A good first resource is the PDPM NTA Comorbidity Mapping spreadsheet. 437 0 obj <> endobj The visualization is interactive. Adjustments to the PDPM rates include: 2.3% reduction in FY 2023. additional 2.3% decrease in FY 2024. 18% of the Nursing adjustment factor is multiplied to the Nursing rate only patients with diagnosis of AIDS. hbspt.cta._relativeUrls=true;hbspt.cta.load(2297384, '30c35813-92d3-4fa1-bc3f-6b232de017b1', {"useNewLoader":"true","region":"na1"}); Topics: Other codes can still be listed in I8000. CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. 2 &r}p")|@ O&]LpLk| Mvl(Pv[C0AMfxYp&NymfJXdO@QhCec*2-K8P3Tjp6'+Q :~_%`n/[w}_,0-|:%?h6'#%?7?\o(@Ln 9w9Fhe`P8B09@(@DT\QG+ (CQ {dX r4`H*B4,&0hl3()%zI[)jCN8{SNa%PED~ eT T(m:l] 43FH&"@`BN`Kk(f We earn. The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. To assist stakeholders in understanding the potential impacts of the proposed PDPM, we are providing a provider-specific impact analysis file, which details the estimated . The idea is that the facility should be paid for the care they are delivering, based on the patients characteristics. h4Pj0^z[ 8 >BRA$+Vfa Find toolkits, webinars, on-demand trainings, templates, and much more to meet the needs of your facility. The NTA looks at conditions and extensive services that are associated with significant increase in costs for a skilled nursing facility. 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. The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. In 2019, CMS has further revised and finalized the version of PDPM that will go into effect October 1, 2019. These groups and indices, combined with other components of the payment system, provide a total reimbursement process that Observation services are not covered as part of the inpatient stay. You are never alone in this field and resources are available in seminars, webinars, the CMS website, MDS manual, etc. For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. 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. Patient has at least three qualifying inpatient days in an acute hospital. 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. 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. Everyone I've talked to agrees the NTA payment is a good idea. Diligent review of the medical history and clinical record is essential. They are assisted by certified nursing assistants (CNAs) and licensed staff assist them during medication administration ordered by the patients attending physician in the facility. Patients rely on you. These conditions may warrant completion of an Interim Payment Assessment (IPA) thus increasing the NTA component score and potentially the total per diem. 437 27 }|YAxz .diS\]0}3sfowMm@ If the 25% is exceeded, a non-fatal warning will appear on the final validation report during the MDS submission process. PDPM Series Part 4: Non-Therapy Ancillaries Case Mix Groups. a" I54043lquizzes/446951 (Question 2 5 / 5 pts The Section I has a lot of items that can effect NTA pay. 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. Yes, I am aware that ICD-10 codes do change occasionally. Admittedly, thats a lot to look through. xref 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. 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. 2207 Morgan Ave, Suite D Welcome to Gravity healthcare Consulting & Online Education 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. 0000002038 00000 n Focuses on clinically relevant factors rather than volume-based services or RUG levels. Remember that after the 3 day interrupted stay he is considered a new admission for purposes of Part A PDPM. I wish I could be in your training the 29th. Points (1-8) are assigned to specific conditions. With several big changes ahead, the margin for error slim for most providers. The map below shows every SNF in the US that accepted Medicare Part A patients in 2017. Rehab and Nursing staff should complete the Section GG on the MDS form for indicated ADL tasks on Day 1-3 of admission with the admission date as Day 1. 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. The Patient-Driven Payment Model focuses on the patients unique characteristics and needs based on diagnosis which arise during inpatient hospital stay. With this component being paid at a 3x rate for 1st 3 days of . ~,/-I\!/JfB. Previous articles in this series outlined the physical and occupational therapy component and the speech language pathology component. The general method for calculation of any NTA category is as follows: HUMk@(h; ! This isnt exactly a new problem, but it didnt drive reimbursement before. What do I need to know? 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. His I0020B Primary Diagnosis and his claim's Principal Diagnosis is now the aftercare of the hip fracture. We know now that every diagnosis and condition counts. 3HFDRkse$:stHqPJoHK-qL_sh|Kg?unioWAsfH8[^9{'~-? There must be a reason for it, right? There are a total of five rates that make up your pay under PDPM.) 