What are the PDPM clinical categories?

In the PDPM, there are five case-mix adjusted components: Physical Therapy (PT), Occupational Therapy (OT), Speech-Language Pathology (SLP), Non-Therapy Ancillary (NTA), and Nursing. Each resident is to be classified into one and only one group for each of the five case-mix adjusted components.

How many types of assessments are under PDPM?

Under PDPM (effective October 1, 2019), there are 3 SNF PPS assessments: the 5-day Assessment, the Interim Payment Assessment (IPA) and the PPS Discharge Assessment. The 5- day assessment and the PPS Discharge Assessment are required.

What are the PDPM codes?

What are the criteria used to determine an SLP Case-Mix Group?

The SLP component uses the patient's PDPM clinical category, cognitive function, the presence of an SLP related comorbidity, and the presence of a swallowing disorder or a mechanically- altered diet to assign a resident to an SLP component group.

What is the NTA case-mix component?

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. A resident's NTA score is the sum of the points associated with each comorbidity that they have.

Patient Driven Payment Model/Clinical Categories/ ICD10 Mapping Tool

What does NTA mean in PDPM?

Under PDPM, CMS has broken the singular nursing component of RUG-IV into two separate components – Nursing and Non-Therapy Ancillary (NTA) – to adeptly account for the wide-ranging variations within the skilled population.

What are NTA services?

Some examples of “services” that are captured for NTA classification include: IV Medication, Radiation, Suctioning, Infection Isolation and Feeding Tube.

What is Section GG on MDS?

SECTION GG: FUNCTIONAL ABILITIES AND GOALS

Intent: This section includes items about functional abilities and goals. It includes items. focused on prior function, admission performance, discharge goals, and discharge performance.

What is CMI in PDPM?

Primary Factors for Payment Under PDPM

There are two primary factors for payment, a base rate and a case-mix index (CMI) value for each classification group within the case-mix adjusted payment components that will be determined under PDPM.

How many PDPM codes are there?

A lot has been made of the complexity of PDPM. We've all heard by now there are more than 28 thousand code combinations.

What are the 6 components of PDPM?

In the PDPM, there are five case-mix adjusted components: Physical Therapy (PT), Occupational Therapy (OT), Speech-Language Pathology (SLP), Non-Therapy Ancillary (NTA), and Nursing. Each resident is to be classified into one and only one group for each of the five case-mix adjusted components.

How do I choose a PDPM primary diagnosis?

Driving PDPM Operations: Selecting the Primary Diagnosis

Under PDPM, the diagnosis coded on the 5-day/Initial Minimum Data Set (MDS) in section I0020B (primary reason for skilled stay) largely determines reimbursement for the entire Medicare stay, unless an Interim Payment Assessment (IPA) is necessary.

How many HHRGs are there?

Currently, 153 case-mix groups called Home Health Resource Groups (HHRGs) as measured by the OASIS are available for classification. The assessment must also be completed for each subsequent episode of care a patient receives.

What is an IPA assessment?

The Integrated Performance Assessment (IPA) is a cluster assessment featuring three tasks, each of which reflects one of the three modes of communication--Interpretive, Interpersonal and Presentational.

What is an IPA MDS assessment?

The Interim Payment Assessment (IPA) is an optional MDS assessment performed after the initial assessment, usually after a change in patient's condition, to capture a change in patient characteristics.

What is IPA under PDPM?

Another CMS option under PDPM is to implement the Interim Payment Assessment (IPA). The IPA may be completed by providers in order to report a change in the patient's PDPM classification, rather than discharge the patient from receiving Part A services. CMS has made it clear that the IPA is an optional assessment.

What is case-mix in MDS?

Case Mix Index CMI Weight or numeric score assigned to each RUG-III group that reflects the relative resources predicted to provide care to a resident. The higher the case mix weight, the greater the resource requirements for the resident.

What is RUG IV?

RUG-IV is a patient classification system for skilled nursing patients used by the federal government to determine reimbursement levels. This method is stemming from the SNF PPS FY2012 Final Rule and was previously RUG-III.

What do hipps codes mean?

Definition. Health Insurance Prospective Payment System (HIPPS) rate codes represent specific sets of patient characteristics (or case-mix groups) health insurers use to make payment determinations under several prospective payment systems.

What is the difference between Section G and Section GG?

Section G: The guidance is to code the most amount of assistance provided within a 7 day look-back. In Section GG: Guidelines are to code the baseline performance ability within the first three days following admission and before treatment begins.

When should GG tab be completed?

For an eval only that is completed at least 2 days after the facility admission, Rehab Optima will require an admission GG assessment and discharge GG assessment to be completed. For this situation enter dashes in all performance areas.

What is question a2300 on MDS?

Assessment Reference Date. Submitted by pcuser on Fri, 01/11/2019 - 10:55. ASSESSMENT REFERENCE DATE (ARD) The specific end-point for the look-back periods in the MDS assessment process.

How do you calculate PDPM?

The ABILITY CAREWATCH PDPM calculator uses the payment for each component and is calculated by multiplying the case-mix index (CMI) that corresponds to the patient's case-mix group (CMG) by the wage adjusted component base payment rate, then by the specific day in the variable per diem adjustment schedule when ...

How many scheduled PPS assessments are there?

The Medicare-required PPS assessment schedule includes 5-day, 14-day, 30-day, 60-day, and 90-day scheduled assessments. Except for the first assessment (5-day assessment), each assessment is scheduled according to the resident's length of stay in Medicare-covered Part A care.

What is the combined limit on concurrent and group therapy services under PDPM?

Townsend: Under PDPM, there's a 25 percent limit on concurrent and group therapy per discipline so, as an example, if a resident received 800 minutes of physical therapy, no more than 200 minutes of this therapy could be provided on a concurrent or group basis.