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. It can be very difficult to select ICD-10 codes with appropriate specificity for the NTA component—or for any other PDPM component—if NACs don’t know how to do ICD-10 coding,” says Tracy Montag, BSN, RN, RAC-MT, clinical consultant with the Senior Living Services Consulting Group at RKL LLP in York, PA. “Sometimes, busy NACs will use whatever simple term or unspecified ICD-10 code that the physician writes down. You also will want to alert the nursing team about any areas where you may want to focus nursing documentation to support the coding of those NTA qualifiers. The provider will report on the Minimum Data Set (MDS) each of the comorbidities that a person has. 9/20/2019 2 RUG-IV Classifies residents into a therapy RUG based on therapy minutes and days. This list of options is not used for PDPM payment, but is used as risk adjustments for some of the QRP Quality Measures. For example, what was the resident’s history and physical (H&P) when they were first admitted to the acute-care hospital? A resident’s NTA score is the sum of the points associated with each comorbidity that they have. PDPM MDS Items ! Blog Through Change – Patient Needs Remain the Same Overview. The PDPM will now include an NTA category based on a point system. “Think of it as an overall chart/MDS discussion that includes a focus on the NTA qualifiers. Items on this list could change at any time with new legislative and For example, some dietitians will write out a note to the physician, and the physician will co-sign to say, ‘I agree this resident is at risk for malnutrition.’”, Part of this education should focus on interdisciplinary communication requirements, adds Dow. The impact of recognizing Morbid obesity and Malnutrition for NTA capture under PDPM Source: Table 16, Chapter 6, RAI User’s Manual. o. Comorbidities associated with high increases in NTA costs grouped into various point tiers. “You need additional input from these interdisciplinary team members because of two factors: (1) The NTA qualifiers morbid obesity, which is coded in item I8000 (1 point), and malnutrition, which is coded in I5600 (1 point), and (2) The coding in section K—items K0100 (Swallowing Disorder) and K0510C2 (Mechanically Altered Diet While a Resident)—that helps drive the SLP payment component.”, NACs may need to do retraining to ensure that dietary managers and dietitians understand how these items are coded, says Montag. “For example, d, Occasionally, a physician-documented diagnosis may not be strictly required, points out Dow. She has PDPM expertise as well as Pennsylvania and Maryland Medicaid Case-Mix expertise. LATEST PDPM WEBINAR: OPTIMAL REIMBURSEMENT DURING COVID-19. The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. Video PDPM – Communication and Collaboration PDPM Overview. If the resident receives TPN while in the SNF, you will see higher NTA … PDPM: Patient Driven Payment Model PDPM […] PDPM coding questions? NACs need to have the education and training to be able to identify opportunities to collaborate with the physician and confirm a more specific diagnosis.”. 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. Under PDPM, CMS identified 50 conditions that were related to increases in NTA costs for a skilled nursing facility (SNF). TRAINING & WEBINAR LIBRARY. You want to be able to flip through the NTA list and other PDPM references any time you do a chart review. Are there any surgical reports? PDPM: NTA (Non Therapy Ancillary) Supporting Documentation. Q: ... then you can code the Z code for BMI >40 and get the NTA point for morbid obesity without having specific MD documentation of “morbid” obesity, as BMI is one of the few ICD-10 codes that can be assigned based on documentation from clinicians other than … The PDPM system is case-mix index combining which Prep Your Restorative Nursing Program for PDPM. Access Materials. Points assigned for each additional comorbidity present, with more points awarded for higher-cost tiers • PDPM MDS Items ! Conditions/Extensive Service. The Centers for Medicare & Medicaid Services (CMS) realizes that the cost impact of medications, at the time of admission, is extensive. • NTA component receives 300% of the base per-diem rate for days 1-3 of a stay. PDPM coding questions? PDPM is still less than two years old, and it just takes time to memorize how each of the components works.”