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PDPM��The Heart Beat of Your Facility

Presented By

clinical@smkmedical.com�PH: 313-314-8267

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Visit SMKMED.COM OR Call 313-314-8267

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DISCLAIMER

This presentation is an educational resource for long-term care professionals, reflecting current federal regulations and practices as of the publication date. It should not be considered absolute or universally applicable. The information provided must be interpreted in the context of individual organizational and state regulations.

This content aims to offer practical knowledge on the covered subject matter and is provided with the understanding that SMK Medical LLC and MDS Education are not offering legal advice or other professional services.

Please note that it is the responsibility of the student or observer to validate the information, as CMS rules and regulations may change over time.

Visit SMKMED.COM OR Call 313-314-8267

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Learning Objectives

Questions to stimulate the IDT to look deeper into reimbursement issues during your Weekly Medicare Meeting
Ensuring your facility is capturing appropriate PDPM reimbursement rates by reviewing one component – NTA’s
Should Nursing skill continue after Therapy has completed? What questions and care issues should be reviewed and discussed.
Are you ensuring a safe & successful discharge plan?
Reviewing Secondary Payers before day 20 – has the Medicaid application been completed, if not – what are the barriers?
Is skilling until “Benefit Exhaust” the right call?

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Todays discussion topic: ��NTA Points– Non Therapy Ancillary

WHAT THE ADMINISTRATOR SHOULD KNOW TO DRIVE DISCUSSION DURING THE MEDICARE MEETING.

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NTA Points - Questions

How many NTA points were calculated for this resident? What are they for?

Is the resident on any IV Medications at the facility? Was it coded in Section O? (5 pts)

Was Malnutrition (risk for) or actual / Morbid Obesity – do they have the appropriate DX code? Was the code captured in Section I? (1 pt)

Infections – MDRO’s (VRE, MRSA, ESBL). Is an DX code input for these & were they coded to Section I? (1 pt)

For a Diabetic resident: do they have a foot ulcer? Is this coded in Section M & does a Diagnosis code exist for the area in Section I? (This adds 1 additional pt to the diabetes for total = 3 points)

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Not all NTA items are listed – these are categories

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NTA Rates: are set annual by CMS and vary based on State / County / Rural or Urban

Rates are an example not intended as current actual / factual information.

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Todays focus:

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PDPM HIPPS Components – Creating your rate. ��

This is the SNF Rates for FY 2023 for Wayne County for Example only.

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HIPPS Code – how to identify the 5 components��NTA component – the 4^th letter of the HIPPS code

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Questions to ask during the Medicare Meeting:�

Medicare Benefit Days: have the days been verified?
Benefit Exhaust Date: if in the next 30 days – Will resident be LTC or DC? What is the payer after M’care ends?
Secondary Payer: has the co-pay benefit been validated?
If no secondary payer: What are the financial arrangements for the co-pay amount?
Medicaid Application: Has it been started / completed? Barriers?
What is the Primary Diagnosis for this resident? Are care needs being addressed / consults / referrals.
Skilled Documentation: What is the skilled need? Is daily documentation in place to support the on-going need?
Were the BIMS & PHQ-9 assessments completed by the ARD? Were dashes used to complete these?
What is the discharge plan? What is the tentative dc date?
NTA points for this resident? Pt’s = 0 should be reviewed during stay.
Outside Appointments: Are these appointments r/t their current skilled stay? If not, can they be rescheduled to ensure no interruption to their recovery?

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MDS EDUCATION�CLINICAL@SMKMEDICAL.COM�313-314-8267��FOR MORE INFORMATION ON HOW WE CAN ASSIST YOU – VISIT OUR WEBSITE: MDSEDUCATION.COM ��FOLLOW US ON: LINKEDIN FOR BLOGS AND UPCOMING EDUCATIONAL WEBINARS

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