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. 0000000836 00000 n Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. 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. SNF PDPM Provider-Specific Impact File. 1=BY)#CT 'a7bA(XdHE ? Explain the impact of the variable per diem rate in the NTA component and how it impacts PDPM payment. Focuses on clinically relevant factors rather than volume-based services or RUG levels. The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. Other diagnoses will affect the Non-therapy Ancillary (NTA) component. ^(:eOCQ'SM7(Rmnvr/+eO.)hicZjz.,vO&u. 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 . 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. The PDPM Clinical Categories are discussed below. 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. PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. For example, Mr. Steve is a long term care resident due to Parkinson's Disease. MDS Item Field rows in tan represent MDS item groups identified in CMS PDPM documentation and do not have data entry fields. 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". Request for labs, imaging studies and surgical reports whichever is applicable. 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). 0000008175 00000 n This article was originally published in February 2019, and has been updated in October 2019 with several more tips. When reviewing the CMI components driving PDPM reimbursement it's important to consider the critical role of the Non-Therapy Ancillary (NTA) score. In the past, we only checked this box even if the resident was a diabetic and also had retinopathy. These nurses are also trained to complete a full All Rights Reserved By Nursingcecentral 2022 |. In 2019, CMS has further revised and finalized the version of PDPM that will go into effect October 1, 2019. Hospitals | Specialties Postpartum Preeclampsia Diagnosis and Management Postpartum preeclampsia is a condition that can affect women from the time after delivery and up to 6 weeks after. In order to determine the patients NTA comorbidity score accurately, providers must identify all comorbidities for which a resident would qualify, then total the points. Overview In July 2018, CMS finalized a new case-mix classification model, the Patient Driven Payment Model (PDPM), that, effective beginning October 1, 2019, will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay. We earn 1 NTA point and qualify for Nursing Category Special Care Low for a Stage IV Pressure Ulcer when coded in M0300. Previous articles in this series outlined the physical and occupational therapy component and the speech language pathology component. border: 1px solid black; ANOVA Rural versus Urban NTA case-mix (click to enlarge). View fullsize The categories impact a resident's case-mix classification. Which codes are the most important? There must be a reason for it, right? 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. What if we could limit those codes down to just those ICD-10 codes that are likely to occur. Some didnt occur at all. 66y% MDS 3.0 Section I Thats a lot of white space. .com NTA Diagnosis Tool CMS identified a list of 50 conditions and extensive services associated with increases in NTA costs. 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. 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. INTRODUCTION. Fax: (812) 471-7802 When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. The more comorbidities a patient has, the more medications he or she probably requires. 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. (difference of NE-NF and NA-NB). The Non-Therapy Ancillary Services (NTA) component is a total score of all listed conditions and/or extensive services that apply to the resident. Any delay in getting this information is going to be problematic. You can view either rural, urban or both. 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. Section I has a lot of items that can effect NTA pay. a" I54043lquizzes/446951 (Question 2 5 / 5 pts The All about coding rehabilitation for joint replacements: Its important to know the reason for the joint replacement since coding a joint replacement due to a fracture is different than when a joint replacement is due to an elective surgery. 2207 Morgan Ave, Suite D %PDF-1.6 % To further understand the difference between long-term care facilities and skilled nursing/rehabilitation facilities, we will focus on the services they offer. You can filter by NTA rate. 0000001405 00000 n 0000006770 00000 n This is especially important for those residents who are long-term and later qualify for skilled care. 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. 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. Refer to RAI pages J37-J38 for more on coding J2100. (Right). (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. At first, it took me longer to get used to making calculations in determining the highest allowable rate for the patient. Comorbidities are assigned points based on the cost in care associated with the condition or service, with points ranging from 1 to 8. 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. In this article, we discuss the non-therapy ancillary (NTA) component. 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. 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. 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. Dietitians are classified in the NTA discipline. Coding of these areas will affect the Speech Case Mix Index. 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. Far more items than would actually fit on the MDS 3.0 Instrument. Speaking of individual facilities, lets take a look at that as well. The Centers for Medicare & Medicaid Services (CMS) realizes that the cost impact of medications, at the time of admission, is extensive. HVmo0)>bbJS:i>h4B6u~>!bB8lr lk4-M~V CIExej[_@{wpuCm/8yU\mqpC1!Ll%5##P:a,Orh[a%zDUd V#~RLXP9BZ,/Y798(|&a"#.G. While the SNF certs and the Therapy Certs may contain this documentation, they are often not signed or approved until after the ARD. 