This page addresses follow-up questions and additional information pertinent to our webinar
Long-term Care Coding: Coding for the Long-Haul.
** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.
Q: Can you talk more about the per diem adjustments to the PT, OT, and NTA components? How does that work?
A: Per CMS, the PT and OT components were found to be higher at the beginning of the patient’s stay and decline slowly over the course of the stay. So using a variable per-diem adjustment allows allocation of more resources and payments at the beginning of the stay and then that variable rate decreases during the patient’s residency.
NTA costs were found to be highly concentrated at the beginning of a stay and then decrease to a lower level that remains constant over the remainder of the stay. So the NTA component utilizes a separate adjustment schedule than the PT and OT components.
CMS does have the Variable Per-diem Adjustment Factors and Schedule on its website for reference.
Q: You mentioned the Nursing Case-Mix Component follows the same characteristics as RUG-IV. Can you explain how RUG-IV works?
A: The RUG-IV payment system (which was used prior to PDPM) focused more on volume of therapy services rather than the overall clinical picture of the patient. The nursing case-mix group is similar in that it uses comparable criteria like extensive services, depression, restorative nursing, and functional status to classify patients. However, the nursing component has an available 25 component groups in PDPM, instead of the 43 component groups it had in RUG-IV.
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Meet the Presenter: Tommi Mooney, MS, RHIA, CCS
Tommi brings ten years of experience in coding and auditing to the team as a Senior Coding Quality Auditor. Her career began as a Hospital Coding Specialist, where she quickly advanced through various roles, ultimately becoming the Director of Coding over Internal Audits and Education. In each of these positions, Tommi honed her skills in coding, auditing, and compliance. Throughout her career, Tommi has overseen internal audits, developed educational resources for coding professionals, and provided guidance to ensure coding accuracy and compliance across departments. Her leadership and dedication to improving coding quality have made her a key contributor to the team, where she provides audit oversight and coding expertise to support clients.
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