Q:
I had a resident admitted to our SNF under skilled care who has been diagnosed with HIV/AIDS, but the NTA points are not generating in the HIPPS code. Can you please explain why this is happening and what corrective action should be taken to ensure reimbursement is accurate?
A:
To account for the increase costs associated with caring for patients with the AIDS diagnosis who are admitted to the SNF for Medicare skilled services, CMS has made adjustments to two components under PDPM. This adjustment includes an 18% add on to the nursing component as well as the additional 8 non-therapy ancillary (NTA) points associated with this diagnosis that you reference in your question.
You will not be able to see either of these adjustments on the HIPPS code in section Z0100 of the MDS. That is because the adjustment is applied to the rate when the claim is processed. As a result, it is critical that the ICD.10 code for the AIDs diagnosis of B20 appear on the claim. It does not need to be in the admitting or primary diagnosis field to impact reimbursement. For example, you may admit a patient with a primary reason for admission to receive rehabilitation for a hip fracture (S72.002D), who also has a diagnosis of AIDs (B20). Even though it is not the primary reason for skilled care it is impacting the cost of care, and accurately appending the diagnosis to the claim will result in increased reimbursement when the claim is processed.
It is also important to note, that due to privacy considerations many states have laws to prohibit the electronic transmission of diagnosis coded for HIV and other sexually transmitted diseases. As a result, the coding of the AIDs diagnosis on the MDS in these states is not allowed. It is important to know whether your state is one of the states in which the coding of this diagnosis is prohibited.
Validating that the diagnoses that impact PDPM are appropriately coded on the MDS (if applicable) and on the claim is a critical step of the Triple Check process.
Contact Proactive to learn more about a clinical reimbursement partnership to support and mentor your team. Proactive partnerships allow you to have our experts “on staff” at a flat monthly installment fee which is a fraction of the cost of maintaining a full-time salary.
Chris Calo, RN, BSN, RAC-CT
MDS Consultant
Was this article helpful? Access weekly insights when you sign up for our weekly newsletter!