, we will focus on the services they offer. PDPM Chart Audit Simple and Easy: Winning in PDPM Payment and Regulatory Strategies . 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. Incorporate NTA identification into the daily clinical meeting as it is ever important to identify when a change in condition or services takes place. 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. Wound Care? SNF PDPM Provider-Specific Impact File. Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing components. Yes, Im aware that if you dont look at every. 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. endstream endobj 452 0 obj <>stream MDS Item Field rows in tan represent MDS item groups identified in CMS PDPM documentation and do not have data entry fields. Predicting PDPM Reimbursement - Proactive LTC Consulting pdpm nta listhorse heaven hills road conditionshorse heaven hills road conditions Great info! Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. IV medications provided as a resident and coded in Section O would also qualify for NTA points. How to Calculate PDPM Rates: A PDPM Cheat Sheet - Experience Care: Long Comorbidities are assigned points based on the cost in care associated with the condition or service, with points ranging from 1 to 8. 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. For RUGs IV PPS, the payment is based on a per diem rate that is constant for the entire length of stay. These components for classification and payment include: Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST), Non-therapy Ancillary (NTA) as well as Nursing. 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. CMS The score determines NTA payment groups and indices. PDPM MDS Items ! (At this point, I can feel the cold stares from our MDS Experts. z@~. 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. 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. 0000005276 00000 n 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. As under the previous RUGIV model, the presence of an AIDS diagnosis continues to be identified through the . 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. 0000007482 00000 n 1=BY)#CT 'a7bA(XdHE ? Other codes can still be listed in I8000. Learn why in this video from Aegis Therapies. !on!$ Q7ER}x;:lRcP%?9w_ mm ' These nurses are also trained to complete a full All Rights Reserved By Nursingcecentral 2022 |. ordered by the patients attending physician in the facility. }|YAxz .diS\]0}3sfowMm@ The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation. } 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 Updates the ICD-10 mapping used to classify patients under the PDPM framework. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. 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 PDPM clinical categories represent groups of similar diagnosis codes, which are used as part of the resident's classification under the PT, OT, and . Ensure you have staff who are trained in ICD-10 coding. endstream endobj 447 0 obj <> endobj 448 0 obj <> endobj 449 0 obj [278 0 0 0 0 889 0 0 333 333 0 0 278 333 0 278 556 556 556 556 556 556 556 556 556 556 278 0 0 584 0 0 0 667 667 722 722 667 611 778 722 278 500 667 556 833 722 778 667 0 722 667 611 722 667 944 0 667 0 0 0 0 0 0 0 556 556 500 556 556 278 556 556 222 222 500 222 833 556 556 556 0 333 500 278 556 500 722 500 500 500] endobj 450 0 obj <>stream 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. PDF PDPM Component Variable Per-Diem and RUG-IV Rate Reference Tables Try it out!). Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. 0000277284 00000 n Non-Therapy Ancillaries: What are you missing? | MDS Consultants The non-therapy ancillary (NTA) classification of PDPM reinforces why ICD-10 coding plays a key role under PDPM. 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 CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. Any delay in getting this information is going to be problematic. oYyTQb`y{y;..nI^vY5[3?O%5;5E8_kT}m}02|E}}q4:>9=6 /W=.8,w,8m_?Y\Y\v &0,/}["JO=>?]"y;?P'WY4[;of}7gh.RF)# `,J Z5FXMM:&Dh,A*hJtiL."%oKt [|Qc\0aXjK@ EdO4&_? Admittedly, thats a lot to look through. 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. PDF Non-Therapy Ancillary Services Conditions/Extensive Services - SimpleLTC A Knowledgeable and Compassionate partner. 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 FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. One can see from the table above that if comorbidities are missed, the facility could possibly miss out on reimbursement. The Ultimate Guide to PDPM - Seagrove Rehab Partners These conditions, along with the number of points associated with the condition and how it is reported, can be found by downloading the CMS document titled Fact Sheet: NTA Comorbidity Score. 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. 0000001085 00000 n 0000004542 00000 n 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. Documentation by the physician and nursing must also support the skilled nature of the codes that are recorded as NTA conditions. The PDPM diagnosis list determines the reimbursements for a Medicare Part A stay. A SANE nurse is an RN who has been trained to examine and assess clients who have a reported a sexual assault. Facilities must ensure efficient processes are in place when selecting the primary diagnosis. Section I has a lot of items that can effect NTA pay. Whats in it for me? HVmo0)>bbJS:i>h4B6u~>!bB8lr lk4-M~V CIExej[_@{wpuCm/8yU\mqpC1!Ll%5##P:a,Orh[a%zDUd V#~RLXP9BZ,/Y798(|&a"#.G. PDF PATIENT-DRIVEN PAYMENT MODEL: FREQUENTLY ASKED QUESTIONS (FAQs) 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. The administration of IV fluids may qualify for the Parenteral/IV Feeding - High or Parenteral/IV Feeding - low NTA points. AVONA confirms that rural facilities do indeed have lower NTA case-mix. 0000003037 00000 n 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. 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. For example, an NTA comorbidity score of 11 equals a CMI of 2.53. If you have an idea lets discuss! 26 11.4 Will section I0020B override section I0020, 1-13 for the primary reason for SNF admission since It's easy to get to those 50, but the tricky part is understanding which ICD-10 codes match to the comorbidities. border: 1px solid black; 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. Previous articles in this series outlined the physical and occupational therapy component and the speech language pathology component. Section I of MDS 3.0 is reserved for Active Diagnoses and Item I8000 is you to enter up to 10 additional active diagnoses with corresponding ICD-10 codes. PDPM, Non-Therapy Ancillaries & MDS Section I Ive done that for urban and rural for every state. In 2019, CMS has further revised and finalized the version of PDPM that will go into effect October 1, 2019. PDF Welcome to Gravity healthcare Consulting & Online Education An NTA comorbidity score of 12 = a CMI of 3.24. No paper. (This isnt going to work well on mobile devices, FYI.). 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 Also, there is a 25% combined limit on concurrent and/or group therapy. 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 Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. b!+XQ{ +LgOIYe/Q6RVpYY_N/.~iMu1fY*eR}W_E[,7vrR!XSF};qZW&e"S5!CW}3GU|muc?_X`dcg7(zRU8k? The general method for calculation of any NTA category is as follows: The Fiscal Year (FY) 2021 PDPM ICD-10-CM Mappings file includes the NTA Comorbidity to ICD-10-CM Mapping, which maps comorbidities in the NTA component captured in item I8000 to allowable ICD-10 codes. There are a lot of items from section I8000. There are a total of five rates that make up your pay under PDPM.)