All PDPM components are assigned an appropriate score to multiply to the federally assigned case mix index group. It will be imperative that the coding is accurate on the MDS for the NTA conditions. 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 . 0000005276 00000 n
Next you multiply the case-mix index by the rate, either rural ($74.56) or urban ($78.05). 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. You can rely on us. PDPM Chart Audit Simple and Easy: Winning in PDPM Payment and Regulatory Strategies . Just 1 NTA point can have an average worth of anywhere from $18 to $55 per day. 0000002491 00000 n
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! &)` R #V? U? Patient has at least three qualifying inpatient days in an acute hospital. 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. 0000009611 00000 n
There are a lot of items from section I8000. 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. These clinical categories are PT, OT, and SLP. The higher the score, the higher the NTA rate. Always be on the lookout for new updates which usually happen every year and usually effective by October 1 of each updated year. 1=BY)#CT
'a7bA(XdHE ? You can also zoom in to see detail. But now, if the resident also happens to have diabetic retinopathy, we can earn an extra NTA point if we also include the specific Diabetic Retinopathy code in I8000. The Non-Therapy Ancillary Services (NTA) component is a total score of all listed conditions and/or extensive services that apply to the resident. 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. 5!!!!!May!be!used!by!permission!only!Proactive!Medical!Review,!LLC!!!!!www.proactivemedicalreview.com!!!! 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. 0000190726 00000 n
It is highly recommended for the MDS nurse to make calculations which can determine the highest acceptable reimbursement rate for the facility. Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. As mentioned earlier, these NTA comorbidities are reported (coded) throughout the MDS. A}
2?d`aYW!3,8h|J/K\J:s&Ve>1|9WiixusVo\sGP8saBT!+(z$lYnAZZp@6Y1m`[ jKeMQ5i.7HCGIC1iGIc' The functional scoring is based on residents performance in. PDPM HIPPS Coding Crosswalk In order to accommodate the new payment groups, the PDPM HIPPS algorithm is . PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. The skilled services are provided by a Medicare-certified SNF. The PDPM program has six payment components. Not all NTAs are ICD-10 codes, some are MDS items. Skilled nursing services are covered under the Federal Governments. endstream
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Comorbidities are assigned points based on the cost in care associated with the condition or service, with points ranging from 1 to 8. Our wound certified educators train, educate, and guide our providers and client facilities on the most efficacious wound care treatments and follow up. The MDS nurse should be alert to these changes to ensure timely completion of the required MDS assessment. Intermittent Catheterization? (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. Primary Diagnosis - List I0020B Surgical Procedures - List J2100/J2300-J5000 Aphasia I4300 Cerebrovascular Accident . 0000277284 00000 n
Just 1 NTA point can have an average worth of anywhere from $18 to $55 per day. Everyone Ive talked to agrees the NTA payment is a good idea. The PDPM diagnosis list determines the reimbursements for a Medicare Part A stay. It more accurately accounts for expenses and isnt overshadowed by therapy. AVONA confirms that rural facilities do indeed have lower NTA case-mix. MDS 3.0 Section I Thats a lot of white space. Title: Microsoft Word - FINAL PDPM Triple Check Checklist.docx Author: jleatherbarrow Created Date: 1/29/2020 4:19:17 PM The five CMGs then convert to a corresponding case mix index (CMI), which is a multiplier to the base rate for a particular CMG. His I0020B Primary Diagnosis and his claim's Principal Diagnosis is now the aftercare of the hip fracture. or privately paid by the patient if he/she does not qualify under the Medi-Cal program. 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. 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. Conduct interview assessments for the Brief Interview for Mental Status (BIMS), and Mood ON ASSESSMENT REFERENCE DATE (ARD) OR A DAY PRIOR TO ARD. Items on this list could change at any time with new legislative and (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. HVmo0)>bbJS:i>h4B6u~>!bB8lr
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V#~RLXP9BZ,/Y798(|&a"#.G. These nurses are also trained to complete a full All Rights Reserved By Nursingcecentral 2022 |. The PDPM classification system is based on support of the patients characteristics. For example, an I69.091 code (dysphagia following non-traumatic sub-arachnoid hemorrhage) in I0020B will map to Acute Neurological category and contribute to determining the case mix group. Under PDPM there are 161 Minimum Data Set (MDS) item fields. 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. The new nurse assessment coordinator (NAC) may be overwhelmed with the numerous tasks required of the position. PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. endstream
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CMS Actually, were going to limit our scope to only I8000 items. 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. Documentation by the physician and nursing must also support the skilled nature of the codes that are recorded as NTA conditions. 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. last. A frequent question: "If the mapping file lists a code as "return to provider", can I still use it on the MDS?". (I did abbreviate a few of the names for sanity.) 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. Remember this is using 2017 data so it assumes that providers make no adjustments which is not realistic.