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. SNF PDPM Provider-Specific Impact File. Skilled nursing services are covered under the Federal Governments. And lastly, an update on therapy revenue codes and the claim CMS Transmittal 2270 from March 13, 2019 states that beginning October 1, 2019, the Medicare contractor will no longer require therapy services to be present on SNF or Swing Bed claims. 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. 66y% 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). 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. ;DktP'pm}iE/4K~bY?c~220E+t;sdvGHz P, 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 PDPM classification system is based on support of the patients characteristics. SNF FY 2022 Proposed Rule Learn the Facts Behind the Headlines Part 3: How is My Rate Calculated, Regulatory Reminder! Preparedness for coding changes will be the key to a smooth transition. These maps look significantly different from a lot of the others weve seen. Under PDPM, long-term care facilities will receive reimbursement based on services that each resident receives. Hoo0#=)HU64*)T%DH!$swwb4fc|i]\/8gr? Of importance to note is the condition of HIV/AIDS under the NTA component. 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. The higher the total point value, the greater the payment (CMI). This button displays the currently selected search type. %%EOF How can a facility ensure that they are not leaving money on the table due to under-coded NTAs? b!+XQ{ +LgOIYe/Q6RVpYY_N/.~iMu1fY*eR}W_E[,7vrR!XSF};qZW&e"S5!CW}3GU|muc?_X`dcg7(zRU8k? border: 1px solid black; The FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. Just 1 NTA point can have an average worth of anywhere from $18 to $55 per day. (This isnt going to work well on mobile devices, FYI.). 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. Given that CMS has released the distribution of case-mix groups for NTA for all skilled nursing facilities, we can calculate an average case-mix index for everyone. The MDS nurse should be alert to these changes to ensure timely completion of the required MDS assessment. HVmo0)>bbJS:i>h4B6u~>!bB8lr lk4-M~V CIExej[_@{wpuCm/8yU\mqpC1!Ll%5##P:a,Orh[a%zDUd V#~RLXP9BZ,/Y798(|&a"#.G. Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing components. 0000001405 00000 n One can see from the table above that if comorbidities are missed, the facility could possibly miss out on reimbursement. endstream endobj 452 0 obj <>stream We earn 1 NTA point for second or third degree burn coded in M1040F. You can filter by NTA rate. Refer to the PDPM Calculation Worksheet for more information. 0 The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation. CMS identified 50 conditions and services that were related to an increased cost for skilled nursing facilities. endstream endobj 1697 0 obj <>stream You can also zoom in to see detail. 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. Always be on the lookout for new updates which usually happen every year and usually effective by October 1 of each updated year. Under PDPM, 50 conditions and extensive services are considered for NTA classification. Ensure you have staff who are trained in ICD-10 coding. They likely need the extra protein because either they have protein malnutrition (can be verified by lab results) or they are "at risk" for protein malnutrition. $HJ0!$j-g#W d9bEi0~og$.J8-Lb =lZ.SSz|'!`%/ Facilities that work to establish these best practices associated with the NTA component will increase revenue and see other benefits such as improved Quality Measures, reduced readmission rates, and improve skilled documentation. 0000003961 00000 n CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. It will be imperative that the coding is accurate on the MDS for the NTA conditions. At the direction of the attending physician, a patient needs skilled care from and/or under the supervision of a skilled nursing or therapy staff daily. First, it corrects an issue where diagnosis codes were mapped to NTA comorbidities as 1 to 1 mappings where 1 to 2 mappings were intended from the PDPM_ICD10_Mappings_FY20XX Excel sheet. Identification of NTA conditions and services should start even before the SNF admission. 0000004207 00000 n It especially packs a heavy punch when considering that the NTA per diem rate is tripled for the first three days of the stay. NF is the lowest grouper with a score of 0, while NA is highest with a score of 12+. Often overlooked, Non-Therapy Ancillaries or NTAs will be more important than ever in PDPM. Whats in it for me? Which codes are the most important? Yes, I get that is bad. This does not include conditions that are resolved. Was there a need for an IV? !on!$ Q7ER}x;:lRcP%?9w_ mm ' such has bed mobility, transfers in and out of bed, walking in the room, walking in the corridor, locomotion on unit peripheral to the patients room, locomotion off unit which involves areas farther from the patients room such as dining areas, rehabilitation rooms, activity rooms and other administrative offices, toileting, eating, personal hygiene and bathing. 0000003037 00000 n startxref 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. To further understand the difference between long-term care facilities and skilled nursing/rehabilitation facilities, we will focus on the services they offer. and the grouper software will pick it up from I8000. 