. Documentation by the physician and nursing must also support the skilled nature of the codes that are recorded as NTA conditions. 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 PDPM’s NTA component, and they also receive a special 18% add-on to the nursing component of the payment. Consequently, not only do you need to review auto-populated diagnoses to ensure they are still active, but you also need to make sure they are coded in the correct MDS item to satisfy the requirements for an NTA comorbidity or for any other PDPM payment component.”. Title: Book1 Author: “Therefore, there must be a physician-signed diagnosis, and that diagnosis must be considered active within the seven-day lookback period for every NTA diagnosis captured in section I. PDPM – Focus on NTA Often overlooked, Non-Therapy Ancillaries or NTAs will be more important than ever in PDPM. When reviewing the CMI components driving PDPM reimbursement it’s important to consider the critical role of the Non-Therapy Ancillary (NTA) score. Classifications for NTA points range from 0 points to 12 points. CMS identified 50 conditions and services that were related to an increased cost for skilled nursing … Here is the example for the NTA Component from LWCI’s PDPM Rate Chart that is available for purchase on the LWCI Learning Center. Next Steps & Resources As we prepare for PDPM implementation, one thing a facility can start doing now is familiarizing themselves with the list of NTA conditions, comorbidities and extensive services. “More than half of the NTA comorbidities derive from ICD-10-CM codes captured in item I8000 (Additional Active Diagnoses). “For example, five of the seven allowable ICD-10 codes that qualify a resident for morbid obesity in the FY 2021 NTA Comorbidity to ICD-10-CM Mapping are actually body mass index (BMI) diagnoses. Use the mapping tool to learn NTA’s ICD-10 coding options, 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 that are captured in item I8000 to allowable ICD-10 codes. About; Partners; Leadership; Careers; News & Stories; Support; Select Page. Category: Blog Topics: Long-Term Care Share: PDPM got started on October 1, 2019. 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 User’s Manual. NTA PDPM Quick Guide. Read more. For permission to use or reproduce this article in full or in part, please complete a permissions form. The patient’s NTA comorbidity score is the sum of the points associated with each relevant comorbidity. PDPM; COVID-19 Resource Center; Company. “The dietitian should know that if they assess that a resident meets the criteria for malnutrition or morbid obesity, they should flag the NAC using e-mail or whatever interdepartmental communication system the facility uses. SNF Claim: 8. In RUGs-IV, the more assistance a resident needed would result in a higher Section G score ! SLP-related comorbidities: ¨ Laryngeal Cancer; ¨ Apraxia; ¨ Dysphagia; ¨ ALS; ¨ Oral Cancers; ¨ Speech and Language Deficits. NTA Comorbidity Score; PDPM Patient Classification; Variable Per Diem Adjustment; PDPM Frequently Asked Questions. CMS’ data study showed that costs remain relatively constant over time after the fourth day of stay, so they return to an adjustment factor of 1.0. Kay Hashagen, Senior Consultant. The list can be found on pages 35-38 in the CMS PDPM Presentation. These conditions, along with the number of points associated with the condition and how it is reported, can be found by downloading the CMS document titled “Fact Sheet: NTA Comorbidity Score. PDPM reduces the number of classifications from the previously proposed RCS-1 plan by 80%. PDPM FAQs (ZIP) (revision posted 8-30-19) Go to top PDPM Training Presentation This section … You Are Here:Home/Today in Long-Term Care. Before that, we had RUG scores. PDPM 101: What Skilled Nursing Providers Need to Know Now Far and away SNN’s most-read story of 2019, this rundown of PDPM basics caught on with readers when it was published in late March — and then again during the frantic lead-up to the payment model’s implementation at the beginning of October, when it would routinely pop up in our top stories of … Overview. The NTA comorbidities are based on a point system. PDPM and Non-Therapy Ancillaries The non-therapy ancillary (NTA) part of the patient driven payment model (PDPM) is considered by most people I've talked to as being better than what we're currently doing. 