Understanding PDPM and the Interim Payment Assessment - LW Consult PDPM, Non-Therapy Ancillaries & MDS Section I HU]o0}G?G<
m*-$R5k'EC(K@!BE`;s 2I2,[fy@770&05 Bal[|# f1 `j[>,Uf[OrGUXore:qVKP2T(r`~F& +g80qjM8#)A{)@c}A,F^Ec{HN"!l!]_J3? 0000004207 00000 n
This problem isnt new either but now it will drive reimbursement. For example, if a resident admits and the dietitian notes the BMI is over 40, query the physician to confirm a morbid obesity diagnosis. 0 DetI
Rloh,mJLEo(DA"pd#Se.e)6d;[+I=R^2rcZ'F6C"x=*!J&[KL~^ogN3#)LNb}:QOd 0}pE` )S
The Patient Driven Payment Model (PDPM) - FHCA Pulse The PDPM Rate is derived from the sum of all the PDPM component rates: PT base rate x PT case mix index (CMI) x VPD adjustment factor, OT base rate x OT CMI x VPD adjustment factor, NTA base rate x NTA CMI x VPD adjustment factor, Nursing base rate x Nursing CMI x 18% Nursing adjustment factor (only for AIDS patients). We know now that every diagnosis and condition counts. 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. The saying, haste makes waste applies in the completion of MDS assessments and calculation of the maximized PDPM rate for the patient. NTA component receives 300% of the base per-diem rate for days 1-3 of a stay. endstream
endobj
1696 0 obj
<>stream
Of importance to note is the condition of HIV/AIDS under the NTA component. 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. Adjustments to the PDPM rates include: 2.3% reduction in FY 2023. additional 2.3% decrease in FY 2024. Five Important Considerations for Successful Billing Under PDPM 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 map below shows every SNF in the US that accepted Medicare Part A patients in 2017. 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. This NTA CMI is added to the other components to calculate the total reimbursement for the patient. With PDPM payment method, the determinants of payment are categorized into the following case-mix adjusted components: The PDPM rate is adjusted over the course of facility stay by the inclusion of a variable per diem (VPD) adjustment on the following three components: PT, OT and NTA. The NTA Component of PDPM: Best Practices for Accurate Scoring A good first resource is the PDPM NTA Comorbidity Mapping spreadsheet. When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. mp:U@|8B
*zL$#Tk\*SU%mQlTYA
Rj&-N
_VjWpb[5R8'i, Evansville, IN 47711, Phone: (812) 471-7777 (I did abbreviate a few of the names for sanity.) Learn why in this video from Aegis Therapies. Center for Medicare and Medicaid Services. No paper. If the Primary Diagnosis you listed in I0020B also happens to be a SLP Comorbidity qualifier from the SLP Comorbidity list, the grouper software will pick it up as a comorbidity from I8000. See the table below. Now let's discuss the I0020B Primary Diagnosis and the Claim's Principal Diagnosis. 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. For the NTA component, the CMI is multiplied against the applicable per diem adjustment factor and is then applied to determine the case-mix adjusted payment associated with each of these payment components for each utilization day under PDPM. 0000002742 00000 n
Its important to comprehend more than just the basics of PDPM. When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. code. Re-calculate expected daily rate based on the completed Rehab and Nursing Functional Scores and re-review principal diagnosis. List the 3 MDS items that qualify a resident for the Extensive Nursing Service group. 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. 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". Verify coding, dont assume. Patient Driven Payment Model (PDPM): What Dietitians Need to Know PDF Skilled Nursing Facility PPS Final Rule for FY 2022 I am sure we'll continue to understand even more as the months go by. Great info! Some didnt occur at all. These maps look significantly different from a lot of the others weve seen. Not all NTAs are ICD-10 codes, some are MDS items. 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. The Ultimate Guide to PDPM - Seagrove Rehab Partners 0000007482 00000 n
The NTA component is an important component to capture and reimburse the facility for costly medications, services, and supplies needed to care for residents. PDPM Goes Beyond Therapy: Finding the Hidden - Skilled Nursing News 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. 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. (difference of NE-NF and NA-NB). It more accurately accounts for expenses and isnt overshadowed by therapy. Sometimes the code may be a qualifier for other PDPM components, sometimes it won't be. MDS 3.0 Section I Thats a lot of white space. (At this point, I can feel the cold stares from our MDS Experts. It is highly advisable for MDS nurses to review each assessment to ensure that all skilled services are captured during the assessment period to maximize reimbursement rate for the facility based on the patients diagnosis and acuity. Refer to the PDPM Calculation Worksheet for more information. Conduct interview assessments for the Brief Interview for Mental Status (BIMS), and Mood ON ASSESSMENT REFERENCE DATE (ARD) OR A DAY PRIOR TO ARD. 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). These conditions may warrant completion of an Interim Payment Assessment (IPA) thus increasing the NTA component score and potentially the total per diem. Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. The non-therapy ancillary (NTA) classification of PDPM reinforces why ICD-10 coding plays a key role under PDPM. As a result, client facilities realize improved wound healing results, improved survey scores and NTA reimbursement under PDPM. 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). 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 (, Behavioral Symptoms and Cognitive Performance Problems, The Centers for Medicare and Medicaid Services (. Reducing Missed Non-Therapy Ancillary (NTA) Opportunities It is for this type of services they offer which also categorize them as skilled nursing and rehabilitation facilities becoming a, A long-term care facility provides custodial care requiring supervised, minimal or total dependence in the performance of the activities of daily living (. ) The Centers for Medicare & Medicaid Services (CMS) realizes that the cost impact of medications, at the time of admission, is extensive. The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. Speaking of individual facilities, lets take a look at that as well. 18% of the Nursing adjustment factor is multiplied to the Nursing rate only patients with diagnosis of AIDS. Focuses on clinically relevant factors rather than volume-based services or RUG levels. @ Homework - Chapter 31: HlTT x + . Yes, I get that is bad. Under PDPM there are 161 Minimum Data Set (MDS) item fields. 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. 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). you could miss something. Five are case-mix adjusted to allow for variances in diagnoses, severity of illness and other variables associated with the probability of improvement with treatment: Physical therapy (PT) - includes a variable per diem factor Occupational therapy (OT) - includes a variable per diem factor Hoo0Gw7I18J+-+hLC&QI$[3iB:s]:?\GqA ATc#(R2:nl/?e. ` 0!RJ3t f{ WN"Y@L1+;HXZL@\uB*4c*fi$1( )}hciksm2hn 1cU(YTS46ye&? &JHyBIQ fF Custodial care does not require the assistance of a licensed staff. HUO0~^iq3N&@-0*Si$L9)-ziwg';q_}(Ak"CwKi "@~|iA`!c Do whatever you want with a SKILLED: fill, sign, print and send online instantly. With postpartum preeclampsia, patients are now not seeing a health care provider by NCC News and Content Team | Jan 24, 2023 | Specialties. endstream
endobj
453 0 obj
<>stream
We earn. This could be a difference of $29.23 per day for Urban and $27.93 per day for a Rural facility. No software installation. ~,/-I\!/JfB. PDF PDPM HIPPS Coding Crosswalk - naviHealth The presence of these conditions and extensive services is reported by providers . On any device & OS. What do I need to know? CMS identified a . 0000008175 00000 n
Reimbursement for these services is covered under the State of Californias Medi-Cal program or privately paid by the patient if he/she does not qualify under the Medi-Cal program. Ensure you have staff who are trained in ICD-10 coding. The Patient-Driven Payment Model focuses on the patients unique characteristics and needs based on diagnosis which arise during inpatient hospital stay. 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. Remember this is using 2017 data so it assumes that providers make no adjustments which is not realistic. The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. 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. 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. 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. PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. z@~. 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. thead { Which codes are the most important? Research indicated that for those SNF patients with AIDS, NTA costs per day were 151% higher and wage-weighted nursing staff time was 18% greater than for other patients. Basic versions of many 2019 AHCA PDPM Academy copyrighted document resources and webinars are available to . (10 items fit). Primary Diagnosis - List I0020B Surgical Procedures - List J2100/J2300-J5000 Aphasia I4300 Cerebrovascular Accident . 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. NF is the lowest grouper with a score of 0, while NA is highest with a score of 12+. 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. 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 program has six payment components. PDF Patient Driven Payment Model - Missouri Long-Term Care Information Update Other diagnoses will affect the Non-therapy Ancillary (NTA) component. Often overlooked, Non-Therapy Ancillaries or NTAs will be more important than ever in PDPM. trailer
How often will the items on this list be available to you when you are doing the 5 day assessment? Click here to visit our shop. It more accurately accounts for expenses and isn't overshadowed by therapy. Highlights: 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. (2019). 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. PDPM includes a new pay category, the non-therapy ancillary or NTA. With every dollar spent on nutrition screening and interventions, the Academy of Nutrition and Dietetics has reported savings of $3.25 3. Copyright LW Consulting, Inc 2022. endstream
endobj
1698 0 obj
<>stream
;DktP'pm}iE/4K~bY?c~220E+t;sdvGHz P,
(This isnt going to work well on mobile devices, FYI.). PDF PMR MDS Items PDPM - nehca.org 0000006001 00000 n
Request for labs, imaging studies and surgical reports whichever is applicable. %PDF-1.4
%
Highlights: Hiring both part-time 2 days/week and full-time 4-5 days/week (benefits for FT only) Hours: Monday-Friday ~7am to 4pm; no evenings, weekends, call, or holidays . A}
