Under PDPM, there are six payment components. On day 4 it goes back to the rate shown. trailer and the grouper software will pick it up from I8000. It especially packs a heavy punch when considering that the NTA per diem rate is tripled for the first three days of the stay. 437 0 obj <> endobj Physician Job in Akron, OH - AmeriWound | CareerBuilder.com 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. PDPM - Focus on NTA - YouTube The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. Learn More Resource PDPM Series Part 5: Assessment Requirements. 5!!!!!May!be!used!by!permission!only!Proactive!Medical!Review,!LLC!!!!!www.proactivemedicalreview.com!!!! o NTA = All NTA items identified with a value of two or more points on the NTA table. More than half of them come from I8000 and many of these have multiple qualifying ICD-10 diagnosis codes. <<50FFC127310FCF468ABFE4B7414A5B70>]/Prev 423154>> Try Now! 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. Payment is based on services provided by five disciplines: physical therapy, occupational therapy, speech language pathology, nursing, and non-therapy ancillary (NTA). For the NTA, an adjustment factor of 3.0 is applied to the total NTA CMI for days 1-3. Title: Microsoft Word - FINAL PDPM Triple Check Checklist.docx Author: jleatherbarrow Created Date: 1/29/2020 4:19:17 PM Seek advice from experts, trainers and other MDS nurses when needed to clarify any areas in the MDS assessment or PDPM calculation. ;iHIBK = >N]Y}dZ}HvtZ04D8YV4r4Od^/NJ x/i"9WirMdy2d*{E^lEu}Jg t@C`[aNOGgg0?bd'r EVm@Av;*%f?Wp :1&[+cZhqhU;IKBU Classroom Walkthrough Checklist Resource Center K 12 Resources Frontline Education April 18th, 2019 - Broken Arrow Public Schools a large urban suburban district with deep roots in the community serves more than 19 000 students Recognized as one of the top or service for purposes of classification under the PDPM's NTA component. It is not clear why this would be the case. HVmo0)>bbJS:i>h4B6u~>!bB8lr lk4-M~V CIExej[_@{wpuCm/8yU\mqpC1!Ll%5##P:a,Orh[a%zDUd V#~RLXP9BZ,/Y798(|&a"#.G. 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. mp:U@|8B *zL$#Tk\*SU%mQlTYA Rj&-N _VjWpb[5R8'i, by Proactive LTC Consulting | Jan 6, 2020 | Audits, Compliance, Education, MDS, Medical Review, PDPM. Medicare Skilled Nursing Facility PPS SNF PPS Payment Model Research The non-therapy ancillary (NTA) classification of PDPM reinforces why ICD-10 coding plays a key role under PDPM. 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. 0000011153 00000 n For example, an NTA comorbidity score of 11 equals a CMI of 2.53. 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). requires an analytical mind and financial knowledge to determine the highest allowable reimbursement for the facility. 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). But, since it's new, we're going to have to work on understanding how it's supposed to work, and how we can most easily and efficiently complete the assessment with accurate information. Ill also compare urban versus rural facilities when it comes to NTA case-mix. 1=BY)#CT 'a7bA(XdHE ? This PDPM model aims to utilize the individual patient's characteristics and needs based on diagnosis as opposed to the RUG-IV system relying on volume of services. These conditions may warrant completion of an Interim Payment Assessment (IPA) thus increasing the NTA component score and potentially the total per diem. The southwest of the US, Michigan, Ohio and West Virginia would have the highest NTA rates. (Nursing, Social Services, Dietary and Activity Staff). At first, it took me longer to get used to making calculations in determining the highest allowable rate for the patient. The NTA Component of PDPM: Best Practices for Accurate Scoring Next you multiply the case-mix index by the rate, either rural ($74.56) or urban ($78.05). ~,/-I\!/JfB. hb```b``ia`e`ff@ a(meU=r%::@`uH@V01:000x1p`5`gy4AuG/Dg* ZF:&'[-@ >` t!R You can rely on us. table, th, td { comorbidities used under PDPM for NTA classification is assigned a certain number of points, between one and eight, based on its relative costliness. Adjustments to the PDPM rates include: 2.3% reduction in FY 2023. additional 2.3% decrease in FY 2024. [|Qc\0aXjK@ EdO4&_? Wound Care? The Primary Diagnosis in I0020B and the Principal Diagnosis should match. Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). Lets breakdown the PDPM model to better understand how reimbursement is determined. Learn why in this video from Aegis Therapies. Below is a summary of the determinants of payment and which section on the MDS assessment form they are derived from. Each component has its case mix index to determine the component rate. 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. Remember, the CMS list is authoritative, mine is only for your convenience. 