26 11.4 Will section I0020B override section I0020, 1-13 for the primary reason for SNF admission since “You want to look through all of the key records that may have been signed off by a physician and that that you can pull diagnoses from. ... We earn 2 NTA points if … NTA comorbidities are documented in the MDS and require a physician’s diagnosis and accurate ICD-10 code. Optimize ICD-10 coding practices and maximize PDPM revenue with our free Diagnosis Explorer tool. PDPM is turning what we knew with regard to the Resource Utilization Groups on its head. Medical Diagnosis, Orders, MAR/TAR, Nursing Admission Data Collection UDA, Daily Skilled Charting UDA, Nutrition UDAs, Pain UDAs, Braden Scale UDA, Wts/Vitals, Care … There’s a big difference between the two and by the time you finish this article in a few minutes you’ll have at least the basics down and you’ll know how much you should be getting paid! White Paper ICD Coding and PDPM PDPM Overview. I0020 is also a gateway to the I0020B Primary Diagnosis code. A critical takeaway in the scoring of Section GG in PDPM, as compared to Section G in RUGs IV scoring, lies within the analysis of the per diem rates for nursing, physical therapy and occupational therapy. The idea is that the facility should be paid for the care they are delivering, based on the patient’s characteristics. 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. Blog Top Five PDPM Myths Busted! Under PDPM, there are so many payment ‘balls in the air’ when you do a PPS MDS. And some of the areas providers capture within those categories could be the target of audits by the government. PDPM is new for SNFs. Therefore, a resident with an NTA comorbidity score of 10 would qualify for the NB NTA case-mix group. “NACs, especially new NACs, should keep that list handy. NTA FAQS Your PDPM Resource “For example, the software will code a diagnosis in I8000, but will fail to auto-populate the corresponding checkbox in I0100 – I6500. o. CMS has added diagnosis codes to the list with the seventh digit of D for use in the ICD-10 code mapping to the NTA comorbidity CC176 “Complications of Specified Implanted Device or Graft” to calculate the PDPM NTA score. 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 (OT), speech-language pathology (SLP), nursing, and non-therapy ancillaries (NTA). New PDPM HIPPS Code. List the key factors for costs predictive of the OT/PT components of PDPM; List the five SLP components of PDPM, to include the required documentation supporting the presence of each component ; Identify the determination factors for classifying a resident into a Non-Therapy Ancillary (NTA) case‐mix group; Recognize the key changes to MDS Assessments, when comparing RUG-IV to PDPM… Therapy RUGs are used to bill over 90% of Part A days PDPM Moves away from … Access Materials. Email: Contact Us, The list of NTA comorbidities is extensive,” acknowledges, Note: The Centers for Medicare & Medicaid Services (CMS) lists the NTA comorbidities in table 16, “NTA Comorbidity Score Calculation,” in chapter 6 of the, in I0100 – I6500. Learn why in this video from Aegis Therapies. For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. “For example, 14 diagnosis codes can be coded in I8000 to qualify a resident for the lung transplant status NTA comorbidity (3 points), 27 diagnosis codes can qualify for the cardio-respiratory failure and shock NTA comorbidity (1 point), and 124 diagnosis codes can qualify for the proliferative diabetic retinopathy and vitreous hemorrhage NTA comorbidity (1 point).”, While unable to diagnose, NACs can use the NTA Mapping tool to identify potential diagnoses, says Montag. Under PDPM, an adjustment is applied to certain PDPM components that varies the per diem payment over the course of the stay. For example, a resident with IV medications (5 points) coded in MDS item O0100H2, diabetes mellitus (2 points) coded in I2099, isolation (1 point) coded in O0100M2, and wound infection (2 points) coded in I2500 would have a total NTA comorbidity score of 10. Not exactly. 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 … This could be a difference of $29.23 per day for Urban and $27.93 per day for a Rural facility. 