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. The Patient-Driven Payment Model focuses on the patients unique characteristics and needs based on diagnosis which arise during inpatient hospital stay. Good talk. His I0020B Primary Diagnosis and his claim's Principal Diagnosis is now the aftercare of the hip fracture. This list of options is not used for PDPM payment, but is used as risk adjustments for some of the QRP Quality Measures. Also, there is a 25% combined limit on concurrent and/or group therapy. 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. As mentioned earlier, these NTA comorbidities are reported (coded) throughout the MDS. 0000003793 00000 n With this component being paid at a 3x rate for 1st 3 days of . Primary Diagnosis - List I0020B Surgical Procedures - List J2100/J2300-J5000 Aphasia I4300 Cerebrovascular Accident . 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. 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. 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. Zi@Ym"l?]L?*;YaRxwFhSGkhSFRQJIp.V4v!fbN91GE]Y:+s CMS identified 50 conditions and services that were related to an increased cost for skilled nursing facilities. 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. #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. Coding of these areas will affect the, Postpartum Preeclampsia Diagnosis and Management, Hyperemesis Gravidarum: More Than Just Morning Sickness. 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. While the SNF certs and the Therapy Certs may contain this documentation, they are often not signed or approved until after the ARD. 0000278826 00000 n 66y% Based on that, I have made you an extreme cheat sheet, that you should use with extreme caution. When also coded in I8000, I69.091 will also contribute again to the case mix group because it is on the SLP comorbidity list. No paper. b!+XQ{ +LgOIYe/Q6RVpYY_N/.~iMu1fY*eR}W_E[,7vrR!XSF};qZW&e"S5!CW}3GU|muc?_X`dcg7(zRU8k? Suctioning? or privately paid by the patient if he/she does not qualify under the Medi-Cal program. 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. NTA Componenet NTA Component NTA Comorbidity Score NTA Case Mix Group CMI 12+ NA 3.25 9-11 NB 2.53 6-8 NC 1.85 3-5 ND 1.34 1-2 NE 0.96 0 NF 0.72 Presumption of Coverage Comorbidities Included in NTA Comorbidity Score and Assigned Points Condition/Extensive Service MDS Item Points HIV/AIDS SNF Claim ICD-10 B20 8 Parenteral IV Feeding: Level High Remember, the CMS list is authoritative, mine is only for your convenience. The Patient-Driven Payment Model focuses on the patients unique characteristics and needs based on diagnosis which arise during inpatient hospital stay. The score determines NTA payment groups and indices. 0000009034 00000 n PDPM or Patient-Driven Payment Model is the new system, replacing the RUG-IV, for calculating reimbursement by Medicare in the skilled nursing setting. Involve the Interdisciplinary Team. Comorbidities associated with higher increases in NTA costs are grouped into higher point tiers, while those that are associated with lower increases in NTA costs are grouped into lower point tiers. These nurses are also trained to complete a full All Rights Reserved By Nursingcecentral 2022 |. Additionally, PDPM applies variable per diem payment adjustments to three components, PT, OT, and NTA, to account for changes in resource use over a stay. PDPM payments will be based on six groupsone non-case mix group (CMG) and five specific CMGs: PT, OT, SLP, NTA and nursing. 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 (. ) PDPM Series Part 4: Non-Therapy Ancillaries Case Mix Groups. PDPM Chart Audit Simple and Easy: Winning in PDPM Payment and Regulatory Strategies . List the 3 MDS items that qualify a resident for the Extensive Nursing Service group. Skilled nursing facilities now have more than a year of experience with the Patient-Driven Payment Model (PDPM), the updated case-mix classification system used in the Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS) that includes five case-mix-adjusted payment components: physical therapy (PT), occupational therapy endstream endobj 454 0 obj <>stream 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. 8cq1o22#|Bm1il,4iw&C|E^F+oq:>_|M\v+iTOigWJ:dCa$Qv_n/q|wCuukk+e';iJB2C &!Ar8c _~r Q: Our EMR system will calculate the BMI. Its important to comprehend more than just the basics of PDPM. They cant all be equally likely, right? But, since it's new, we're going to have to work on understanding how it's supposed to work, and how we can most easily and efficiently complete the assessment with accurate information. 