CMS stated in the final rule for FY 2023 that they intend to take a more cautious approach to mitigate the potential negative impacts on the nursing home industry with this parity adjustment by spreading it across a two-year period. Incorporate NTA identification into the daily clinical meeting as it is ever important to identify when a change in condition or services takes place. (Note that this map is showing ONLY the NTA rate. When reviewing the CMI components driving PDPM reimbursement it's important to consider the critical role of the Non-Therapy Ancillary (NTA) score. Any delay in getting this information is going to be problematic. 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. 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. Admittedly, thats a lot to look through. The International Code for Diseases, Tenth Revision, Clinical Modification Codes which popularly known as the ICD-10 CM which is coded on Section I0020B of the MDS assessment is mapped to a clinical category which will be part of the determinant of payment for the PDPM components. For example, an NTA comorbidity score of 11 equals a CMI of 2.53. For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. . ANOVA Rural versus Urban NTA case-mix (click to enlarge). Love what you read? If you have an idea lets discuss! We earn 2 NTA points if Diabetes is coded in MDS item I2900. Whats in it for me? To assist stakeholders in understanding the potential impacts of the proposed PDPM, we are providing a provider-specific impact analysis file, which details the estimated . NTA component receives 300% of the base per-diem rate for days 1-3 of a stay. This gives you enough time to prepare for their implementation of any changes as MDS assessments are time sensitive. Hoo0#=)HU64*)T%DH!$swwb4fc|i]\/8gr? 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. HUO0~^iq3N&@-0*Si$L9)-ziwg';q_}(Ak"CwKi "@~|iA`!c The patients NTA comorbidity score is the sum of the points associated with each relevant comorbidity. 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. 0000004542 00000 n
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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. Some didnt occur at all. 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 . Note that for the first 3 days of the stay you get 3 times the rate shown on the map. List the 3 MDS items that qualify a resident for the Extensive Nursing Service group. The Clinical Categories by Diagnosis mapping file only applies to the code listed in I0020B. Do whatever you want with a SKILLED: fill, sign, print and send online instantly. Think about this A resident with a Stage IV pressure ulcer has physician orders and Registered Dietician recommendations for a protein supplement. Refer to RAI pages J37-J38 for more on coding J2100. Highlights: Hiring both part-time 2 days/week and full-time 4-5 days/week (benefits for FT only) Hours: Monday-Friday ~7am to 4pm; no evenings, weekends, call, or holidays . ;iHIBK
= >N]Y}dZ}HvtZ04D8YV4r4Od^/NJ x/i"9WirMdy2d*{E^lEu}Jg t@C`[aNOGgg0?bd'r EVm@Av;*%f?Wp
:1&[+cZhqhU;IKBU The Primary Diagnosis in I0020B and the Principal Diagnosis should match. 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. Copyright LW Consulting, Inc 2022. I0020 is also a gateway to the I0020B Primary Diagnosis code. 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. Speaking of individual facilities, lets take a look at that as well. If a resident is admitted into a Part A stay within 30 days after major surgical procedure (as a hospital inpatient) that carried some degree of risk to life or had the potential for severe disability, then J2100 (recent surgery requiring active SNF care) is checked "yes".