Pdpm Nta Grouper Tool

Bob Roberts
• Sunday, 20 June, 2021
• 8 min read

In May 2017, CMS released an Advanced Notice of Proposed Rule making (AN PRM) which outlined a new case-mix model, the Resident Classification System, Version I (RCS-I), that would be used to replace the existing RUG-IV case-mix model, used to classify residents in a covered Part A stay into payment groups under the SNF PPS. Since the AN PRM, we continued our stakeholder engagement efforts to address the concerns and questions raised by commenters with RCS-I.

pdpm nta nursing rates facility groups clinical analytics data index
(Source: www.simpleltc.com)


Below are several items we have posted concurrent with the FY 2019 SNF PPS Norm to assist stakeholders in reviewing and commenting on the proposed PDP. For a subset of these ICD-10-CM diagnosis codes, the clinical category will be modified if there were specific related surgical procedures performed in the hospital stay immediately preceding admission to the skilled nursing facility.

The surgical procedure code lists provided will be used as a reference by the skilled nursing facility staff to augment the resident’s clinical category classification. The staff would review the information sent by the preceding hospital stay to identify any procedures defined in these surgical clinical categories.

To assist stakeholders in understanding the process by which SNF residents would be classified into PDP payment groups, we are providing three files. The first file provides a narrative step-by-step walkthrough that would allow stakeholders to manually determine a resident’s PDP classification based on the data from an MDS assessment.

In the second phase of the project, which is now in process, the contractor is using the findings from this Base Year Final Summary Report as a guide to identify potential models suitable for further analysis. Acumen hosted a third Technical Expert Panel in June 2016 to provide an outline of basic payment structure for a revised SNF PPS, including the various new components of the revised SNF PPS and a discussion of potential pricing schedules which may be incorporated.

Acumen hosted a fourth Technical Expert Panel in October 2016 to provide an outline of the recommended alternative payment model for a revised SNF PPS, including the various new components of the revised SNF PPS and a discussion of potential pricing schedules which may be incorporated. Based on the work conducted by Acumen during the second phase of the project, which included substantial feedback from stakeholders and four Technical Expert Panels, the contractor drafted a Technical Report (PDF), which discusses the research conducted by the contractor on developing an alternative to the existing methodology used to pay for services under the SNF PPS.

(Source: www.healthpro-heritage.com)

To assist stakeholders in their review of the RCS-I model, as discussed in the SNF PPS Advance Notice of Proposed Rule making (AN PRM) and Technical Report provided above, we are providing a provider-specific impact analysis file, which details the estimated impact of the RCS-I model discussed in the AN PRM on Medicare Part A payments to each SNF in the country. This file provides a step-by-step walk-through that allows stakeholders to manually determine a resident’s RCS-I classification based on the data from an MDS assessment.

This document should be used in conjunction with the discussions found in the AN PRM and accompanying Technical Report to better understand the process for resident classification under RCS-I. The contractor is continuing with further refinements and considering potential improvements to the overall SNF PPS payment structure, and we welcome your comments and feedback.

In July 2018, CMS finalized a new case-mix classification model, the Patient Driven Payment Model (PDP), 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. This site includes a variety of educational and training resources to assist stakeholders in preparing for PDP implementation.

Taking the following steps can help nurse assessment coordinators (ACS) capture the optimal TNA comorbidity score: This video tutorial is approximately 22 minutes in length and is designed to provide targeted guidance for accurate coding using live-action patient/resident scenarios.

Read more An update to the PDP Grouper DLL has been posted, along with its source code and test cases. This version, V1.0008, corrects an issue with a dynamic array that was not consistently reinitialized when processing multiple assessments within a short time frame.

(Source: www.youtube.com)

It is important to include the control item STATE_ PDP _OBRA_CD (as defined in the V3.00.5 errata for the FINAL version (v3.00.1) of the MDS 3.0 Data Specifications) for assessments with target date on or after October 1, 2020. Note that this FINAL version supports the ICD-10 codes that are defined in the data specifications as valid for item I0020B for FY2021.