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. On any device & OS. PDF FINAL PDPM Triple Check Checklist border: 1px solid black; 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. 6/23/22 Capturing Non-Therapy Ancillary (NTA) in PDPM - GEM Health Care 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. 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 (2019) Fact Sheet: PDPM Payments for SNF Patients with HIV/AIDS https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/PDPM_Fact_Sheet_AIDS_v3_508.pdf. The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. With this component being paid at a 3x rate for 1st 3 days of stay, its important to quickly and accurately identify and code patient conditions. Note that for the first 3 days of the stay you get 3 times the rate shown on the map. Preparedness for coding changes will be the key to a smooth transition. Just 1 NTA point can have an average worth of anywhere from $18 to $55 per day. 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 As a result, client facilities realize improved wound healing results, improved survey scores and NTA reimbursement under PDPM. PDPM Series Part 4: Non-Therapy Ancillaries Case Mix Groups. The categories impact a resident's case-mix classification. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. 0000008175 00000 n 26 11.4 Will section I0020B override section I0020, 1-13 for the primary reason for SNF admission since But if discharged on 10/01/19, it must be included on the claim. PDF MDS Item Fields - All PDPM Case-Mix Adjusted Components The Patient-Driven Payment Model (PDPM), is fast approaching with implementation set for October 2019. 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. 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. There is also the impact of the Variable Per Diem Adjustment Factor that is applied to the NTA Component. Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). This could be a difference of $29.23 per day for Urban and $27.93 per day for a Rural facility. How can a facility ensure that they are not leaving money on the table due to under-coded NTAs? What if we could limit those codes down to just those ICD-10 codes that are likely to occur. Sometimes the code may be a qualifier for other PDPM components, sometimes it won't be. PDPM (Patient-Driven Payment Model) | Let's Break It Down! This update addresses two issues with the NTA comorbidities mapping. (At this point, I can feel the cold stares from our MDS Experts. (10 items fit). PDF Welcome to Gravity healthcare Consulting & Online Education 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. code. (By the way, we created a PDPM Calculator for you to experiment with and get a better understanding of how PDPM works. startxref In this post, we going to look at one important piece of the NTA puzzle, section I. Involve the Interdisciplinary Team. Coding of these areas will affect the, Postpartum Preeclampsia Diagnosis and Management, Hyperemesis Gravidarum: More Than Just Morning Sickness. For example, Mr. Steve is a long term care resident due to Parkinson's Disease. F 0000001865 00000 n PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. Try it out!). (This isnt going to work well on mobile devices, FYI.). In 2019, CMS has further revised and finalized the version of PDPM that will go into effect October 1, 2019. %%EOF NON-THERAPY ANCILLARY & PDPM - Concept Rehab Remember, a diagnosis has to be active and documented by a physician or nonphysician extender to qualify as an NTA item. The PDPM Clinical Categories are discussed below. HUMk@(h; ! Determinant for payment is based on the number of therapy minutes provided regardless of residents acuity, diagnosis and other skilled nursing services provided. To ease some of this burden, AAPACN developed the Sample Task List for the Nurse Assessment Coordinator tool . Under PDPM, Section GG drives PT and OT, and nursing which affects reimbursement. h4Pj0^z[ 8 >BRA$+Vfa (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. AVONA confirms that rural facilities do indeed have lower NTA case-mix. pdpm nta list horse heaven hills road conditions A year later, he falls and sustains a hip fracture. Welcome to Gravity healthcare Consulting & Online Education Base rates are either rural or urban as determined by geographic location. HUO0~^iq3N&@-0*Si$L9)-ziwg';q_}(Ak"CwKi "@~|iA`!c Other SLP co-morbidities picked up from the grouper software include the checkboxes for I4300 (aphasia), I4500 (stroke/CVA/TIA), I4900 (hemiplegia/hemiparesis), I5500 (traumatic brain injury), O0100E2 (tracheostomy while a resident), and O0100F2 (ventilator/respirator while a resident). %PDF-1.6 % First, it corrects an issue where diagnosis codes were mapped to NTA comorbidities as 1 to 1 mappings where 1 to 2 mappings were intended from the PDPM_ICD10_Mappings_FY20XX Excel sheet. (2019). 