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. These are: Physical Therapy (PT): 14 MDS items Occupational Therapy (OT): 14 MDS items Speech Language Pathology (SLP): 33 MDS items Nursing: 129 MDS items Non-Therapy Ancillary (NTA): 33 MDS items RUG-IV: Resource Utilization Groups version 4 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". 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 FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. I believe that this payment method acknowledges not only the skilled rehabilitation services provided to the patient, but also the complexity of skilled nursing services rendered to the patient and appropriately incorporated in the PDPM rate calculation. This simply shows you a starting point. Classroom Walkthrough Checklist Resource Center K 12 Resources Frontline Education April 18th, 2019 - Broken Arrow Public Schools a large urban suburban district with deep roots in the community serves more than 19 000 students Recognized as one of the top 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. $HJ0!$j-g#W d9bEi0~og$.J8-Lb =lZ.SSz|'!`%/ Inappropriate Schizophrenia Diagnosis/Coding and Survey Citation Posting, Regulatory Reminders: Consolidated Billing Update 2023, Osteomyelitis of vertebra, site unspecified, Other acute osteomyelitis, unspecified ankle and foot, Staphylococcal arthritis, unspecified knee, Other acute osteomyelitis, unspecified site, Pneumococcal arthritis, unspecified joint, Other chronic osteomyelitis, unspecified ankle and foot, Other acute osteomyelitis, unspecified tibia and fibula, Other chronic osteomyelitis, unspecified site, Direct infection of unspecified joint in infectious and parasitic diseases classified elsewhere, Staphylococcal arthritis, unspecified hip, Direct infection of unspecified knee in infectious and parasitic diseases classified elsewhere, Staphylococcal arthritis, unspecified shoulder, Other chronic osteomyelitis, unspecified tibia and fibula, Other acute osteomyelitis, unspecified femur, Direct infection of vertebrae in infectious and parasitic diseases classified elsewhere, Other chronic osteomyelitis, unspecified thigh, Direct infection of multiple joints in infectious and parasitic diseases classified elsewhere, Other acute osteomyelitis, multiple sites, Staphylococcal arthritis, unspecified ankle and foot, Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission, Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, Infection and inflammatory reaction due to unspecified internal joint prosthesis, initial encounter, Embolism due to internal orthopedic prosthetic devices, implants and grafts, initial encounter, Embolism due to vascular prosthetic devices, implants and grafts, initial encounter, Other mechanical complication of unspecified internal joint prosthesis, initial encounter, Dislocation of unspecified internal joint prosthesis, initial encounter, Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, initial encounter, Infection and inflammatory reaction due to internal fixation device of unspecified site, initial encounter, Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter, Other mechanical complication of aortic (bifurcation) graft (replacement), initial encounter, Other mechanical complication of other internal orthopedic devices, implants and grafts, initial encounter, Breakdown (mechanical) of internal fixation device of unspecified bone of limb, initial encounter, Infection and inflammatory reaction due to cardiac valve prosthesis, initial encounter, Mechanical loosening of unspecified internal prosthetic joint, initial encounter, Broken internal joint prosthesis, unspecified site, initial encounter, Embolism due to genitourinary prosthetic devices, implants and grafts, initial encounter, Secondary esophageal varices without bleeding, Secondary esophageal varices with bleeding, Alcoholic cirrhosis of liver without ascites, Antineoplastic chemotherapy induced pancytopenia, Agranulocytosis secondary to cancer chemotherapy, Acute respiratory failure, unspecified whether with hypoxia or hypercapnia, Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia, Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia, Acute and chronic postprocedural respiratory failure, Acute pulmonary insufficiency following thoracic surgery, Acute and subacute infective endocarditis, Acute and subacute endocarditis, unspecified, Endocarditis and heart valve disorders in diseases classified elsewhere, Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus, Epilepsy, unspecified, intractable, with status epilepticus, Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus, Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus, Respiratory bronchiolitis interstitial lung disease, Respiratory disorders in diseases