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. For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. Your NTA payment is driven by the presence of a number of conditions and/or extensive services. ,: >i*S7O=X8ZA'ic2+(!olVz`zz_"K@I 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. or privately paid by the patient if he/she does not qualify under the Medi-Cal program. (Note that this map is showing ONLY the NTA rate. A year later, he falls and sustains a hip fracture. 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. 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. 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. 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. 0000004542 00000 n Under PDPM, long-term care facilities will receive reimbursement based on services that each resident receives. pdpm nta listhorse heaven hills road conditionshorse heaven hills road conditions His I0020B Primary Diagnosis and his claim's Principal Diagnosis is now the aftercare of the hip fracture. The administration of IV fluids may qualify for the Parenteral/IV Feeding - High or Parenteral/IV Feeding - low NTA points. Yes, I am aware that ICD-10 codes do change occasionally. PATIENT DRIVEN PAYMENT MODEL |4 . 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. It is highly recommended for the MDS nurse to make calculations which can determine the highest acceptable reimbursement rate for the facility. Highlights: !on!$ Q7ER}x;:lRcP%?9w_ mm ' Stay tuned. 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. Specialties Hyperemesis Gravidarum: More Than Just Morning Sickness Pregnancy and nausea are terms used in unison with one another. 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. 0000003793 00000 n If you have an idea lets discuss! Try it out!). Yes, you can, just not in I0020B. Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). A list of these specific retinopathy codes are in the SLP mapping file from CMS. (10 items fit). Below is a summary of the determinants of payment and which section on the MDS assessment form they are derived from. Variable Per Diem Adjustment Factors and ScheduleNTA. 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 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. Everyone I've talked to agrees the NTA payment is a good idea. hb```b``ia`e`ff@ a(meU=r%::@`uH@V01:000x1p`5`gy4AuG/Dg* ZF:&'[-@ >` t!R These components for classification and payment include: Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST), Non-therapy Ancillary (NTA) as well as Nursing. The NTA component is an important component to capture and reimburse the facility for costly medications, services, and supplies needed to care for residents. program for a limited time or on a short-time basis and must meet the following requirements: hospital insurance and have eligible days left to use during the benefit period. The FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. |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? Zi@Ym"l?]L?*;YaRxwFhSGkhSFRQJIp.V4v!fbN91GE]Y:+s endstream endobj 1698 0 obj <>stream It is important that the completion of an IPA does not reset the VPD. The Clinical Categories by Diagnosis mapping file only applies to the code listed in I0020B. For situations like this, the MDS nurse will choose to complete an Interim Payment Assessment (IPA) to capture such changes and eventually increase the daily reimbursement rate. Five of the six are case-mix adjusted. (Click either image to enlarge.). If your facility has a low NTA rate, it may just mean you have work to do, documentation-wise. 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. RUG Classification Groups based on the volume and intensity of therapy provided to patient: Determinants of Payment for PDPM are summarized below. The list includes diagnosis codes, which will be recorded in the I8000 section of the MDS. 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. I0020 is also a gateway to the I0020B Primary Diagnosis code. Securely download your document with other editable templates, any time, with PDFfiller. ~,/-I\!/JfB. CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. 0000003961 00000 n The table below shows how the sum of the NTA points converts to an NTA Case Mix Group and a corresponding NTA CMI. Our wound certified educators train, educate, and guide our providers and client facilities on the most efficacious wound care treatments and follow up. Q: Our EMR system will calculate the BMI. 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. Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing components. The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. Points (1-8) are assigned to specific conditions. PDPM MDS Items ! This has been a key consideration in designing the various elements of the new model. To account for changes in resource PT, OT, and NTA utilization over the course of a SNF stay, PDPM utilizes a variable per-diem adjustment factor that adjusts the per-diem payment for these components over the course of the resident stay. ;iHIBK = >N]Y}dZ}HvtZ04D8YV4r4Od^/NJ x/i"9WirMdy2d*{E^lEu}Jg t@C`[aNOGgg0?bd'r EVm@Av;*%f?Wp :1&[+cZhqhU;IKBU 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. ordered by the patients attending physician in the facility. Patients rely on you. Center for Medicare and Medicaid Services. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. } The FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. 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. 0000002280 00000 n Good talk. Often overlooked, Non-Therapy Ancillaries or NTAs will be more important than ever in PDPM. But if discharged on 10/01/19, it must be included on the claim. The most up to date guidelines are available at. The map below shows every SNF in the US that accepted Medicare Part A patients in 2017. With every dollar spent on nutrition screening and interventions, the Academy of Nutrition and Dietetics has reported savings of $3.25 3. Admittedly, thats a lot to look through. 0000003037 00000 n 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. The AHCA Patient Driven Payment Model (PDPM) Resource Center provides AHCA provider members with a suite of original content, tools, and training options and resources to assist providers in how to be successful in implementing the new Medicare Part A PDPM SNF PPS, effective October 2019.
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pdpm nta list