Non-therapy ancillaries (NTA) are a core component of the Patient Driven Payment Model (PDPM) in calculating reimbursements for your skilled nursing facility (SNF). By applying best practices and ensuring collaboration among interdisciplinary teams, your SNF can integrate NTA coding into your workflow.
Impact of NTA and PDPM for SNFs
The NTA component of PDPM has a major influence on your SNF’s revenue. These NTAs are assigned point values or comorbidity scores that determine how your center will be reimbursed for the services provided. This payment structure is designed to offer higher reimbursements for comorbidities that require more complex care.
With this structure, SNFs are encouraged to accurately describe patients’ conditions to maximize their reimbursements. The specificity in NTA also ensures residents receive the right care for their conditions, which can help improve outcomes.
What Is the NTA Comorbidity Score?
The NTA comorbidity score is a weighted count of a patient’s comorbidities. PDPM does not use a simple count of comorbidities because doing so ignores the difference in cost between different conditions. Each condition in the NTA classification is assigned a certain number of points, between 1 and 8, based on relative costliness.
To calculate the comorbidity score, providers must identify every comorbidity the patient qualifies for and find the sum of their points. This comorbidity score is then used to classify a resident into an NTA component classification group.
Coding Recommendations
To maximize PDPM and NTA reimbursements in your SNF, your team should:
- Review hospital documentation: Residents will come to your SNF with a range of hospital documentation, including a discharge summary, surgeon consults, history and physical (H&P) information, consultations, and anything else relevant to the patient’s condition. These documents will help you understand present comorbidities for NTA coding.
- Know your coding locations: NTA comorbidities all have a specified source in Table 16: NTA Comorbidity Score Calculation in chapter 6 of the RAI User’s Manual. It is essential to code each item with the correct number, or your facility will not receive points for the documentation.
- Familiarize yourself with the NTA conditions: The NTA component of PDPM features 50 conditions and services that can contribute points to a case-mix classification. When you transition to PDPM, it’s valuable to become familiar with these conditions for your charting practices. Keeping a list nearby for reference is also helpful.
- Understand dietary needs: Generally, NTA will require input from interdisciplinary team members, like dieticians and dietary managers. A resident’s dietary needs can reveal a handful of conditions listed in the NTA chart, such as morbid obesity or swallowing disorder. Another example is code K0510C2, which means a patient eats a mechanically altered diet of soft-textured foods while at your center.
- Be specific: Specificity is key in your coding practices to accurately describe a patient’s needs and maximize your revenue. This is especially true when you consider that more than 50% of the NTA comorbidities derive from code ICD-10-CM in item I8000 — Additional Active Diagnoses. Claiming a basic ICD-10 code does not say much about a resident’s condition.
- Discuss NTAs in utilization meetings: Collaboration helps you effectively capture a resident’s condition and communicate best practices across your interdisciplinary team. Make NTAs a talking point before Palliative Performance Scale (PPS) assessments to ensure all providers are on the same page about diagnoses and correct codes.
How Can First Docs Help Your Facility?
First Docs is a physician-first organization dedicated to filling the gaps in care centers like SNFs. Our committed and compassionate attending physicians provide high-impact leadership at your skilled nursing center to support PDPM practices.
Learn more about our services today.
