Harmony Healthcare International (HHI) Blog

PDPM - Where are We Now Q&A: Part 1

C.A.R.E.S.

Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency Survey


Question 1 of 9: Should the NTA diagnosis be listed on the UB?

H19 7168Harmony Healthcare International (HHI) recommends that all active NTA diagnoses be included and properly sequenced on the UB-04 for the time period covered by the claim.  For MDS purposes, an active diagnosis is defined as one that has a direct relationship to the patient's functional status, cognitive status, mood and behavior status, nurse monitoring, medical treatment or risk of death.  The diagnoses on a UB-04 claim support the reasons that skilled services were provided during the claim period being billed.  On the initial claim, it is expected that the diagnoses related to the NTA Case Mix group for a 5-day assessment completed during that claim period would support both the HIPPS code and skilled services.  Since only one assessment is required at the beginning of the stay, it is the MDS that best supports the HIPPS Code and not always the UB-04.

Remember, the presence of HIV/AIDs is identified through the entry of the ICD-10-CM code, B-20, on the claim and this results in a significant rate adjustment.  Patients with an HIV/AIDS diagnosis are assigned the highest NTA point value (8 points) of any condition or service under the NTA component, plus they receive an 18% add-on to the nursing component of the payment.  There are 16 states with laws that prevent healthcare providers from reporting HIV/AIDS diagnosis information to CMS through the current MDS Assessment System and/or prevent CMS from seeing this diagnosis within that system but the HIV/AIDs diagnosis on the UB-04 will trigger the appropriate reimbursement.

Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have.  You can contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 


 harmony20 October 29-30 2020 Encore Boston Harbor

Topics: PDPM, NTA

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