2?d`aYW!3,8h|J/K\J:s&Ve>1|9WiixusVo\sGP8saBT!+(z$lYnAZZp@6Y1m`[ jKeMQ5i.7HCGIC1iGIc' Yes, you can, just not in I0020B. 0000278826 00000 n
We earn 2 NTA points if Diabetes is coded in MDS item I2900. A Knowledgeable and Compassionate partner. The higher the score, the higher the NTA rate. Just 1 NTA point can have an average worth of anywhere from $18 to $55 per day. PDPM (Patient-Driven Payment Model) | Let's Break It Down! xref
As a result, client facilities realize improved wound healing results, improved survey scores and NTA reimbursement under PDPM. But toward the end of January, reporter Maggie Flynn poked holes in the idea that ICD-10 mastery was a necessity. I0020 is also a gateway to the I0020B Primary Diagnosis code. Yes, I am aware that ICD-10 codes do change occasionally. 7 Tips for Using a PDPM Mapping Tool - experience.care For example, IV medications (5 points) coded in MDS item O0100H2 or isolation (1 point) coded in O0100M2. Once you have identified the condition/extensive service on the MDS or claim, the points associated with each comorbidity are added up for a total NTA score which is associated with 1 of the 6 case-mix groups shown below. 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. The more comorbidities a patient has, the more medications he or she probably requires. The MDS nurse should be alert to these changes to ensure timely completion of the required MDS assessment. background-color: #2c4a88; CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. PDPM - Focus on NTA - YouTube (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. Each patient has a different reimbursement rate as compared to the RUG-IV PPS rate in the past. 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. endstream
endobj
452 0 obj
<>stream
The correct coding for NTA will require a team effort and diligent review of coding and supporting documentation to ensure 100% accuracy. On day 4 it goes back to the rate shown. Hover over a facility to see the name, NTA Rate, NTA case-mix index and whether the facility is urban or rural. A frequent question: "If the mapping file lists a code as "return to provider", can I still use it on the MDS?". 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. SANE is an acronym that stands for Sexual Assault Nurse Examiner. 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. It will be imperative that the coding is accurate on the MDS for the NTA conditions. 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. (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. Lets breakdown the PDPM model to better understand how reimbursement is determined. 0000003037 00000 n
} One can see from the table above that if comorbidities are missed, the facility could possibly miss out on reimbursement. PDPM, Secret Lists, and New Rules: The Top Skilled Nursing Stories of Just 1 NTA point can have an average worth of anywhere from $18 to $55 per day. last. by Proactive LTC Consulting | Jan 6, 2020 | Audits, Compliance, Education, MDS, Medical Review, PDPM. As outlined in the SNF PDPM technical report, CMS was looking for the new reimbursement plan to account accurately and appropriately for the increased costs associated with caring for patients with AIDS. ;iHIBK
= >N]Y}dZ}HvtZ04D8YV4r4Od^/NJ x/i"9WirMdy2d*{E^lEu}Jg t@C`[aNOGgg0?bd'r EVm@Av;*%f?Wp
:1&[+cZhqhU;IKBU PDPM ICD10 Consulting Confidential 2019 A Native American-Owned business Page . Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. 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. For the Non-Therapy Ancillary Component, each diagnosis has a corresponding score which is multiplied to the federal NTA case mix index. 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 . 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 . Your PDPM Questions Answered - Part 4: Non-Therapy - Relias SNF PDPM Provider-Specific Impact File. Payment is based on services provided by five disciplines: physical therapy, occupational therapy, speech language pathology, nursing, and non-therapy ancillary (NTA). @.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 PDPM Clinical Categories are discussed below. 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. Nursing and NTA Components of PDPM - Hansen Hunter & Co. P.C. INTRODUCTION. Anyone involved with ICD-10 coding should have ready access to the coding guidelines. Educate yourself on the. Understanding the Value of the MDS Nurse Under PDPM, Psoriatic Arthropathy & Systemic Sclerosis, Myelodysplastic Syndromes and Myelofibrosis. This gives you enough time to prepare for their implementation of any changes as MDS assessments are time sensitive. .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. Points (1-8) are assigned to specific conditions. You are never alone in this field and resources are available in seminars, webinars, the CMS website, MDS manual, etc. In it, youll find the 1,612 codes that map to the different comorbidities. The choice of PDPM diagnosis has become rocket science for MDS nurses as this gives more weight in the calculation of the PDPM rate for the facility. 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. Think about this A resident with a Stage IV pressure ulcer has physician orders and Registered Dietician recommendations for a protein supplement. PDPM: Calculating your NTA comorbidity score - SimpleLTC Intermittent Catheterization? Custodial care does not require the assistance of a licensed staff. Retrieved from: https://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html, Center for Medicare and Medicaid Services.