Also, please note that the grouper expects valid FY2021 ICD-10 codes for I8000A-J when processing assessments with target date on or after October 1, 2020. Read more Navigating the COVID-19 public health emergency can be difficult for skilled nursing facilities (SNES).

Read more Key information about how to submit MDS files and how to obtain and understand error messages on initial and final validation reports. While most of the information used to establish these codes is already on the Bra assessments, the additional data collection will require both time to complete and training performing correctly.

Notably, the addition of completing the admission performance column for section GG (Functional Abilities) will take the most time. However, the stress and workload can be mitigated with a strong preparation plan and ongoing support to direct care staff.

Follow these four steps to ensure your team is ready to complete successfully the documentation and data collection for section GG on Bra assessments: CMS is publishing this final rule consistent with the legal requirements to update Medicare payment policies for SNF son an annual basis.

pdpm crosswalk healthpro heritage rugs iv
(Source: healthpro-heritage.com)

In recognition of the significant impact of the COVID-19 public health emergency, and limited capacity of health care providers to review and provide comment on extensive proposals, CMS has limited annual SNF rule making required by statute to essential policies including Medicare payment to SNES. In response to stakeholder feedback, we are also finalizing changes to the International Classification of Diseases, Version 10 (ICD-10) code mappings, effective October 1, 2020.

During the PA Department of Health Teleconference, Kerry Weaver, HC Senior Consultant with Myers & Stauffer announced that Pennsylvania has elected to collect PDP data on Bra assessments; however, the collection of this data will take place no earlier than January 1, 2021. For more information, please log onto the website below for the teleconference MP3 and PowerPoint presentation slides.

Table of Contents Introduction & Overview 3 Data Input 4 Running the Model 5 Patient Analysis 7 Facility Analysis 8 Appendix: Data Input Glossary 9 Introduction & Overview The tool allows the user to input patient-level data and derive estimated PDP payments for non-interrupted patient stays. The user will be able to use this tool to understand the difference between reimbursement under RUG-IV and PDP at a patient and facility level.

As a reminder, HCA replies to inquiries on a biweekly basis. Introduction: This tab provides a high-level overview of the model including a table of contents.

Payment Analysis: The patient PDP calculation is run through an embedded Macro in the Excel document and patient-level results are summarized on this tab. Certain ICD -10 codes are insufficient to be considered a Primary Diagnosis.

pdgm checklist
(Source: www.healthpro-heritage.com)

If an entered Primary Diagnosis Code (Column “CX”) is insufficient, it will be flagged as “Return to Provider” and the user will be required to provide another primary diagnosis code. Note: If the I8000A (Primary Diagnosis Code) is blank, the patient will receive a $0 PDP payment for the stay.

Running the Model Step 1: Click the “Developer” tab at the top of the page and select Macros on the left. If you don't have the Developer tab, click on the File menu and then select Options.

Click Developer checkbox under the list of main tabs on the right. Step 2: Highlight the “Macro2” line from the options available and select “Edit”.

Step 3: Update the “from=47” to the number of lines in the Data Input tab. Note: Every time you wish to refresh a data set, the results of the calculation in the “Payment Analysis” tab need to be cleared by deleting Row 22 and below.

For the benefit of the user, Rows 1-21 have been locked and can’t be edited or deleted accidentally. You can then copy/paste your list into the highlighted yellow fields in order to auto populate the table.

healthpro heritage cms
(Source: www.healthpro-heritage.com)

Note: There is no further manipulation required for the patient analysis tab. Since we launched the PDP Calculator in May 2018, we’ve received an incredible amount of positive feedback.

On August 8, 2018, CMS published the Fiscal Year 2019 SNF Prospective Payment System (SNF PPS) final rule, which details the replacement of the RUG-IV model with a revised case mix methodology called the Patient-Driven Payment Model (PDP) that will take effect October 1, 2019. This tool -kit is intended to provide at-a-glance resources to assist in understanding the five components of PDP.

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