We earn 1 NTA point for second or third degree burn coded in M1040F. a" I54043lquizzes/446951 (Question 2 5 / 5 pts The <<50FFC127310FCF468ABFE4B7414A5B70>]/Prev 423154>> ^(:eOCQ'SM7(Rmnvr/+eO.)hicZjz.,vO&u. 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. This has been a key consideration in designing the various elements of the new model. 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 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. Understanding the Value of the MDS Nurse Under PDPM, Psoriatic Arthropathy & Systemic Sclerosis, Myelodysplastic Syndromes and Myelofibrosis. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. His claim's principal diagnosis is Parkinson's Disease. by Proactive LTC Consulting | Jan 6, 2020 | Audits, Compliance, Education, MDS, Medical Review, PDPM. For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. NF is the lowest grouper with a score of 0, while NA is highest with a score of 12+. The score determines NTA payment groups and indices. 0000009611 00000 n There are a total of five rates that make up your pay under PDPM.) 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). Wound Care? INTRODUCTION. Explain the impact of the variable per diem rate in the NTA component and how it impacts PDPM payment. 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. HUMk@(h; ! #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. It more accurately accounts for expenses and isn't overshadowed by therapy. The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation. The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. The MDS nurse should be alert to these changes to ensure timely completion of the required MDS assessment. When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. Think about this A resident with a Stage IV pressure ulcer has physician orders and Registered Dietician recommendations for a protein supplement. Everyone Ive talked to agrees the NTA payment is a good idea. CMS MDS 3.0 RAI Manual. His I0020B Primary Diagnosis and his claim's Principal Diagnosis is now the aftercare of the hip fracture. Whats in it for me? 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. 0000002742 00000 n You are never alone in this field and resources are available in seminars, webinars, the CMS website, MDS manual, etc. At first, it took me longer to get used to making calculations in determining the highest allowable rate for the patient. You can read more about this in the Official ICD10 Guidelines for Coding and Reporting FY2020, Section II, Subsection K. For example: The definition of Group Therapy has changed. Note that for the first 3 days of the stay you get 3 times the rate shown on the map. Speaking of individual facilities, lets take a look at that as well. 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. Other specific items will be recorded in various parts of the MDS including Section K, M, N, and O. With postpartum preeclampsia, patients are now not seeing a health care provider by NCC News and Content Team | Jan 24, 2023 | Specialties. Specialties Hyperemesis Gravidarum: More Than Just Morning Sickness Pregnancy and nausea are terms used in unison with one another. 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. See the table below. How often will the items on this list be available to you when you are doing the 5 day assessment? 0000001085 00000 n Therefore, the code in I0020B must be directly related to the I0020 Primary Medical Condition. As mentioned earlier, these NTA comorbidities are reported (coded) throughout the MDS. Yes, I get that is bad. What if we could limit those codes down to just those ICD-10 codes that are likely to occur. Just 1 NTA point can have an average worth of anywhere from $18 to $55 per day. 437 27 Ive done that for urban and rural for every state. 1694 0 obj <>stream You can filter by NTA rate. As outlined in the SNF PDPM technical report, CMS was looking for the new reimbursement plan to account accurately and appropriately for the increased costs associated with caring for patients with AIDS. Do not be apprehensive to query the physician if a diagnosis is not clear or is suspected and not documented. The table below shows how the sum of the NTA points converts to an NTA Case Mix Group and a corresponding NTA CMI. Refer to the PDPM Calculation Worksheet for more information. 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. Some sources even noting companies are finding losses of $500 to just over $1500 due to missed diagnoses, of both malnutrition and obesity, throughout total admissions spans of residents 2. (Ui7A7dR;5|jDM\sEamJFK3O.C[=vBD:]'N+T_ rhc_ex>mHR&o6Bfr*W0zG3KWmxK6P46n=Jt0Pn'OGC~&S};& Dt];vwj+E0R"^T 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. Under the PDPM structure, there are no rules regarding when nursing home staff can perform an IPA, McCarthy noted, and even slight changes to a resident's care plan could result in additional NTA points that could bring in extra per-day reimbursement dollars. last. 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). Yes, I am aware that ICD-10 codes do change occasionally. Zi@Ym"l?]L?*;YaRxwFhSGkhSFRQJIp.V4v!fbN91GE]Y:+s Specialties What Is a SANE Nurse? 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 resulting sum is the NTA comorbidity score, which is used to classify each resident into an NTA case-mix group. PDPM Chart Audit Simple and Easy: Winning in PDPM Payment and Regulatory Strategies . (Click either image to enlarge.). 