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. We also qualify for Special Care Low in the Nursing Category when there is an application of a dressing to the foot with the ulcer. 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. With the transition from Resource Utilization Group Version IV (RUG-IV) to the Patient-Driven Payment Model (PDPM) on October 1, 2019, the MDS nurse requires an analytical mind and financial knowledge to determine the highest allowable reimbursement for the facility. This is especially important for those residents who are long-term and later qualify for skilled care. It is critical that all coded conditions are accurate AND supported by nursing and physician documentation. Yes, I get that is bad. Other codes can still be listed in I8000. (10 items fit). Five of the six are case-mix adjusted. 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. var divElement = document.getElementById('viz1528375166404'); var vizElement = divElement.getElementsByTagName('object')[0]; vizElement.style.width='100%';vizElement.style.height=(divElement.offsetWidth*0.75)+'px'; var scriptElement = document.createElement('script'); scriptElement.src = 'https://public.tableau.com/javascripts/api/viz_v1.js'; vizElement.parentNode.insertBefore(scriptElement, vizElement); Use the rate filter to show only the highest or lowest NTA rates. If your facility has a low NTA rate, it may just mean you have work to do, documentation-wise. o NTA = All NTA items identified with a value of two or more points on the NTA table. 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. 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. ANOVA Rural versus Urban NTA case-mix (click to enlarge). For example, if a resident admits and the dietitian notes the BMI is over 40, query the physician to confirm a morbid obesity diagnosis. 2207 Morgan Ave, Suite D With supportive documentation, it can be coded in I5600. The PDPM clinical categories represent groups of similar diagnosis codes, which are used as part of the resident's classification under the PT, OT, and . Evansville, IN 47711, Phone: (812) 471-7777 Daily Medicare charting should focus on all possible nursing clinical categories, special care high, special care low, clinically complex, behavioral symptoms and cognitive performance, and reduced physical function. I would really like to see how item I8000 changes on a resident from the 5 day to later assessments. h4Pj0^z[ 8 >BRA$+Vfa (4.0CSVMEB3nHSQ(9gvNtp}|srUzUX/%3vf+R6Fe Kb`Mr"yWz~tck~>1gK\,)?yt_Jy2Z2poUa-GFjRC'.`?/`;Mwk!$e#W,rLz:+ZL`Y4;Z%Up|h\/nzD]#N.
hrmct Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). PATIENT DRIVEN PAYMENT MODEL |4 . 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. 0000003793 00000 n
Item I0020 and I0020B: Item I0020 (primary medical condition category that best describes the primary reason for admission lists several options. Lets breakdown the PDPM model to better understand how reimbursement is determined. }|YAxz .diS\]0}3sfowMm@ This could be a difference of $29.23 per day for Urban and $27.93 per day for a Rural facility. With such a close relationship to payment, it is critical the staff member(s) responsible for ICD-10 coding are knowledgeable in this area. 0000009034 00000 n
You can rely on us. (Note that this map is showing ONLY the NTA rate. CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. 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. The PDPM Clinical Categories are discussed below. Patient has at least three qualifying inpatient days in an acute hospital. ! CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. by NCC News and Content Team | Mar 1, 2023 | Hospitals, Specialties. Which codes are the most important? Sometimes the code may be a qualifier for other PDPM components, sometimes it won't be. 437 27
(At this point, I can feel the cold stares from our MDS Experts. The higher the score, the higher the NTA rate. 0000000016 00000 n
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. The map below shows every SNF in the US that accepted Medicare Part A patients in 2017. No software installation. 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. ENSURE TO CAPTURE EVERYTHING PRIOR TO COMPLETION OF THE 5-DAY MDS ASSESSMENT! With several big changes ahead, the margin for error slim for most providers. The NTA looks at conditions and extensive services that are associated with significant increase in costs for a skilled nursing facility. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. All PDPM components are assigned an appropriate score to multiply to the federally assigned case mix index group. 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. Intermittent Catheterization? 26 11.4 Will section I0020B override section I0020, 1-13 for the primary reason for SNF admission since endstream
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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. 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 components for classification and payment include: Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST), Non-therapy Ancillary (NTA) as well as Nursing. All Rights Reserved. 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. 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 . Good talk. The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. 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. PDPM ICD10 Consulting Confidential 2019 A Native American-Owned business Page . (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 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). When the variable per diem adjustment is applied, the increase NTA component goes up 3x; in the example above, the daily rate for days 1-3 would increase by $87.70 for Urban and $83.78 for Rural. last. Always be on the lookout for new updates which usually happen every year and usually effective by October 1 of each updated year. Coding of these areas will affect the, Postpartum Preeclampsia Diagnosis and Management, Hyperemesis Gravidarum: More Than Just Morning Sickness. Primary reason for SNF care or PDPM diagnosis coded on Section I00200B (ICD-10 code) of the MDS assessment, Functional status coded on Section GG of the MDS assessment, Cognitive Status: BIMS score coded on the Section C of the MDS assessment, presence of a swallowing disorder or mechanically altered diet coded on Section K of the MDS assessment, other SLP-related comorbidities coded on Section I of the MDS assessment, Extensive services received coded on Section of the MDS assessment such as Tracheostomy, Ventilator, and Isolation, Presence of Depression coded on Section D: PHQ9 on the MDS assessment, Restorative nursing services coded on Section O of the MDS assessment, Comorbidities present coded on Section I of the MDS assessment, Extensive services received coded on Section O of the MDS assessment: Tracheostomy, Ventilator and Isolation. As under the previous RUGIV model, the presence of an AIDS diagnosis continues to be identified through the . Under PDPM, long-term care facilities will receive reimbursement based on services that each resident receives. Updates the ICD-10 mapping used to classify patients under the PDPM framework. Remember this is using 2017 data so it assumes that providers make no adjustments which is not realistic. Refer to the PDPM Calculation Worksheet for more information. Previous articles in this series outlined the physical and occupational therapy component and the speech language pathology component. endstream
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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.
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