classified elsewhere, Other alveolar and parieto-alveolar conditions, Idiopathic interstitial pneumonia, not otherwise specified, Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema, Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema, Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema, Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema, Morbid (severe) obesity due to excess calories, Morbid (severe) obesity with alveolar hypoventilation, Body mass index (BMI) 70 or greater, adult, Ulcerative colitis, unspecified, without complications, Crohns disease, unspecified, without complications, Other ulcerative colitis without complications, Ulcerative (chronic) pancolitis without complications, Ulcerative (chronic) proctitis without complications, Crohns disease of small intestine without complications, Crohns disease of large intestine without complications, Idiopathic aseptic necrosis of unspecified femur, Idiopathic aseptic necrosis of unspecified bone, Idiopathic aseptic necrosis of bone, other site, Systemic lupus erythematosus, organ or system involvement unspecified, Ankylosing spondylitis of unspecified sites in spine, Wegeners granulomatosis without renal involvement, Polymyositis, organ involvement unspecified, Dermatopolymyositis, unspecified, organ involvement unspecified, Systemic involvement of connective tissue, unspecified, Unspecified inflammatory spondylopathy, site unspecified, Refractory anemia without ring sideroblasts, so stated, Other specified disorders involving the immune mechanism, not elsewhere classified, Disorder involving the immune mechanism, unspecified. Variable Per Diem Adjustment Factors and ScheduleNTA. tr:nth-child(even) {background-color: #f2f2f2;} &)` R #V? U? Condition/Extensive Service Source Points Aseptic Necrosis of Bone MDS Item I8000 1 Asthma COPD Chronic Lung Disease MDS Item I6200 2 z@~. MDS 3.0 Section I Thats a lot of white space. We earn 1 NTA point and qualify for Nursing Category Special Care Low for a Stage IV Pressure Ulcer when coded in M0300. Perhaps the most "transformative" component relates to Non-Therapy Ancillary (NTA) Services. Consider adding the list of NTAs to current pre-admission screening forms or otherwise creating a way to identify and communicate potential conditions and services that may continue during the SNF stay. 0000001865 00000 n HVmo0)>bbJS:i>h4B6u~>!bB8lr lk4-M~V CIExej[_@{wpuCm/8yU\mqpC1!Ll%5##P:a,Orh[a%zDUd V#~RLXP9BZ,/Y798(|&a"#.G. How can a facility ensure that they are not leaving money on the table due to under-coded NTAs? 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). 0 DetI Rloh,mJLEo(DA"pd#Se.e)6d;[+I=R^2rcZ'F6C"x=*!J&[KL~^ogN3#)LNb}:QOd 0}pE` )S 26 11.4 Will section I0020B override section I0020, 1-13 for the primary reason for SNF admission since thead { F Notice there is a big pocket of low NTA rates that covers most of Iowa. Below is a summary of the determinants of payment and which section on the MDS assessment form they are derived from. The five CMGs then convert to a corresponding case mix index (CMI), which is a multiplier to the base rate for a particular CMG. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. Yes, I am aware that ICD-10 codes do change occasionally. Ensure you have staff who are trained in ICD-10 coding. Section I has a lot of items that can effect NTA pay. Resolved conditions should not be listed since therapy would not be treated for a resolved condition. 0000006770 00000 n INTRODUCTION. Reimbursement, LW Consulting, Inc.5925 Stevenson Avenue, Suite GHarrisburg, PA 17112, Ph:800-320-5401Local Ph: 717-233-6100Fx:717-233-4633. 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. ;DktP'pm}iE/4K~bY?c~220E+t;sdvGHz P, The presence of these conditions and extensive services is reported by providers . A year later, he falls and sustains a hip fracture. Yes, you can, just not in I0020B. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. The patients functional score which is coded on Section GG of the MDS form is derived by assessing the patients usual self-performance in the ADL task areas during the first three days of facility stay. This button displays the currently selected search type. Payment is based on services provided by five disciplines: physical therapy, occupational therapy, speech language pathology, nursing, and non-therapy ancillary (NTA). Comorbidities are assigned points based on the cost in care associated with the condition or service, with points ranging from 1 to 8. info@proactivemedicalreview.com, Blog by Jessica Cairns, RN, RAC-CT, CMAC, and Eleisha Wilkes, RN, RAC-CTA, Click to share on LinkedIn (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Twitter (Opens in new window), Deep