9/20/2019 2 RUG-IV Classifies residents into a therapy RUG based on therapy minutes and days. PDPM Overview Effective Oct 1, 2019 (FY20) Nov2018 Judy Wilhide Brandt, RN, BA, CPC, QCP, RAC-MT, DNS-CT 909-800-9124 ... NTA = non-therapy ancillaries 5 Non-Case Mix Nursing NTA PT ST OT NTA = non-therapy ancillaries 6 Non-Case Mix Nursing NTA PT ST OT Full component rate for days 1 –20, then both American Association of Nurse Assessment Coordination (AANAC) The NTA … Non-therapy RUGs were based on certain resident characteristics. It is important to be aware of the conditions to look for that contribute to NTA points, as many of these have historically been omitted from diagnosis coding on the MDS 3.0. The bottom line is that accurate payment in the NTA component depends on coding each and every NTA comorbidity the resident qualifies for according to the coding instructions in the RAI User’s Manual. This section contains frequently asked questions (FAQs) related to PDPM policy and implementation. CMS' Final Rule states Patient-Driven Payment Model (PDPM) will replace the current RUG-IV system October 1, 2019. With the major shift from RUG-IV to PDPM, our post-acute care experts have received a multitude of questions revolving around diagnosis coding and how it greatly … Note: AANAC offers an ICD-10 certificate and training program specifically designed for NACs and other SNF interdisciplinary team members. It will be imperative that the coding is accurate on the MDS for the NTA conditions. Within theses maps CMS has added a significant number of codes. When reviewing the CMI components driving PDPM reimbursement it’s important to consider the critical role of the Non-Therapy Ancillary (NTA) score. For RUGs IV PPS, the payment is based on a per diem rate that is constant for the entire length of stay. ICD-10 Coding Quick Guide. 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. PDPM and Non-Therapy Ancillaries The non-therapy ancillary (NTA) part of the patient driven payment model (PDPM) is considered by most people I've talked to as being better than what we're currently doing. 5 AI 1 – (5 day) Documentation must support appropriate setting of ARD and documentation to support coding items on the 5 day assessment. Are there any tests, such as X-rays, a computerized tomography (CAT or CT) scan, or a magnetic resonance imaging (MRI)?”, Knowing upfront which NTA comorbidities the resident is most likely to have can help NACs get the supporting documentation in line before the assessment reference date (ARD) of the 5-day PPS MDS, says Dow. However, in order to get the NTA point, you must have the supporting documentation to code I8000 with one of the respiratory failure diagnoses that is included in the NTA Mapping tool under the cardio-respiratory failure and shock umbrella category. The NTA component uses a weighted comorbidity score (i.e., high-cost conditions or extensive services count for more points) to assign a SNF resident to an NTA case-mix group. PDPM: NURSING COMPONENT CRYSTAL PLANK, BSN, RN, RAC-CT Clinical Consultant/Quality Educator MU MDS and Quality Research Team Sinclair School of Nursing QIPMO PDPM PT OT SLP Nursing NTA Non-Case Mix Total PDPM Rate. In thi The view from 20,000 feet: A monumental departure from RUGs • Therapy hours give way to clinical complexity • Cost to Medicare may remain constant, but many SNFs will see lower per-diem rates • Potential … ... Comorbidities listed under the NTA category determine the … CMS’ data study showed that costs remain relatively constant over time after the fourth day of stay, so they return to an adjustment factor of 1.0. A: CMS has provided an NTA ICD-10 Mapping document that identifies which ICD-10 codes would qualify for the different NTA conditions. Your Questions on PDPM’s Non-Therapy Ancillaries Case Mix Groups 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 (OT), speech-language pathology (SLP), nursing, and non-therapy ancillaries (NTA). That way, you won’t end up in a situation where you are past the ARD and you realize you could have coded an NTA comorbidity if you only had documentation within the look-back period.”, The benefits of a good initial chart review don’t stop with the NTA and other PDPM components, adds Dow. Specifically for NTA, costs are very high for days one through three, leading to at an adjustment factor (multiplier) of 3.0. Two primary factors impact classification: Base rate for each of 6 components (PT, OT, SLP, Nursing, Non-Therapy