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). Click here to visit our shop. The Patient-Driven Payment Model (PDPM), is fast approaching with implementation set for October 2019. 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. &)` R #V? U? 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. 0000007482 00000 n This NTA CMI is added to the other components to calculate the total reimbursement for the patient. 1694 0 obj <>stream 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. All disciplines should complete all their assessments ON TIME to CAPTURE all skilled services and accurately calculate residents daily rate PRIOR TO completion and transmission of the MDS 5-day assessment. Do whatever you want with a SKILLED: fill, sign, print and send online instantly. Inappropriate Schizophrenia Diagnosis/Coding and Survey Citation Posting, Regulatory Reminders: Consolidated Billing Update 2023. Coding of these areas will affect the Speech Case Mix Index. Condition/Extensive Service Source Points Aseptic Necrosis of Bone MDS Item I8000 1 Asthma COPD Chronic Lung Disease MDS Item I6200 2 The list includes diagnosis codes, which will be recorded in the I8000 section of the MDS. ANOVA Rural versus Urban NTA case-mix (click to enlarge). 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. 0000189184 00000 n The PDPM program has six payment components. It more accurately accounts for expenses and isnt overshadowed by therapy. Notice there is a big pocket of low NTA rates that covers most of Iowa. The higher the score, the higher the NTA rate. The score determines NTA payment groups and indices. The saying, haste makes waste applies in the completion of MDS assessments and calculation of the maximized PDPM rate for the patient. 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. Additionally, PDPM applies variable per diem payment adjustments to three components, PT, OT, and NTA, to account for changes in resource use over a stay. Custodial care does not require the assistance of a licensed staff. A list of these specific retinopathy codes are in the SLP mapping file from CMS. 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. hl 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. The PDPM diagnosis list determines the reimbursements for a Medicare Part A stay. 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. 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 NTA component receives 300% of the base per-diem rate for days 1-3 of a stay. Sometimes the code may be a qualifier for other PDPM components, sometimes it won't be. For RUGs IV PPS, the payment is based on a per diem rate that is constant for the entire length of stay. For the NTA, an adjustment factor of 3.0 is applied to the total NTA CMI for days 1-3. ^(:eOCQ'SM7(Rmnvr/+eO.)hicZjz.,vO&u. Everyone Ive talked to agrees the NTA payment is a good idea. endstream endobj 1696 0 obj <>stream 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. A long-term care facility provides custodial care requiring supervised, minimal or total dependence in the performance of the activities of daily living (ADLs) such has bed mobility, transfers in and out of bed, walking in the room, walking in the corridor, locomotion on unit peripheral to the patients room, locomotion off unit which involves areas farther from the patients room such as dining areas, rehabilitation rooms, activity rooms and other administrative offices, toileting, eating, personal hygiene and bathing. The functional scoring is based on residents performance in. Points are scored if the condition or service is present. AVONA confirms that rural facilities do indeed have lower NTA case-mix. With PDPM payment method, the determinants of payment are categorized into the following case-mix adjusted components: The PDPM rate is adjusted over the course of facility stay by the inclusion of a variable per diem (VPD) adjustment on the following three components: PT, OT and NTA. 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. 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 The table below shows how the sum of the NTA points converts to an NTA Case Mix Group and a corresponding NTA CMI. 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. RUG Classification Groups based on the volume and intensity of therapy provided to patient: Determinants of Payment for PDPM are summarized below. ;iHIBK = >N]Y}dZ}HvtZ04D8YV4r4Od^/NJ x/i"9WirMdy2d*{E^lEu}Jg t@C`[aNOGgg0?bd'r EVm@Av;*%f?Wp :1&[+cZhqhU;IKBU Based on that, I have made you an extreme cheat sheet, that you should use with extreme caution. Intermittent Catheterization? The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation to ensure 100% accuracy. Under PDPM, there are six payment components. No software installation. hb```b``ia`e`ff@ a(meU=r%::@`uH@V01:000x1p`5`gy4AuG/Dg* ZF:&'[-@ >` t!R 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. For example, IV medications (5 points) coded in MDS item O0100H2 or isolation (1 point) coded in O0100M2.