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). 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. 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. There are a lot of items from section I8000. 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. Points are added together for all conditions. If the resident went from the hospital directly to a LTCH first, then to your SNF, you can code the surgery because an LTCH is a post-acute long term care hospital, not an acute care hospital. SLP: NSG: NTA: This audit format form contains the MDS 3.0 items that drive payment for the Part A Medicare PDPM SNF-PPS payment. 0000005276 00000 n Good talk. No paper. Variable Per Diem Adjustment Factors and ScheduleNTA. Involve the Interdisciplinary Team. trailer 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. These residents may have a significant number of inaccurate or resolved diagnoses if a facility doesnt have a process for ongoing diagnosis reconciliation. %PDF-1.4 % In this article, we discuss the non-therapy ancillary (NTA) component. The higher the score, the higher the NTA rate. The new nurse assessment coordinator (NAC) may be overwhelmed with the numerous tasks required of the position. The PDPM program has six payment components. 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. Other SLP co-morbidities picked up from the grouper software include the checkboxes for I4300 (aphasia), I4500 (stroke/CVA/TIA), I4900 (hemiplegia/hemiparesis), I5500 (traumatic brain injury), O0100E2 (tracheostomy while a resident), and O0100F2 (ventilator/respirator while a resident). Learn more about Jessica, Eleisha, and the rest of the Proactive team. The more comorbidities a patient has, the more medications he or she probably requires. Whats in it for me? When reviewing the CMI components driving PDPM reimbursement its important to consider the critical role of the Non-Therapy Ancillary (NTA) score. background-color: #2c4a88; The NTA looks at conditions and extensive services that are associated with significant increase in costs for a skilled nursing facility. Far more items than would actually fit on the MDS 3.0 Instrument. The Patient-Driven Payment Model focuses on the patients unique characteristics and needs based on diagnosis which arise during inpatient hospital stay. 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. The PDPM Clinical Categories are discussed below. The saying, haste makes waste applies in the completion of MDS assessments and calculation of the maximized PDPM rate 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. IV medications provided as a resident and coded in Section O would also qualify for NTA points. Consider adding the list of NTAs to current pre-admission screening forms or otherwise creating a way to identify and communicate potential conditions and services that may continue during the SNF stay. Reimbursement for these services is covered under the. The categories impact a resident's case-mix classification. Everyone I've talked to agrees the NTA payment is a good idea. 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). by NCC News and Content Team | Mar 1, 2023 | Hospitals, Specialties. It's easy to get to those 50, but the tricky part is understanding which ICD-10 codes match to the comorbidities. 0000000836 00000 n (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. 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. 463 0 obj <>stream Updates the ICD-10 mapping used to classify patients under the PDPM framework. Under PDPM, there are six payment components. Group therapy now allows for as few as 2 residents and as many as 6 residents. But if the resident is transferred back to the hospital and is admitted as an inpatient, let's say for pneumonia, then returns to the SNF after the 3-day interrupted stay window, a new 5-Day will be required and the surgery will not be able to be coded in J2100, because the surgery did not occur "during the inpatient hospital stay that immediately preceded the residents Part A admission". Some didnt occur at all. MDS Item Field rows in tan represent MDS item groups identified in CMS PDPM documentation and do not have data entry fields. - Corrected typo in minimum point value thresholds used to ify patients into groups "NA" and "NB" under the NTA component. If your facility has a low NTA rate, it may just mean you have work to do, documentation-wise. The administration of IV fluids may qualify for the Parenteral/IV Feeding - High or Parenteral/IV Feeding - low NTA points. If the Primary Diagnosis you listed in I0020B also happens to be a SLP Comorbidity qualifier from the SLP Comorbidity list, the grouper software will pick it up as a comorbidity from I8000. I0020 is also a gateway to the I0020B Primary Diagnosis code. But toward the end of January, reporter Maggie Flynn poked holes in the idea that ICD-10 mastery was a necessity. As under the previous RUGIV model, the presence of an AIDS diagnosis continues to be identified through the . 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. This isnt exactly a new problem, but it didnt drive reimbursement before. Fax: (812) 471-7802 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. For RUGs IV PPS, the payment is based on a per diem rate that is constant for the entire length of stay. 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.
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