Re-calculate expected daily rate based on the completed Rehab and Nursing Functional Scores and re-review principal diagnosis. z@~. In this fourth webinar of our six part series, learn which items on the MDS or Medicare claim will be used to determine the NTA score and its impact on payment. 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. Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). (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. 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 3HFDRkse$:stHqPJoHK-qL_sh|Kg?unioWAsfH8[^9{'~-? They are assisted by certified nursing assistants (. @.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; code. Contact us now and sign up to receive our newsletters here. At first, it took me longer to get used to making calculations in determining the highest allowable rate for the patient. When the severe skin burn is also coded in MDS section I8000, we qualify for the Nursing Clinically Complex Category. (Right). 0000002491 00000 n 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. Which codes are the most important? to The higher the total point value, the greater the payment (CMI). The RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. On day 4 it goes back to the rate shown. HUO0~^iq3N&@-0*Si$L9)-ziwg';q_}(Ak"CwKi "@~|iA`!c (Click either image to enlarge.). 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. 0 b!+XQ{ +LgOIYe/Q6RVpYY_N/.~iMu1fY*eR}W_E[,7vrR!XSF};qZW&e"S5!CW}3GU|muc?_X`dcg7(zRU8k? 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". Far more items than would actually fit on the MDS 3.0 Instrument. 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. 437 0 obj <> endobj 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: MDS Item Field rows in tan represent MDS item groups identified in CMS PDPM documentation and do not have data entry fields. When reviewing the CMI components driving PDPM reimbursement it's important to consider the critical role of the Non-Therapy Ancillary (NTA) score. 0000004207 00000 n Stay tuned. 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. 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. The most up to date guidelines are available at. 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. 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 . 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. Involve the Interdisciplinary Team. 0000001085 00000 n 0000006001 00000 n While the SNF certs and the Therapy Certs may contain this documentation, they are often not signed or approved until after the ARD. #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. A} 2?d`aYW!3,8h|J/K\J:s&Ve>1|9WiixusVo\sGP8saBT!+(z$lYnAZZp@6Y1m`[ jKeMQ5i.7HCGIC1iGIc' Specialties What Is a SANE Nurse? 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. Resolved conditions should not be listed since therapy would not be treated for a resolved condition. F 0000003793 00000 n 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. Custodial care does not require the assistance of a licensed staff. Payment is based on services provided by five disciplines: physical therapy, occupational therapy, speech language pathology, nursing, and non-therapy ancillary (NTA). Ill also compare urban versus rural facilities when it comes to NTA case-mix. 8cq1o22#|Bm1il,4iw&C|E^F+oq:>_|M\v+iTOigWJ:dCa$Qv_n/q|wCuukk+e';iJB2C &!Ar8c _~r ! 0000277284 00000 n 0000011153 00000 n Do whatever you want with a SKILLED: fill, sign, print and send online instantly. Under PDPM, Section GG drives PT and OT, and nursing which affects reimbursement. They cant all be equally likely, right? The table below shows how the sum of the NTA points converts to an NTA Case Mix Group and a corresponding NTA CMI. Securely download your document with other editable templates, any time, with PDFfiller. Skilled nursing services are covered under the Federal Governments. Primary Diagnosis - List I0020B Surgical Procedures - List J2100/J2300-J5000 Aphasia I4300 Cerebrovascular Accident . 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. 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 PDPM program has six payment components. It's easy to get to those 50, but the tricky part is understanding which ICD-10 codes match to the comorbidities. Refer to RAI pages J37-J38 for more on coding J2100. How should you prioritize your search for ICD-10 codes? Often overlooked, Non-Therapy Ancillaries or NTAs will be more important than ever in PDPM. The long-term care facilities have emerged not only as a permanent home for the elderly during their retirement or post-retirement years but as respite and recuperative facilities even for the younger patients. With several big changes ahead, the margin for error slim for most providers. hb```b``ia`e`ff@ a(meU=r%::@`uH@V01:000x1p`5`gy4AuG/Dg* ZF:&'[-@ >` t!R xref 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 RUG-IV consists of two case-mix adjusted components: Therapy which is based on volume of services provided and nursing. endstream endobj 1696 0 obj <>stream This isnt exactly a new problem, but it didnt drive reimbursement before. 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. Below is the full listing of conditions and services used for NTA classification and the associated number of points for that comorbidity. 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. His I0020B Primary Diagnosis and his claim's Principal Diagnosis is now the aftercare of the hip fracture. (By the way, we created a PDPM Calculator for you to experiment with and get a better understanding of how PDPM works. Under PDPM, an adjustment is applied to certain PDPM components that varies the per diem payment over the course of the stay. Remember that on the therapy plan of care the Treatment Diagnoses should be directly linked the Medical Diagnoses. 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. 