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. Everyone I've talked to agrees the NTA payment is a good idea. !on!$ Q7ER}x;:lRcP%?9w_ mm ' You should understand those things too, reader.). In this article, we discuss the non-therapy ancillary (NTA) component. comorbidities used under PDPM for NTA classification is assigned a certain number of points, between one and eight, based on its relative costliness. This item also impacts your MDS High Risk Pressure Ulcer QM because it is a high risk qualifier (along with impaired bed mobility impaired transfer, or comatose) for the numerator and denominator of the calculation. This has been a key consideration in designing the various elements of the new model. 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). 0000006001 00000 n .com NTA Diagnosis Tool CMS identified a list of 50 conditions and extensive services associated with increases in NTA costs. These residents may have a significant number of inaccurate or resolved diagnoses if a facility doesnt have a process for ongoing diagnosis reconciliation. This is especially important for those residents who are long-term and later qualify for skilled care. CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. 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. As far as treating for late effects, such as weakness after an episode of pneumonia, you should obtain documentation from the physician or physician extender linking the late effects of the unsteady gait and weakness directly to the episode of pneumonia and that the pneumonia has a direct relationship to the current functional status and treatment. or service for purposes of classification under the PDPM's NTA component. The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. We earn 1 NTA point if we code Protein or Calorie Malnutrition/At Risk for Protein or Calorie Malnutrition in MDS item I5600. 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 When reviewing the CMI components driving PDPM reimbursement its important to consider the critical role of the Non-Therapy Ancillary (NTA) score. The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. Ive done that for urban and rural for every state. 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. requires an analytical mind and financial knowledge to determine the highest allowable reimbursement for the facility. 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. If your facility has a low NTA rate, it may just mean you have work to do, documentation-wise. 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. Our wound certified educators train, educate, and guide our providers and client facilities on the most efficacious wound care treatments and follow up. No software installation. startxref We must also understand all the aspects of PDPM coding from every single angle, the relationship between each facet of the components, and the impact on care and revenue. &)` R #V? U? This does not include conditions that are resolved. There are two look back periods that must be met when coding conditions on the MDS: #1 Diagnosis Identification - Documented by the physician or physician extender within the last 60 days. 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. Learn more about Jessica, Eleisha, and the rest of the Proactive team. Yes, you can, just not in I0020B. 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 . One can see from the table above that if comorbidities are missed, the facility could possibly miss out on reimbursement. 0000003961 00000 n As mentioned earlier, these NTA comorbidities are reported (coded) throughout the MDS. How should you prioritize your search for ICD-10 codes? Welcome to Gravity healthcare Consulting & Online Education Often overlooked, Non-Therapy Ancillaries or NTAs will be more important than ever in PDPM. If the 25% is exceeded, a non-fatal warning will appear on the final validation report during the MDS submission process. Each patient has a different reimbursement rate as compared to the RUG-IV PPS rate in the past. With such a close relationship to payment, it is critical the staff member(s) responsible for ICD-10 coding are knowledgeable in this area. Group therapy now allows for as few as 2 residents and as many as 6 residents. This isnt exactly a new problem, but it didnt drive reimbursement before. The functional scoring is based on residents performance in. 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. RUG Classification Groups based on the volume and intensity of therapy provided to patient: Determinants of Payment for PDPM are summarized below. PDPM ICD10 Consulting Confidential 2019 A Native American-Owned business Page . When reviewing the CMI components driving PDPM reimbursement it's important to consider the critical role of the Non-Therapy Ancillary (NTA) score. The map below shows every SNF in the US that accepted Medicare Part A patients in 2017. Of importance to note is the condition of HIV/AIDS under the NTA component. Great info! 