3HFDRkse$:stHqPJoHK-qL_sh|Kg?unioWAsfH8[^9{'~-? last. We earn 1 NTA point for second or third degree burn coded in M1040F. Its interesting to note that the data CMS provided, that I am using here, came from some assessments that we no longer will be doing. List the 3 MDS items that qualify a resident for the Extensive Nursing Service group. ;DktP'pm}iE/4K~bY?c~220E+t;sdvGHz P, Q: Our EMR system will calculate the BMI. What do I need to know? The Patient Driven Payment Model (PDPM) - FHCA Pulse PDF PATIENT DRIVEN PAYMENT MODEL - Centers for Medicare & Medicaid Services This has been a key consideration in designing the various elements of the new model. 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. Inappropriate Schizophrenia Diagnosis/Coding and Survey Citation Posting, Regulatory Reminders: Consolidated Billing Update 2023, Osteomyelitis of vertebra, site unspecified, Other acute osteomyelitis, unspecified ankle and foot, Staphylococcal arthritis, unspecified knee, Other acute osteomyelitis, unspecified site, Pneumococcal arthritis, unspecified joint, Other chronic osteomyelitis, unspecified ankle and foot, Other acute osteomyelitis, unspecified tibia and fibula, Other chronic osteomyelitis, unspecified site, Direct infection of unspecified joint in infectious and parasitic diseases classified elsewhere, Staphylococcal arthritis, unspecified hip, Direct infection of unspecified knee in infectious and parasitic diseases classified elsewhere, Staphylococcal arthritis, unspecified shoulder, Other chronic osteomyelitis, unspecified tibia and fibula, Other acute osteomyelitis, unspecified femur, Direct infection of vertebrae in infectious and parasitic diseases classified elsewhere, Other chronic osteomyelitis, unspecified thigh, Direct infection of multiple joints in infectious and parasitic diseases classified elsewhere, Other acute osteomyelitis, multiple sites, Staphylococcal arthritis, unspecified ankle and foot, Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission, Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, Infection and inflammatory reaction due to unspecified internal joint prosthesis, initial encounter, Embolism due to internal orthopedic prosthetic devices, implants and grafts, initial encounter, Embolism due to vascular prosthetic devices, implants and grafts, initial encounter, Other mechanical complication of unspecified internal joint prosthesis, initial encounter, Dislocation of unspecified internal joint prosthesis, initial encounter, Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, initial encounter, Infection and inflammatory reaction due to internal fixation device of unspecified site, initial encounter, Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter, Other mechanical complication of aortic (bifurcation) graft (replacement), initial encounter, Other mechanical complication of other internal orthopedic devices, implants and grafts, initial encounter, Breakdown (mechanical) of internal fixation device of unspecified bone of limb, initial encounter, Infection and inflammatory reaction due to cardiac valve prosthesis, initial encounter, Mechanical loosening of unspecified internal prosthetic joint, initial encounter, Broken internal joint prosthesis, unspecified site, initial encounter, Embolism due to genitourinary prosthetic devices, implants and grafts, initial encounter, Secondary esophageal varices without bleeding, Secondary esophageal varices with bleeding, Alcoholic cirrhosis of liver without ascites, Antineoplastic chemotherapy induced pancytopenia, Agranulocytosis secondary to cancer chemotherapy, Acute respiratory failure, unspecified whether with hypoxia or hypercapnia, Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia, Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia, Acute and chronic postprocedural respiratory failure, Acute pulmonary insufficiency following thoracic surgery, Acute and subacute infective endocarditis, Acute and subacute endocarditis, unspecified, Endocarditis and heart valve disorders in diseases classified elsewhere, Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus, Epilepsy, unspecified, intractable, with status epilepticus, Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus, Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus, Respiratory bronchiolitis interstitial lung disease, Respiratory disorders in diseases classified elsewhere, Other alveolar and parieto-alveolar conditions, Idiopathic interstitial pneumonia, not otherwise specified, Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema, Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema, Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema, Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema, Morbid (severe) obesity due to excess calories, Morbid (severe) obesity with alveolar hypoventilation, Body mass index (BMI) 70 or greater, adult, Ulcerative colitis, unspecified, without complications, Crohns disease, unspecified, without complications, Other ulcerative colitis without complications, Ulcerative (chronic) pancolitis without complications, Ulcerative (chronic) proctitis without complications, Crohns disease of small intestine without complications, Crohns disease of large intestine without complications, Idiopathic aseptic necrosis of unspecified femur, Idiopathic aseptic necrosis of unspecified bone, Idiopathic aseptic necrosis of bone, other site, Systemic lupus erythematosus, organ or system involvement unspecified, Ankylosing spondylitis of unspecified sites in spine, Wegeners granulomatosis without renal involvement, Polymyositis, organ involvement unspecified, Dermatopolymyositis, unspecified, organ involvement unspecified, Systemic involvement of connective tissue, unspecified, Unspecified inflammatory spondylopathy, site unspecified, Refractory anemia without ring sideroblasts, so stated, Other specified disorders involving the immune mechanism, not elsewhere classified, Disorder involving the immune mechanism, unspecified. Specialties What Is a SANE Nurse? h2430Q0P0430S0 Perhaps the most "transformative" component relates to Non-Therapy Ancillary (NTA) Services. This information is essential. Group therapy now allows for as few as 2 residents and as many as 6 residents. Always be on the lookout for new updates which usually happen every year and usually effective by October 1 of each updated year. Other diagnoses will affect the Non-therapy Ancillary (NTA) component. 66y% Le^#N"TaAKTt endstream endobj 1698 0 obj <>stream 0000001085 00000 n 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. The more comorbidities a patient has, the more medications he or she probably requires. With every dollar spent on nutrition screening and interventions, the Academy of Nutrition and Dietetics has reported savings of $3.25 3. the design of the PDPM case-mix system implemented in FY 2020. Whats in it for me? Some didnt occur at all. The FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. Therefore, the code in I0020B must be directly related to the I0020 Primary Medical Condition. It is highly advisable for MDS nurses to review each assessment to ensure that all skilled services are captured during the assessment period to maximize reimbursement rate for the facility based on the patients diagnosis and acuity. (4.0CSVMEB3nHSQ(9gvNtp}|srUzUX/%3vf+R6Fe Kb`Mr"yWz~tck~>1gK\,)?yt_Jy2Z2poUa-GFjRC'.`?/`;Mwk!$e#W,rLz:+ZL`Y4;Z%Up|h\/nzD]#N. hrmct Of importance to note is the condition of HIV/AIDS under the NTA component. 437 27 After a qualifying hospital stay, he has returned to the SNF for aftercare of the hip fracture. (difference of NE-NF and NA-NB). 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. .center {text-align: center;}, Foot Code, Except Diabetic Foot Ulcer Code, Once we have totaled the score from the table above, we use it to map to a case-mix group and case-mix index. Coding Speech Related Comorbidities Under PDPM - Language Fundamentals Explain the impact of the variable per diem rate in the NTA component and how it impacts PDPM payment. 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. When expanded it provides a list of search options that will switch the search inputs to match the current selection. Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. PDF PDPM Component Variable Per-Diem and RUG-IV Rate Reference Tables @ Homework - Chapter 31: HlTT x + . Item I0020 and I0020B: Item I0020 (primary medical condition category that best describes the primary reason for admission lists several options. %PDF-1.4 % We earn 1 NTA point and qualify for Nursing Category Special Care Low for a Stage IV Pressure Ulcer when coded in M0300. PDPM HIPPS Coding Crosswalk In order to accommodate the new payment groups, the PDPM HIPPS algorithm is . PDPM Goes Beyond Therapy: Finding the Hidden - Skilled Nursing News All PDPM components are assigned an appropriate score to multiply to the federally assigned case mix index group. Either way, you must still also code the I0020B primary condition I0010 through I8000. (Right). PDF NTA Diagnosis Tool - PDPMICD10 Yes, I get that is bad. PDPM Chart Audit Simple and Easy: Winning in PDPM Payment and Regulatory Strategies . 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. The Financial Impact of Malnutrition and PDPM } PDPM, Non-Therapy Ancillaries & MDS Section I His claim's principal diagnosis is Parkinson's Disease. No paper. These nurses are also trained to complete a full All Rights Reserved By Nursingcecentral 2022 |. - Corrected typo in minimum point value thresholds used to ify patients into groups "NA" and "NB" under the NTA component. It will be imperative that the coding is accurate on the MDS for the NTA conditions. The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. 2207 Morgan Ave, Suite D Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing components. 0 Copyright LW Consulting, Inc 2022. AHCA Free PDPM Archive Library of Resources for All Provider Members