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. 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. Not having the correct codes can have a domino effect and result in missed reimbursement, or claim inaccuracies. Yes, I am aware that ICD-10 codes do change occasionally. 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. AVONA confirms that rural facilities do indeed have lower NTA case-mix. 437 27 Sometimes the code may be a qualifier for other PDPM components, sometimes it won't be. Five of the six are case-mix adjusted. 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). Refer to RAI pages J37-J38 for more on coding J2100. This list of options is not used for PDPM payment, but is used as risk adjustments for some of the QRP Quality Measures. These components for classification and payment include: Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST), Non-therapy Ancillary (NTA) as well as Nursing. 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. But if discharged on 10/01/19, it must be included on the claim. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. 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 saying, haste makes waste applies in the completion of MDS assessments and calculation of the maximized PDPM rate for the patient. ! PDPM includes a new pay category, the non-therapy ancillary or NTA. A Knowledgeable and Compassionate partner. The Patient-Driven Payment Model (PDPM), is fast approaching with implementation set for October 2019. The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. The more comorbidities a patient has, the more medications he or she probably requires. (Click either image to enlarge.). Our wound certified educators train, educate, and guide our providers and client facilities on the most efficacious wound care treatments and follow up. Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing components. NF is the lowest grouper with a score of 0, while NA is highest with a score of 12+. SNF PDPM Provider-Specific Impact File. Re-calculate expected daily rate based on the completed Rehab and Nursing Functional Scores and re-review principal diagnosis. You should understand those things too, reader.). Below is a summary of the determinants of payment and which section on the MDS assessment form they are derived from. Everyone I've talked to agrees the NTA payment is a good idea. This item includes diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. All Rights Reserved. In this fourth webinar of our six part series, learn which items on the MDS or Medicare claim will be used to determine the NTA score and its impact on payment. A year later, he falls and sustains a hip fracture. Remember that on the therapy plan of care the Treatment Diagnoses should be directly linked the Medical Diagnoses. On any device & OS. 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. How often will the items on this list be available to you when you are doing the 5 day assessment? We earn 2 NTA points if Diabetes is coded in MDS item I2900. Understanding the Value of the MDS Nurse Under PDPM, Psoriatic Arthropathy & Systemic Sclerosis, Myelodysplastic Syndromes and Myelofibrosis. 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. Its important to comprehend more than just the basics of PDPM. 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. PDPM Series Part 4: Non-Therapy Ancillaries Case Mix Groups. Now let's discuss the I0020B Primary Diagnosis and the Claim's Principal Diagnosis. We earn 1 NTA point when Other Skin Problems (foot ulcers/lesions) is coded in MDS item M1040A (infection of the foot such as cellulitis or purulent drainage), M1040B (diabetic foot ulcer), or M1040C (other open lesion of foot). 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. (Nursing, Social Services, Dietary and Activity Staff). 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. PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. endstream endobj 451 0 obj <>stream PDPM ICD10 Consulting Confidential 2019 A Native American-Owned business Page . Custodial care does not require the assistance of a licensed staff. Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. Daily Medicare charting should focus on all possible nursing clinical categories, special care high, special care low, clinically complex, behavioral symptoms and cognitive performance, and reduced physical function. The southwest of the US, Michigan, Ohio and West Virginia would have the highest NTA rates. The Patient-Driven Payment Model focuses on the patients unique characteristics and needs based on diagnosis which arise during inpatient hospital stay. The Centers for Medicare & Medicaid Services (CMS) realizes that the cost impact of medications, at the time of admission, is extensive. Anyone involved with ICD-10 coding should have ready access to the coding guidelines. [|Qc\0aXjK@ EdO4&_? We earn 1 NTA point if we code Protein or Calorie Malnutrition/At Risk for Protein or Calorie Malnutrition in MDS item I5600. Learn more about Jessica, Eleisha, and the rest of the Proactive team. 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 . Lastly, lets look a little more closely at rural versus urban. With several big changes ahead, the margin for error slim for most providers. Also, there is a 25% combined limit on concurrent and/or group therapy. a" I54043lquizzes/446951 (Question 2 5 / 5 pts The by Proactive LTC Consulting | Jan 6, 2020 | Audits, Compliance, Education, MDS, Medical Review, PDPM. Patient classification system where patients are grouped according to their care and resource needs. Other codes can still be listed in I8000. 0000000836 00000 n It may also include a condition that started while the patient was getting care in the SNF for a hospital-related medical condition such as antibiotic medications via intravenous (IV) route to treat infections even if it was not the reason the patient was admitted to the acute hospital. To ease some of this burden, AAPACN developed the Sample Task List for the Nurse Assessment Coordinator tool . These clinical categories are PT, OT, and SLP. border: 1px solid black; yid T[KaEev0D/wRDQhDB['QgDTBEB)2"xt"Xn2 QN[%=> FhzdBI^8/HD Classifications from the RUG-IV assign patients to payment classification groups, called RUGs, within the payment components: Rehabilitation Plus Extensive Services, Rehabilitation, Extensive Services, Special Care High, Special Care Low, Clinically Complex, Behavioral Symptoms and Cognitive Performance Problems and Reduced Physical Function. Start (and continue) the conversation. IV medications provided as a resident and coded in Section O would also qualify for NTA points. Hover over a facility to see the name, NTA Rate, NTA case-mix index and whether the facility is urban or rural. There are a total of five rates that make up your pay under PDPM.) 0000002491 00000 n 66y% 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. Evansville, IN 47711, Phone: (812) 471-7777 Wound Care? CMS stated in the final rule for FY 2023 that they intend to take a more cautious approach to mitigate the potential negative impacts on the nursing home industry with this parity adjustment by spreading it across a two-year period. 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). (difference of NE-NF and NA-NB). The higher the score, the higher the NTA rate. 437 0 obj <> endobj This does not include conditions that are resolved. When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. last. All PDPM components are assigned an appropriate score to multiply to the federally assigned case mix index group. This is especially important for those residents who are long-term and later qualify for skilled care. With this component being paid at a 3x rate for 1st 3 days of . (difference of NE-NF and NA-NB). The required MDS data would be entered in the sub-items listed below the item group identifier. 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). Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). Educate yourself on the. Of importance to note is the condition of HIV/AIDS under the NTA component. ordered by the patients attending physician in the facility. Le^#N"TaAKTt 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. In the past, we only checked this box even if the resident was a diabetic and also had retinopathy. 0000006770 00000 n HUMk@(h; ! The general method for calculation of any NTA category is as follows: 0000278826 00000 n It is highly recommended for the MDS nurse to make calculations which can determine the highest acceptable reimbursement rate for the facility.
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