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. You are never alone in this field and resources are available in seminars, webinars, the CMS website, MDS manual, etc. This item includes diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. We earn 1 NTA point and qualify for Nursing Category Special Care Low for a Stage IV Pressure Ulcer when coded in M0300. This simply shows you a starting point. This NTA CMI is added to the other components to calculate the total reimbursement for the patient. .com NTA Diagnosis Tool CMS identified a list of 50 conditions and extensive services associated with increases in NTA costs. Yes, you can, just not in I0020B. (I did abbreviate a few of the names for sanity.) CMS identified 50 conditions and services that were related to an increased cost for skilled nursing facilities. 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. Facilities must ensure efficient processes are in place when selecting the primary diagnosis. 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. 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. 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. On any device & OS. 0000006770 00000 n . Based on that, we can calculate the rate. For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. (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. These clinical categories are PT, OT, and SLP. 0000007482 00000 n For the NTA, an adjustment factor of 3.0 is applied to the total NTA CMI for days 1-3. 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. The more comorbidities a patient has, the more medications he or she probably requires. Items on this list could change at any time with new legislative and A year later, he falls and sustains a hip fracture. But toward the end of January, reporter Maggie Flynn poked holes in the idea that ICD-10 mastery was a necessity. Points are added together for all conditions. thead { 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. ENSURE TO CAPTURE EVERYTHING PRIOR TO COMPLETION OF THE 5-DAY MDS ASSESSMENT! "FE"u PsFO;416ib_z/[E>#~.G+Y6l|)31}Q50B}Wk?/1wo USIek~)zR*u:1\np2}HPs}@I#RM=e1JtJ22;3(TYt&8W1UN@ID7{V Z +MykUW? 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. 0000009034 00000 n Reimbursement for these services is covered under the. Determinant for payment is based on the number of therapy minutes provided regardless of residents acuity, diagnosis and other skilled nursing services provided. For the Non-Therapy Ancillary Component, each diagnosis has a corresponding score which is multiplied to the federal NTA case mix index. A Knowledgeable and Compassionate partner. Either way, you must still also code the I0020B primary condition I0010 through I8000. Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing components. 0000189184 00000 n requires an analytical mind and financial knowledge to determine the highest allowable reimbursement for the facility. Yes, I am aware that ICD-10 codes do change occasionally. PDPM Series Part 4: Non-Therapy Ancillaries Case Mix Groups. CMS Hover over a facility to see the name, NTA Rate, NTA case-mix index and whether the facility is urban or rural. For example, an NTA comorbidity score of 11 equals a CMI of 2.53. 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). Other specific items will be recorded in various parts of the MDS including Section K, M, N, and O. CMS 100-2 Chapter 8 Series Part I: Access to Medicare Part A Benefits In a SNF. 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. Other diagnoses will affect the Non-therapy Ancillary (NTA) component. The five CMGs then convert to a corresponding case mix index (CMI), which is a multiplier to the base rate for a particular CMG. Lastly, lets look a little more closely at rural versus urban. the design of the PDPM case-mix system implemented in FY 2020. (difference of NE-NF and NA-NB). This update addresses two issues with the NTA comorbidities mapping. Do not be apprehensive to query the physician if a diagnosis is not clear or is suspected and not documented. 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. You can also zoom in to see detail. 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). NF is the lowest grouper with a score of 0, while NA is highest with a score of 12+. Functional scoring is one of the factors used to calculate the PDPM rate for the PT, OT and Nursing components. SANE is an acronym that stands for Sexual Assault Nurse Examiner. 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. Try Now! But, since its new, were going to have to work on understanding how its supposed to work, and how we can most easily and efficiently complete the assessment with accurate information. background-color: #2c4a88; 0000004542 00000 n Was there a need for an IV? 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). We earn. A frequent question: "If the mapping file lists a code as "return to provider", can I still use it on the MDS?". 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 . Retrieved from: https://www.cms.gov/Medicare/Quality-Initiatives-Patient- Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html, Center for Medicare and Medicaid Services. If your facility has a low NTA rate, it may just mean you have work to do, documentation-wise. Explain the impact of the variable per diem rate in the NTA component and how it impacts PDPM payment. Anyone involved with ICD-10 coding should have ready access to the coding guidelines. Non-Therapy Ancillary (NTA) Services - At a Glance The Patient-Driven Payment Model (PDPM) takes effect on October 1, 2019 and represents a significantly different approach to reimbursement for care in Skilled Nursing Facilities (SNFs). The FY 2022 SNF PPS Final Rule: Learn the Facts behind the headlines Part 2 ICD-10 Revisions and PDPM. 0000000016 00000 n Reimbursement, LW Consulting, Inc.5925 Stevenson Avenue, Suite GHarrisburg, PA 17112, Ph:800-320-5401Local Ph: 717-233-6100Fx:717-233-4633. 