Ancillary (NTA) and non-case mix) CMI factor (PT, OT, SLP, Nursing, NTA) PDPM Default Billing • Default HIPPS Code: ZZZZZ In this instance, you would code respiratory failure in both items: I8000 to capture the NTA point, and I6300 to possibly help qualify the resident in the Special Care Low category of the nursing component.”, In addition, some MDS software systems use the electronic health record to seed ICD-10 codes in section I (Active Diagnoses), which can lead to problems, says Montag. Note: The Centers for Medicare & Medicaid Services (CMS) lists the NTA comorbidities in table 16, “NTA Comorbidity Score Calculation,” in chapter 6 of the RAI User’s Manual. There is also the impact of the Variable Per Diem Adjustment Factor that is applied to the NTA Component. “For example, five of the seven allowable ICD-10 codes that qualify a resident for morbid obesity in the, plan in place for weight reduction if appropriate, and the physician should sign off and acknowledge that that is part of the resident’s overall plan of care.”, Stage 4 Unhealed Pressure Ulcer Currently Present, Copyright © 2021 American Association of Post-Acute Care Nursing (AAPACN). If the resident receives TPN while in the SNF, you will see higher NTA and nursing scores for that patient. To access this resource, please login or sign up for a free 30-day trial membership. CMS provides a list of NTA comorbidities that may qualify a resident for a higher reimbursement rate. Blog PDPM Mythbusters – Preparing for Implementation Overview. It more accurately accounts for expenses and isn't overshadowed by therapy. Overview. For more information on preparing for the transition to PDPM, register for our 9-Part PDPM Webinar Series. FAQs NTA FAQs PDPM NTA & Comorbidities. Proactive has answers. “However, for the NTA qualifiers, you must have the appropriate supporting documentation secured in the chart within the look-back period for the resident’s ARD—just like you need supporting documentation to back up any MDS item.”, “You have to follow the coding rules in the RAI User’s Manual,” adds Montag. Physician list the primary diagnosis first ... NTA classification • Based on the presence of certain comorbidities or use of certain extensive services 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. This has been a key consideration in designing the various elements of the new model. A quick trip through our top pieces reveals a year full of new strategies for success, so-called secret lists becoming public, transactions with hefty price tags, and even more updates from … CMS has identified a list of 50 conditions and services that are associated with increases in NTA costs under PDPM. 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. For example, having a diagnosis of HIV/AIDS garners the highest point value at eight. The following list summarizes key features of the PDPM: The PDPM program has six payment components. 4 NTA Payment C – (NC) Documentation must support presence of certain comorbidities or use of certain extensive services which total NTA score range 6-8. The transition to PDPM on October 1 brought forth a whole new reimbursement system centered around primary clinical characteristics of the patient that is dependent on five categories: PT, OT, SLP, NTA and Nursing. One can see from the table above that if comorbidities are missed, the facility could possibly miss out on reimbursement. This will jumpstart the process of turning those working diagnoses identified by the dietary manager or dietitian into physician-documented diagnoses if appropriate.”, Occasionally, a physician-documented diagnosis may not be strictly required, points out Dow. PDPM WORKSHOP. Under PDPM, there are five categories for which providers receive reimbursement: physical therapy, occupational therapy, speech-language pathology, non-therapy ancillary (NTA), and nursing. Why you should watch this: Learn why tracking NTAs is a vital way to recognize … “Respiratory failure is a checkmark MDS item, specifically I6300. As a team, you will have the information you need to sit down and see what you can do to help the resident have a more successful recovery.”, Coordinate with dietary managers/dietitians, Under PDPM, dietary managers and dietitians should be more involved in the MDS process, suggests Dow.
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