Direct skilled services under Medicare Part A often are easy to identify because these services involve specific, complex caregiver-to-resident actions. Their “inherent complexity” means that they can “be performed safely and/or effectively only by or under the general supervision of skilled nursing or skilled rehabilitation personnel,” explains the Centers for …
The development, management, and evaluation of the resident care plan is the OBRA backbone of the Resident Assessment Instrument (RAI) process for all residents regardless of payer source, so it may surprise some nurse assessment coordinators (NACs) and directors of nursing (DNSs) to learn that care plan management and evaluation …
Like care plan management and evaluation and observation and assessment of a resident’s condition, teaching and training activities are a core nonskilled component of resident care that can rise to the level of a skilled service. Another way that these indirect skilled services are alike is that they historically haven’t …
Skilled nursing facilities (SNFs) are increasingly subject to skilled medical review audits from both fee-for-service Medicare (e.g., the SNF Five-Claim Probe and Educate initiative) and individual Medicare Advantage plans. Audit success ultimately hinges on documentation quality, but the presence of documentation in the medical record is no guarantee of the …
With the rush to understand the Patient-Driven Payment Model (PDPM) under the Skilled Nursing Facility Prospective Payment System (SNF PPS), it’s easy to get caught up in meeting the technical criteria for payment—and not pay enough attention to the clinical criteria for meeting a Medicare skilled level of care, says …
Navigating Medicare Part A coverage in skilled nursing facilities (SNFs) is a matter of regulatory compliance. But it’s also a daily ethical test for facility staff and administrators. In many ways it depends on the honor system, and those responsible for billing and care case management must understand and apply …
For skilled nursing facilities (SNFs), diagnosis selection and accurate ICD-10-CM coding are essential for both quality resident care and compliance with regulations. For therapists providing skilled rehabilitation services, the ability to choose the correct diagnosis code is not only crucial for resident outcomes but also ensures proper reimbursement and avoids …
The year 2024 brings a plethora of updates to the Medicare program, several significantly impacting skilled nursing facilities (SNFs). SNF staff must stay well informed about these updates to ensure proper billing and adequate coverage for a beneficiary’s skilled stay. This comprehensive article delves into key updates, encompassing changes in …
This Oct. 24, surveyors will begin enforcing mandatory communication training requirements to ensure that direct-care staff can communicate effectively with residents under F-tag F941 (Communication Training) in Appendix PP of the State Operations Manual, according to the Centers for Medicare & Medicaid Services (CMS) Quality, Safety, and Oversight memo QSO-22-19-NH. …
In May 2023—after the Comprehensive Error Rate Testing (CERT) program determined that skilled nursing facility (SNF) Medicare Part A services have been “a top driver” of the overall Medicare fee-for-service improper payment rate since the switch to the Patient-Driven Payment Model (PDPM) on Oct. 1, 2019—the Centers for Medicare & …