Dive into Federal Regulations in a Year, Mission Possible: SNF Department Head Briefing, https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2020-Coding-Guidelines.pdf, https://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/PDPM_Fact_Sheet_NTAComorbidityScoring_v2_508.pdf, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/PDPM_Fact_Sheet_AIDS_v3_508.pdf, Special Treatments/Programs: Intravenous Medication Post-admit Code, Special Treatments/Programs: Ventilator or Respirator Post-admit Code, Special Treatments/Programs: Transfusion Post-admit Code, Major Organ Transplant Status, Except Lung, Active Diagnoses: Multiple Sclerosis Code, Active Diagnoses: Asthma COPD Chronic Lung Disease Code, Bone/Joint/Muscle Infections/Necrosis Except: Aseptic Necrosis of Bone, Active Diagnoses: Diabetes Mellitus (DM) Code, Other Foot Skin Problems: Diabetic Foot Ulcer Code, Special Treatments/Programs: Tracheostomy Care Post-admit Code, Active Diagnoses: Multi-Drug Resistant Organism (MDRO) Code, Special Treatments/Programs: Isolation Post-admit Code, Specified Hereditary Metabolic/Immune Disorders, Special Treatments/Programs: Radiation Post-admit Code, Stage 4 Unhealed Pressure Ulcer Currently present, Psoriatic Arthropathy and Systemic Sclerosis, Proliferative Diabetic Retinopathy and Vitreous Hemorrhage, Other Foot Skin Problems: Foot Infection Code, Other Open Lesion on Foot Code, Except Diabetic Foot Ulcer Code, Complications of Specified Implanted Device or Graft, Bladder and Bowel Appliances: Intermittent catheterization, Special Treatments/Programs: Suctioning Post-admit Code, Myelodysplastic Syndromes and Myelofibrosis, Systemic Lupus Erythematosus, Other Connective Tissue Disorders, and Inflammatory Spondylopathies, Diabetic Retinopathy Except: Proliferative Diabetic Retinopathy and Vitreous Hemorrhage, Nutritional Approaches While a Resident: Feeding Tube, Disorders of Immunity Except: RxCC97: Immune Disorders, Pulmonary Fibrosis and Other Chronic Lung Disorders. Everyone I've talked to agrees the NTA payment is a good idea. 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. HUMk@(h; ! 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. (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. I wish I could be in your training the 29th. The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. Facilities must ensure efficient processes are in place when selecting the primary diagnosis. Other ancillary services include room and board, activity planning, housekeeping, laundry, and maintenance of fixtures/equipment. View fullsize Patients are assigned a clinical category based on the primary diagnosis for SNF stay. . 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. These residents may have a significant number of inaccurate or resolved diagnoses if a facility doesnt have a process for ongoing diagnosis reconciliation. The NTA component, together with the nursing and non-case mix components, make up the total reimbursement for a patient day under Medicare Part A. NTA classification is based on the presence of certain comorbidities or use of certain extensive services. Sometimes the code may be a qualifier for other PDPM components, sometimes it won't be. Le^#N"TaAKTt The PT and OT payment would be based on: primary reason for SNF care and functional status at admission The sum of the lowest per diem rate under each PDPM component, plus the non-case-mix component is the: default code Which of the following is NOT a case-level adjustment for a MS-LTC-DRG long term stay outlier The PDPM classification system is based on support of the patients characteristics. Do whatever you want with a SKILLED: fill, sign, print and send online instantly. Five of the six are case-mix adjusted. Remember that after the 3 day interrupted stay he is considered a new admission for purposes of Part A PDPM. Refer to RAI pages J37-J38 for more on coding J2100. These groups and indices, combined with other components of the payment system, provide a total reimbursement process that 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. 0000006001 00000 n SNF FY 2022 Proposed Rule Learn the Facts Behind the Headlines Part 3: How is My Rate Calculated, Regulatory Reminder! startxref ;iHIBK = >N]Y}dZ}HvtZ04D8YV4r4Od^/NJ x/i"9WirMdy2d*{E^lEu}Jg t@C`[aNOGgg0?bd'r EVm@Av;*%f?Wp :1&[+cZhqhU;IKBU All PDPM components are assigned an appropriate score to multiply to the federally assigned case mix index group. 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 Intermittent Catheterization? 18% of the Nursing adjustment factor is multiplied to the Nursing rate only patients with diagnosis of AIDS. SNF PDPM Provider-Specific Impact File. Learn more about Jessica, Eleisha, and the rest of the Proactive team. The provider will report on the Minimum Data Set (MDS) each of the comorbidities that a person has. 