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(Ui7A7dR;5|jDM\sEamJFK3O.C[=vBD:]'N+T_ rhc_ex>mHR&o6Bfr*W0zG3KWmxK6P46n=Jt0Pn'OGC~&S};& Dt];vwj+E0R"^T For example, an NTA comorbidity score of 11 equals a CMI of 2.53. Based on that, I have made you an extreme cheat sheet, that you should use with extreme caution. background-color: #2c4a88; 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. How often will the items on this list be available to you when you are doing the 5 day assessment? endstream endobj 454 0 obj <>stream mp:U@|8B *zL$#Tk\*SU%mQlTYA Rj&-N _VjWpb[5R8'i, With several big changes ahead, the margin for error slim for most providers. Coding of these areas will affect the Speech Case Mix Index. 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. Title: Microsoft Word - FINAL PDPM Triple Check Checklist.docx Author: jleatherbarrow Created Date: 1/29/2020 4:19:17 PM PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. Yes, I am aware that ICD-10 codes do change occasionally. CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. Reimbursement, LW Consulting, Inc.5925 Stevenson Avenue, Suite GHarrisburg, PA 17112, Ph:800-320-5401Local Ph: 717-233-6100Fx:717-233-4633. 0000003793 00000 n The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. Try it out!). Specialties What Is a SANE Nurse? There are a total of five rates that make up your pay under PDPM.) Click the comorbidity and see the ICD-10 codes that are most likely to occur. 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. 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. When these conditions and extensive services are reported on the MDS 3.0, they are weighted and used to classify a resident into a specific NTA case-mix group. b!+XQ{ +LgOIYe/Q6RVpYY_N/.~iMu1fY*eR}W_E[,7vrR!XSF};qZW&e"S5!CW}3GU|muc?_X`dcg7(zRU8k? Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing components. ENSURE TO CAPTURE EVERYTHING PRIOR TO COMPLETION OF THE 5-DAY MDS ASSESSMENT! I0020 is also a gateway to the I0020B Primary Diagnosis code. Base rates are either rural or urban as determined by geographic location. (2019). Next you multiply the case-mix index by the rate, either rural ($74.56) or urban ($78.05). The FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. %PDF-1.4 % 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. 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. This button displays the currently selected search type. Patients rely on you. 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. Section I has a lot of items that can effect NTA pay. Refer to RAI pages J37-J38 for more on coding J2100. A Knowledgeable and Compassionate partner. RUG Classification Groups based on the volume and intensity of therapy provided to patient: Determinants of Payment for PDPM are summarized below. 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. This does not include conditions that are resolved. Lastly, lets look a little more closely at rural versus urban. Adjustments to the PDPM rates include: 2.3% reduction in FY 2023. additional 2.3% decrease in FY 2024. 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. 0000003961 00000 n startxref Rehab and Nursing staff should complete the Section GG on the MDS form for indicated ADL tasks on Day 1-3 of admission with the admission date as Day 1. 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. (This isnt going to work well on mobile devices, FYI.). A SANE nurse is an RN who has been trained to examine and assess clients who have a reported a sexual assault. This isnt exactly a new problem, but it didnt drive reimbursement before. Start (and continue) the conversation. It especially packs a heavy punch when considering that the NTA per diem rate is tripled for the first three days of the stay. 0000000016 00000 n Ill also compare urban versus rural facilities when it comes to NTA case-mix. 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. Stay tuned. (2019) Fact Sheet: NTA Comorbidity Score https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/PDPM_Fact_Sheet_NTAComorbidityScoring_v2_508.pdf, Center for Medicare and Medicaid Services. 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. h4Pj0^z[ 8 >BRA$+Vfa 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". 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. 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. Learn why in this video from Aegis Therapies. %%EOF endstream endobj 453 0 obj <>stream Also, there is a 25% combined limit on concurrent and/or group therapy. I am sure we'll continue to understand even more as the months go by. Complete a blank sample electronically to save yourself time and money. 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. Note that for the first 3 days of the stay you get 3 times the rate shown on the map. INTRODUCTION. PDPM and Non-Therapy Ancillaries The non-therapy ancillary (NTA) part of the patient driven payment model (PDPM) is considered by most people I've talked to as being better than what we're currently doing. What do I need to know? 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. endstream endobj 1698 0 obj <>stream We earn 1 NTA point when Other Skin Problems (foot ulcers/lesions) is coded in MDS item M1040A (infection of the foot such as cellulitis or purulent drainage), M1040B (diabetic foot ulcer), or M1040C (other open lesion of foot). Hopefully I dont lose my blogging privileges, but I looked at a years worth of Part A admissions to every SNF in the country and found, gasp, not all codes occur that often. The list includes diagnosis codes, which will be recorded in the I8000 section of the MDS. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. pdpm nta listhorse heaven hills road conditionshorse heaven hills road conditions In it, youll find the 1,612 codes that map to the different comorbidities. The higher the score, the higher the NTA rate. 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. This gives you enough time to prepare for their implementation of any changes as MDS assessments are time sensitive. Seek advice from experts, trainers and other MDS nurses when needed to clarify any areas in the MDS assessment or PDPM calculation. 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. The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. We earn 1 NTA point for second or third degree burn coded in M1040F. 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. No software installation. Le^#N"TaAKTt 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). It is highly recommended for the MDS nurse to make calculations which can determine the highest acceptable reimbursement rate for the facility. 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. eating, oral hygiene, toileting hygiene, sit to lying, lying to sitting on side of bed, sit to stand, chair/bed-to-chair transfer, and toilet transfer assessed on the first three days of admission to the facility with the admission day counted as day 1. As we prepare for the transition to the Patient-Driven Payment Model (PDPM), which is expected to occur on October 1, 2019, we have been reviewing the primary components that make up the Case Mix Index (CMI) for reimbursement. 463 0 obj <>stream Focuses on clinically relevant factors rather than volume-based services or RUG levels. 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. The PDPM Clinical Categories are discussed below. hVmk#7+xG{ZMaMu{vB{[ciF3Viee2!VpIbDAy_X%_A0,R99Kb! These maps look significantly different from a lot of the others weve seen. Resolved conditions should not be listed since therapy would not be treated for a resolved condition. For the NTA, an adjustment factor of 3.0 is applied to the total NTA CMI for days 1-3. Observation services are not covered as part of the inpatient stay. PDPM Chart Audit Simple and Easy: Winning in PDPM Payment and Regulatory Strategies . At first, it took me longer to get used to making calculations in determining the highest allowable rate for the patient. SANE is an acronym that stands for Sexual Assault Nurse Examiner. These components for classification and payment include: Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST), Non-therapy Ancillary (NTA) as well as Nursing. 0000002491 00000 n #2 Diagnosis Status - The diagnosis must have a direct relationship to the resident's current functional status, cognitive status, mood or behavior status, medical treatments, nursing monitoring, or risk of death during the 7-day look-back period. Love what you read? How can a facility ensure that they are not leaving money on the table due to under-coded NTAs? These skilled services are for a medical condition that is a hospital-related medical condition treated during the three-day qualifying inpatient hospital stay (not including the day of discharge from the hospital). 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. tr:nth-child(even) {background-color: #f2f2f2;} A good first resource is the PDPM NTA Comorbidity Mapping spreadsheet. Condition/Extensive Service Source Points Aseptic Necrosis of Bone MDS Item I8000 1 Asthma COPD Chronic Lung Disease MDS Item I6200 2 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. 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).