THURSDAY JUNE 23, 2022 2 PM EASTERN - 90 MINUTES, OHIO HEALTH CARE ASSOCIATION- Virtual Webinar, COST $35 FOR OHCA MEMBERS, $90 FOR NON-MEMBERS, https://webinars.ohca.org/?pg=semwebCatalog&panel=showLive&seminarid=16339, 6/23/22 Capturing Non-Therapy Ancillary (NTA) in PDPM. With such a close relationship to payment, it is critical the staff member(s) responsible for ICD-10 coding are knowledgeable in this area. The PT and OT payment would be based on: primary reason for SNF care and functional status at admission The sum of the lowest per diem rate under each PDPM component, plus the non-case-mix component is the: default code Which of the following is NOT a case-level adjustment for a MS-LTC-DRG long term stay outlier !on!$ Q7ER}x;:lRcP%?9w_
mm '
An NTA comorbidity score of 12 = a CMI of 3.24. |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$z|.WL7y9 ;4H*h;H8H"*RW l? His claim's principal diagnosis is Parkinson's Disease. With the transition from Resource Utilization Group Version IV (RUG-IV) to the Patient-Driven Payment Model (PDPM) on October 1, 2019, the MDS nurse requires an analytical mind and financial knowledge to determine the highest allowable reimbursement for the facility. It is highly advisable for MDS nurses to review each assessment to ensure that all skilled services are captured during the assessment period to maximize reimbursement rate for the facility based on the patients diagnosis and acuity. Medical records department should already code and map for the clinical category to be able to determine principal diagnosis code and calculate expected daily rate for the facility using either the manual PDPM worksheet or software-generated calculation. No software installation. This is an important financial consideration that facilities will not be able to afford to miss out on because of sloppy documentation or review of the records. For example, an NTA comorbidity score of 11 equals a CMI of 2.53. Whats in it for me? Center for Medicare and Medicaid Services. As outlined in the SNF PDPM technical report, CMS was looking for the new reimbursement plan to account accurately and appropriately for the increased costs associated with caring for patients with AIDS. Inappropriate Schizophrenia Diagnosis/Coding and Survey Citation Posting, Regulatory Reminders: Consolidated Billing Update 2023. I would really like to see how item I8000 changes on a resident from the 5 day to later assessments. Determinant for payment is based on the number of therapy minutes provided regardless of residents acuity, diagnosis and other skilled nursing services provided. The PDPM diagnosis list determines the reimbursements for a Medicare Part A stay. There is also the impact of the Variable Per Diem Adjustment Factor that is applied to the NTA Component. 3HFDRkse$:stHqPJoHK-qL_sh|Kg?unioWAsfH8[^9{'~-? The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. The PDPM program has six payment components. To further understand the difference between long-term care facilities and skilled nursing/rehabilitation facilities, we will focus on the services they offer. Other codes can still be listed in I8000. You can also zoom in to see detail. PDPM MDS Items ! The map below shows every SNF in the US that accepted Medicare Part A patients in 2017. Diligent review of the medical history and clinical record is essential. (difference of NE-NF and NA-NB). PDPM NTA Case Mix Classification Groups NTA Score Range NTA Case Mix Group NTA Case Mix Index NTA HIPPS Character 12+ NA 3.24 A 9-11 NB 2.53 B 6-8 NC 1.84 C 3-5 ND 1.33 D 1-2 NE 0.96 E 0 NF 0.72 F . 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. 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. How can a facility ensure that they are not leaving money on the table due to under-coded NTAs? You are never alone in this field and resources are available in seminars, webinars, the CMS website, MDS manual, etc. 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. As mentioned earlier, these NTA comorbidities are reported (coded) throughout the MDS. Click the comorbidity and see the ICD-10 codes that are most likely to occur. 5!!!!!May!be!used!by!permission!only!Proactive!Medical!Review,!LLC!!!!!www.proactivemedicalreview.com!!!! 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. If your therapist are doing Group therapy, remind them that there must be supportive documentation regarding the benefit to the resident when participating in a larger group. Securely download your document with other editable templates, any time, with PDFfiller. It is important that the completion of an IPA does not reset the VPD. Evansville, IN 47711, Phone: (812) 471-7777 HUMk@(h;
! The score determines NTA payment groups and indices. It more accurately accounts for expenses and isn't overshadowed by therapy. and the grouper software will pick it up from I8000. CMS identified a . Coding of these areas will affect the Speech Case Mix Index. CMS identified 50 conditions and services that were related to an increased cost for skilled nursing facilities. 0000001085 00000 n
If the 25% is exceeded, a non-fatal warning will appear on the final validation report during the MDS submission process. 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. Points are scored if the condition or service is present. ANOVA Rural versus Urban NTA case-mix (click to enlarge). Preparedness for coding changes will be the key to a smooth transition. 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 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. Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). 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. hVmk#7+xG{ZMaMu{vB{[ciF3Viee2!VpIbDAy_X%_A0,R99Kb! 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 more comorbidities a patient has, the more medications he or she probably requires. 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 more accurately accounts for expenses and isnt overshadowed by therapy. The Patient-Driven Payment Model (PDPM), is fast approaching with implementation set for October 2019.
This list of options is not used for PDPM payment, but is used as risk adjustments for some of the QRP Quality Measures. ;DktP'pm}iE/4K~bY?c~220E+t;sdvGHz P,
At first, it took me longer to get used to making calculations in determining the highest allowable rate for the patient. Wound Care? 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. The Primary Diagnosis in I0020B and the Principal Diagnosis should match. The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. This isnt exactly a new problem, but it didnt drive reimbursement before. 0000001690 00000 n
1694 0 obj
<>stream
Skilled nursing services are covered under the Federal Governments Medicare program for a limited time or on a short-time basis and must meet the following requirements: The role of the Minimum Data Set (MDS) nurses has evolved all these years from being a clinician to a financial analytical nurse because the MDS assessments have become the basis for facility reimbursement by the Medicare program. The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation. NTA has been separated as an independent component, and NTA classification 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. 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. 0000009611 00000 n
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. 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. 0000277284 00000 n
Patient has at least three qualifying inpatient days in an acute hospital. For the NTA component, the CMI is multiplied against the applicable per diem adjustment factor and is then applied to determine the case-mix adjusted payment associated with each of these payment components for each utilization day under PDPM. With every dollar spent on nutrition screening and interventions, the Academy of Nutrition and Dietetics has reported savings of $3.25 3. 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. It will be imperative that the coding is accurate on the MDS for the NTA conditions. The five CMGs then convert to a corresponding case mix index (CMI), which is a multiplier to the base rate for a particular CMG.