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. The non-therapy ancillary (NTA) classification of PDPM reinforces why ICD-10 coding plays a key role under PDPM. Patient has at least three qualifying inpatient days in an acute hospital. This has been a key consideration in designing the various elements of the new model. Other specific items will be recorded in various parts of the MDS including Section K, M, N, and O. 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). 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. The categories impact a resident's case-mix classification. 1=BY)#CT 'a7bA(XdHE ? 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. 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 Centers for Medicare and Medicaid Services (CMS) have provided the SNFs with a list of ICD-10-CM codes mapping to one of the clinical categories: These clinical categories are used as the Primary PDPM diagnosis giving weight to the calculation of PDPM rates for PT, OT, SLP and Nursing components. 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 (. Often overlooked, Non-Therapy Ancillaries or NTAs will be more important than ever in PDPM. This article was originally published in February 2019, and has been updated in October 2019 with several more tips. PDPM includes a new pay category, the non-therapy ancillary or NTA. 0000002491 00000 n Conduct interview assessments for the Brief Interview for Mental Status (BIMS), and Mood ON ASSESSMENT REFERENCE DATE (ARD) OR A DAY PRIOR TO ARD. trailer HUO0~^iq3N&@-0*Si$L9)-ziwg';q_}(Ak"CwKi "@~|iA`!c Focuses on clinically relevant factors rather than volume-based services or RUG levels. color: white; As a result, client facilities realize improved wound healing results, improved survey scores and NTA reimbursement under PDPM. 0000002280 00000 n endstream endobj 447 0 obj <> endobj 448 0 obj <> endobj 449 0 obj [278 0 0 0 0 889 0 0 333 333 0 0 278 333 0 278 556 556 556 556 556 556 556 556 556 556 278 0 0 584 0 0 0 667 667 722 722 667 611 778 722 278 500 667 556 833 722 778 667 0 722 667 611 722 667 944 0 667 0 0 0 0 0 0 0 556 556 500 556 556 278 556 556 222 222 500 222 833 556 556 556 0 333 500 278 556 500 722 500 500 500] endobj 450 0 obj <>stream For example, if a resident admits and the dietitian notes the BMI is over 40, query the physician to confirm a morbid obesity diagnosis. } 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. 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. I am sure we'll continue to understand even more as the months go by. The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. 0000002038 00000 n With every dollar spent on nutrition screening and interventions, the Academy of Nutrition and Dietetics has reported savings of $3.25 3. Not all NTAs are ICD-10 codes, some are MDS items. Item I0020 and I0020B: Item I0020 (primary medical condition category that best describes the primary reason for admission lists several options. The higher the total point value, the greater the payment (CMI). Explain the impact of the variable per diem rate in the NTA component and how it impacts PDPM payment. The more comorbidities a patient has, the more medications he or she probably requires. Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing components. Below is the full listing of conditions and services used for NTA classification and the associated number of points for that comorbidity. 3HFDRkse$:stHqPJoHK-qL_sh|Kg?unioWAsfH8[^9{'~-? 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 The skilled services are provided by a Medicare-certified SNF. When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. The patients NTA comorbidity score is the sum of the points associated with each relevant comorbidity. 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. These components for classification and payment include: Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST), Non-therapy Ancillary (NTA) as well as Nursing. You are never alone in this field and resources are available in seminars, webinars, the CMS website, MDS manual, etc. To find out if you're leaving any money on the table email MDS Consultants for a PDPM review at info@mds-consultants.com, Find the PDPM ICD-10 Mapping tool at: https://mds-consultants.com/helpful-cms-info/, PDPM step-by-step scoring guide at https://mds-consultants.com/mds-tools/, https://mds-consultants.com/helpful-cms-info/, Coding N2001 N2005: Part A Drug Regimen Review, The Struggle with Antipsychotic Reduction .

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