PDPM New Admission Review-

NTA Component

NTA points are some of the highest-value reimbursement drivers in PDPM — and they are also some of the most commonly missed. Every uncaptured NTA diagnosis at the time of your 5-Day assessment is lost revenue that cannot be recovered after the ARD is set. The PDPM Admission Review — NTA Component by Insight MDS & Therapy Solutions is a comprehensive, clinician-built 14-page chart review tool that gives your MDS coordinators a structured, section-by-section roadmap to identify, verify, and support every qualifying NTA condition at the time of every new admission.

Organized by MDS section for fast, intuitive use, this Tool walks your assessors through the complete NTA scoring spectrum — from Section I diagnoses across infection, immune, respiratory, neurological, skin, nutrition, organ and metabolic disease, and transplant categories, through Section K nutritional approaches, Section M skin conditions, Section O special treatments and procedures, and Section H bladder and bowel appliances — ensuring no qualifying category is overlooked.

Why NTA documentation accuracy matters:
Under PDPM, NTA points are summed across all qualifying conditions and mapped to a case-mix group with CMI values ranging from 0.68 to 3.06. A single high-value condition — such as HIV/AIDS at 8 points, parenteral IV feeding at 7 points, or IV medications at 5 points — can significantly shift a resident's NTA case-mix group and per diem rate. Missing even two or three qualifying conditions at the time of the 5-Day MDS can result in thousands of dollars of lost reimbursement per stay, with no opportunity for correction once the ARD is locked.

In a heightened audit environment, the risk runs both ways — undercoding costs your facility reimbursement, while overcoding without adequate documentation support creates audit exposure and recoupment risk. This Tool is designed to help your team find the right answer — supported by the medical record, verified against current CMS guidance, and documented in a way that stands up to scrutiny.

What this Tool gives your MDS team:

✅ A structured, condition-by-condition review organized by MDS section — mirroring the RAI Manual coding language your assessors already work with
✅ Common qualifying diagnoses and ICD-10 code examples for every NTA category — giving your assessors a practical starting point for chart review without replacing their clinical judgment
✅ Clinical signs and symptoms prompts for each condition — helping assessors identify the active link in the chart that ties the diagnosis to the look-back period
✅ Detailed documentation insights for every condition — specific, actionable guidance on what the chart needs to contain to support the MDS coding, including physician notes, lab values, medication orders, monitoring documentation, and care plan linkage
✅ NTA point values displayed for every qualifying condition, so your team always understands the reimbursement weight of what they are reviewing
✅ A scope and limitations panel that clearly defines how the Tool is to be used, what it does and does not represent, and where to find the complete official CMS NTA list — keeping your team compliant and appropriately informed at every use

Who this Tool is for:
This Tool is designed for MDS Coordinators, MDS Assessors,  Directors of Nursing, Regional Clinical leaders, Nurses wanting to learn MDS, and any member of the interdisciplinary team involved in the PDPM admission assessment process. Whether you are completing a new admission 5-Day MDS, training a new MDS coordinator, or preparing for a Medicare audit, this Tool gives your team a consistent, compliant, and comprehensive framework for NTA review at every admission.

This Tool is an internal educational and chart-review aid only. It is not a CMS publication, not legal, billing, or reimbursement advice, and not a substitute for the CMS RAI User's Manual or the assessor's clinical judgment. All conditions must be verified against the resident's actual medical record and current official CMS sources before coding. Point values, code sets, and category definitions are subject to change — always confirm against the sources current for the fiscal year of the assessment.

📌 Licensed for use by one facility only. Not for redistribution or resale. Full Terms & Conditions provided upon purchase.

Insight MDS & Therapy Solutions
[email protected] | insightmds.com | (561) 223-9122