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. We earn 1 NTA point for second or third degree burn coded in M1040F. These residents may have a significant number of inaccurate or resolved diagnoses if a facility doesnt have a process for ongoing diagnosis reconciliation. 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? Below is a summary of the determinants of payment and which section on the MDS assessment form they are derived from. 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. The provider will report on the Minimum Data Set (MDS) each of the comorbidities that a person has. 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. Complete Section K ON ARD or a DAY PRIOR TO ARD indicating if resident has a swallowing disorder especially if on a mechanically altered diet (Puree or mechanical soft diet). yid T[KaEev0D/wRDQhDB['QgDTBEB)2"xt"Xn2 QN[%=> FhzdBI^8/HD No software installation. Ive done that for urban and rural for every state. %PDF-1.6 % SNF PDPM Provider-Specific Impact File. For RUGs IV PPS, the payment is based on a per diem rate that is constant for the entire length of stay. CMS identified a list of 50 conditions and extensive services that were associated with increases in NTA costs. Dietitians are classified in the NTA discipline. you could miss something. 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. Copyright LW Consulting, Inc 2022. We earn 1 NTA point if we code Protein or Calorie Malnutrition/At Risk for Protein or Calorie Malnutrition in MDS item I5600. These groups and indices, combined with other components of the payment system, provide a total reimbursement process that This problem isnt new either but now it will drive reimbursement. Which codes are you most likely to actually see in the wild? h4Pj0^z[ 8 >BRA$+Vfa 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. First, it corrects an issue where diagnosis codes were mapped to NTA comorbidities as 1 to 1 mappings where 1 to 2 mappings were intended from the PDPM_ICD10_Mappings_FY20XX Excel sheet. Comorbidities are assigned points based on the cost in care associated with the condition or service, with points ranging from 1 to 8. PATIENT DRIVEN PAYMENT MODEL |4 . 0000002038 00000 n 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 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. With every dollar spent on nutrition screening and interventions, the Academy of Nutrition and Dietetics has reported savings of $3.25 3. With supportive documentation, it can be coded in I5600. Custodial care does not require the assistance of a licensed staff. HUMk@(h; ! CMS identified a . The Patient-Driven Payment Model focuses on the patients unique characteristics and needs based on diagnosis which arise during inpatient hospital stay. When expanded it provides a list of search options that will switch the search inputs to match the current selection. Lets breakdown the PDPM model to better understand how reimbursement is determined. The functional scoring is based on residents performance in 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. I0020 is also a gateway to the I0020B Primary Diagnosis code. Observation services are not covered as part of the inpatient stay. Not having the correct codes can have a domino effect and result in missed reimbursement, or claim inaccuracies. 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. (Note that this map is showing ONLY the NTA rate. 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). 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. Center for Medicare and Medicaid Services. <<50FFC127310FCF468ABFE4B7414A5B70>]/Prev 423154>> Refer to the PDPM Calculation Worksheet for more information. Patients rely on you. Click the comorbidity and see the ICD-10 codes that are most likely to occur. An NTA comorbidity score of 12 = a CMI of 3.24. How can a facility ensure that they are not leaving money on the table due to under-coded NTAs? Previous articles in this series outlined the physical and occupational therapy component and the speech language pathology component. IV medications provided as a resident and coded in Section O would also qualify for NTA points. The Clinical Categories by Diagnosis mapping file only applies to the code listed in I0020B. 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. All PDPM components are assigned an appropriate score to multiply to the federally assigned case mix index group. The saying, haste makes waste applies in the completion of MDS assessments and calculation of the maximized PDPM rate for the patient. Verify coding, dont assume. Under PDPM there are 161 Minimum Data Set (MDS) item fields. This article was originally published in February 2019, and has been updated in October 2019 with several more tips. Title: Microsoft Word - FINAL PDPM Triple Check Checklist.docx Author: jleatherbarrow Created Date: 1/29/2020 4:19:17 PM (Nursing, Social Services, Dietary and Activity Staff). 0000002742 00000 n As mentioned earlier, these NTA comorbidities are reported (coded) throughout the MDS. All about coding rehabilitation for joint replacements: Its important to know the reason for the joint replacement since coding a joint replacement due to a fracture is different than when a joint replacement is due to an elective surgery. 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. Welcome to Gravity healthcare Consulting & Online Education Hoo0#=)HU64*)T%DH!$swwb4fc|i]\/8gr? Specialties Hyperemesis Gravidarum: More Than Just Morning Sickness Pregnancy and nausea are terms used in unison with one another. Each component has its case mix index to determine the component rate. The score determines NTA payment groups and indices. We earn 2 NTA points if Diabetes is coded in MDS item I2900. 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. 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.

Maher Funeral Home Obituaries, Accident On 127 In Mercer County, Ohio, Articles P