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 non-therapy ancillary (NTA) part of the patient driven payment model (PDPM) is considered by most people Ive talked to as being better than what were currently doing. 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. Patients rely on you. We know now that every diagnosis and condition counts. Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing 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 . 0000005276 00000 n Just 1 NTA point can have an average worth of anywhere from $18 to $55 per day. 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. ENSURE TO CAPTURE EVERYTHING PRIOR TO COMPLETION OF THE 5-DAY MDS ASSESSMENT! (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. You can see in the histogram that not only are there a lot fewer rural facilities, but they also appear to have lower average case-mix. Skilled nursing services are covered under the Federal Governments. Basic versions of many 2019 AHCA PDPM Academy copyrighted document resources and webinars are available to . 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. Speaking of individual facilities, lets take a look at that as well. 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. The higher the score, the higher the NTA rate. View D0AD3F24-D6BD-4273-B139-8FCA97487E6A.jpeg from NURSING MISC at St. Clair County Community College. Variable Per Diem Adjustment Factors and ScheduleNTA. (2019). Primary Diagnosis - List I0020B Surgical Procedures - List J2100/J2300-J5000 Aphasia I4300 Cerebrovascular Accident . The more comorbidities a patient has, the more medications he or she probably requires. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. The southwest of the US, Michigan, Ohio and West Virginia would have the highest NTA rates. A year later, he falls and sustains a hip fracture. 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. The visualization is interactive. The list includes diagnosis codes, which will be recorded in the I8000 section of the MDS. Comorbidities are assigned points based on the cost in care associated with the condition or service, with points ranging from 1 to 8. 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. Do not be apprehensive to query the physician if a diagnosis is not clear or is suspected and not documented. PDPM MDS Items ! It will be imperative that the coding is accurate on the MDS for the NTA conditions. 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. As a result, patients with AIDS are assigned the highest point value (8 points) of any condition or service for purposes of classification under the PDPMs NTA component, and they also receive a special 18% add-on to the nursing component of the payment. 8cq1o22#|Bm1il,4iw&C|E^F+oq:>_|M\v+iTOigWJ:dCa$Qv_n/q|wCuukk+e';iJB2C &!Ar8c _~r 0000001865 00000 n This simply shows you a starting point. For example, if the MDS Coordinator counts only two of the three comorbidities that a patient has, the CMI for NTA would be 0.96 instead of 1.34. 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. SNF FY 2022 Proposed Rule Learn the Facts Behind the Headlines Part 3: How is My Rate Calculated, Regulatory Reminder! Ensure you have staff who are trained in ICD-10 coding. Refer to the PDPM Calculation Worksheet for more information. The Clinical Categories by Diagnosis mapping file only applies to the code listed in I0020B. Verify coding, dont assume. No paper. These clinical categories are PT, OT, and SLP. See the table below. }|YAxz .diS\]0}3sfowMm@ Conduct interview assessments for the Brief Interview for Mental Status (BIMS), and Mood ON ASSESSMENT REFERENCE DATE (ARD) OR A DAY PRIOR TO ARD. |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? 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. The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation. Five of the six are case-mix adjusted. Section I8000 alone has 27 of these conditions, while sections K, M, N, and O also have items that can contribute to the NTA score. Perhaps the most "transformative" component relates to Non-Therapy Ancillary (NTA) Services. .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. Le^#N"TaAKTt They are assisted by certified nursing assistants (. Remember, the CMS list is authoritative, mine is only for your convenience. There are a lot of items from section I8000. Learn More Resource PDPM Series Part 5: Assessment Requirements. Now let's discuss the I0020B Primary Diagnosis and the Claim's Principal Diagnosis. 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. We earn. Suctioning? Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing components. Focuses on clinically relevant factors rather than volume-based services or RUG levels. The table below shows how the sum of the NTA points converts to an NTA Case Mix Group and a corresponding NTA CMI. 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. 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. Based on that, we can calculate the rate. RUG-IV vs Patient-Driven Payment Model (PDPM), Prior to October 1, 2019, all SNFs which participate under the Medicare program are paid under the Skilled Nursing Facility (SNF). 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. 0 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). 66y% 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. Updates the ICD-10 mapping used to classify patients under the PDPM framework. 0000001405 00000 n Involve the Interdisciplinary Team. 0000009034 00000 n The non-therapy ancillary (NTA) classification of PDPM reinforces why ICD-10 coding plays a key role under PDPM. It especially packs a heavy punch when considering that the NTA per diem rate is tripled for the first three days of the stay. Below is a summary of the determinants of payment and which section on the MDS assessment form they are derived from. PDPM includes a new pay category, the non-therapy ancillary or NTA. Notice there is a big pocket of low NTA rates that covers most of Iowa. The PDPM classification system is based on support of the patients characteristics. The new nurse assessment coordinator (NAC) may be overwhelmed with the numerous tasks required of the position. These conditions may warrant completion of an Interim Payment Assessment (IPA) thus increasing the NTA component score and potentially the total per diem. Patients are assigned a clinical category based on the primary diagnosis for SNF stay. endstream endobj 451 0 obj <>stream z@~. This could be a difference of $29.23 per day for Urban and $27.93 per day for a Rural facility. 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. $HJ0!$j-g#W d9bEi0~og$.J8-Lb =lZ.SSz|'!`%/ 18% of the Nursing adjustment factor is multiplied to the Nursing rate only patients with diagnosis of AIDS. 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. Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. It is important that the completion of an IPA does not reset the VPD. b!+XQ{ +LgOIYe/Q6RVpYY_N/.~iMu1fY*eR}W_E[,7vrR!XSF};qZW&e"S5!CW}3GU|muc?_X`dcg7(zRU8k? All Rights Reserved. Always be on the lookout for new updates which usually happen every year and usually effective by October 1 of each updated year. How can a facility ensure that they are not leaving money on the table due to under-coded NTAs? To ease some of this burden, AAPACN developed the Sample Task List for the Nurse Assessment Coordinator tool . Click the comorbidity and see the ICD-10 codes that are most likely to occur. Try Now! Which codes are the most important? Understanding the Value of the MDS Nurse Under PDPM, Psoriatic Arthropathy & Systemic Sclerosis, Myelodysplastic Syndromes and Myelofibrosis. A good first resource is the PDPM NTA Comorbidity Mapping spreadsheet. 0000001085 00000 n ordered by the patients attending physician in the facility. Based on that, I have made you an extreme cheat sheet, that you should use with extreme caution. In it, youll find the 1,612 codes that map to the different comorbidities. (Right). 0 DetI Rloh,mJLEo(DA"pd#Se.e)6d;[+I=R^2rcZ'F6C"x=*!J&[KL~^ogN3#)LNb}:QOd 0}pE` )S 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. PDPM consists of five case-mix adjusted components: Physical therapy (PT) Occupational therapy (OT) Speech-language pathology (SLP) Nursing Non-therapy ancillary (NTA) PDPM also includes a variable per diem (VPD) adjustment that adjusts the per diem rate to reflect varying costs throughout a patient's stay. SAMPLE Task List for the Nurse Assessment Coordinator (NAC) November 23, 2022. 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. For RUGs IV PPS, the payment is based on a per diem rate that is constant for the entire length of stay. Either way, you must still also code the I0020B primary condition I0010 through I8000. We earn 1 NTA point and qualify for Nursing Category Special Care Low for a Stage IV Pressure Ulcer when coded in M0300. After the PDPM rate for each component is determined, the sum of the PDPM component rates is added to the fixed non-case mix rate which will be the final reimbursement rate for the patient for the entire skilled nursing facility stay. 26 11.4 Will section I0020B override section I0020, 1-13 for the primary reason for SNF admission since PDPM Series Part 4: Non-Therapy Ancillaries Case Mix Groups. Complete a blank sample electronically to save yourself time and money. More than half of them come from I8000 and many of these have multiple qualifying ICD-10 diagnosis codes. PATIENT DRIVEN PAYMENT MODEL |4 . the design of the PDPM case-mix system implemented in FY 2020. Ill also compare urban versus rural facilities when it comes to NTA case-mix. 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. or privately paid by the patient if he/she does not qualify under the Medi-Cal program. The patients NTA comorbidity score is the sum of the points associated with each relevant comorbidity. For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. The required MDS data would be entered in the sub-items listed below the item group identifier. Holds on recalibrating the PDPM "parity adjustment" that is designed to ensure budget neutrality under the new model to assist SNFs in meeting the demands of the COVID-19 pandemic until FY 2023. 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. F Payment is based on services provided by five disciplines: physical therapy, occupational therapy, speech language pathology, nursing, and non-therapy ancillary (NTA). The FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. 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. Coding of these areas will affect the Speech Case Mix Index. Q: Our EMR system will calculate the BMI. Find toolkits, webinars, on-demand trainings, templates, and much more to meet the needs of your facility. The PDPM Clinical Categories are discussed below. Section I has a lot of items that can effect NTA pay. @.dFo8L.3.#V0 F6Qa)bJ3oR/-5F=8tJ7r8*o{ VFh6Em4~qLh8Km,nLjwjW'm,|w>cy?^UKqZ`TU$7h"M9D*;XYi@ YhZ|453}R;|/F>!KLd{mQ*z7-.r|T_]Y^]K42Ca1g_AVYJo1ox/,e*M'LM ThY^SC w{i0[y0j|[1;hfD$;qp4UgNurGg2gKE)dtA6g!kJ|wpl; The calculation of payments is based on the five case-mix adjusted components: Physical Therapy (PT), Occupational Therapy (OT), Speech Language Pathology (SLP), Nursing and Non-therapy ancillary (NTA). 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. 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 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. } The higher the total point value, the greater the payment (CMI). mapping to one of the clinical categories: Orthopedic Surgery (Except Major Joint Replacement or Spinal Surgery, Non-orthopedic Surgery and Acute Neurologic, Other Orthopedic (non-surgical orthopedics and musculoskeletal), Medical Management (medical management, acute infections, cancer, pulmonary, cardiovascular/coagulation, acute neurologic), The patients functional score which is coded on. 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 this post Im going to take a deeper look at it and calculate the average NTA payment by state and facility. For example, if a resident admits and the dietitian notes the BMI is over 40, query the physician to confirm a morbid obesity diagnosis. At the start of 2019, 63% of respondents to SNN's annual outlook survey identified a greater emphasis on coding as a a key PDPM strategy. The score determines NTA payment groups and indices. Observation services are not covered as part of the inpatient stay. 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. Yes, I get that is bad. The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. hl This item includes diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. endstream endobj 1697 0 obj <>stream This gives you enough time to prepare for their implementation of any changes as MDS assessments are time sensitive. The NTA looks at conditions and extensive services that are associated with significant increase in costs for a skilled nursing facility. and the grouper software will pick it up from I8000. SNF PDPM Provider-Specific Impact File. ~,/-I\!/JfB. Other diagnoses will affect the Non-therapy Ancillary (NTA) component. Points are scored if the condition or service is present. A Knowledgeable and Compassionate partner. The MDS nurse should be alert to these changes to ensure timely completion of the required MDS assessment. Stay tuned. In summary, the NTA component is an important component to capture and reimburse the facility for costly medications and supplies that are needed to support patient characteristics. When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. Visit www.TrainingInMotion.org for more details of how we can help you achieve your PDPM goals. CMS identified 50 conditions and services that were related to an increased cost for skilled nursing facilities. background-color: #2c4a88; endstream endobj 454 0 obj <>stream Was there a need for an IV? NTA component receives 300% of the base per-diem rate for days 1-3 of a stay. NF is the lowest grouper with a score of 0, while NA is highest with a score of 12+.
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