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Navigating the Role: Essential Training for New Nurse Assessment Coordinators

Article / Leadership and Management / NAC / Workforce Solutions

Navigating the multifaceted role of the nurse assessment coordinator (NAC) can be daunting, especially for those new to the position. Whether titled NAC, MDS coordinator, Medicare case manager, or another variant, the responsibilities are both far reaching and crucial to ensuring quality care in long-term care facilities.

As facilities increasingly welcome inexperienced NACs amid workforce shortages, comprehensive training is more critical than ever before. It may take up to a year for new NACs to feel confident in the role, so facility operators should be prepared to invest in their success. Improperly trained NACs could lead to survey citations, payment issues, and, worst of all, poor resident outcomes due to lack of understanding of all that is required in the role.

This article will help empower new NACs and their trainers with essential guidance through the initial phases of orientation and beyond. It also offers insights and useful AAPACN resources to foster confidence and competence in this pivotal role.

NAC Job Description

To be successful, the NAC needs a job description specific to this highly individualized role. It will clarify expectations for the new NAC and also help trainers set up a manageable training schedule. The standard nursing job description does not cover all that the NAC role entails. The AAPACN NAC Job Description summarizes the job and lists examples of the essential functions required to fulfill the basic duties, as well as to ensure compliance with the intricate federal regulations surrounding the Resident Assessment Instrument (RAI) process.

Here’s a list of examples of these duties:

  • Coordinate the RAI process
  • Provide oversight of assessment completion and transmission to the national repository
  • Coordinate the completion of the comprehensive care plan according to regulatory requirements
  • Maintain the MDS assessment schedules
  • Be highly involved in determining skilled level of care for Medicare residents and procuring required Medicare-specific documentation
  • Coordinate care with case managers for residents utilizing managed care, health maintenance organizations (HMOs), commercial insurance, and other alternative payment models
  • Provide insight and analysis of MDS-based Quality Measures
  • Serve as a member of the quality assessment and assurance (QAA) and/or the quality assurance and performance improvement (QAPI) committees
  • Work closely with hospital discharge planners and physicians to obtain accurate and complete documentation to support ICD-10-CM diagnosis coding and surgical procedures

Because facilities obviously differ, this AAPACN tool can be customized to include duties specific to an organization. Once the new NAC is in place, it is time to set up an orientation schedule.

Orientation

In addition to the general orientation requirements for any new staff members in the facility, the NAC may also need more role-specific training. Although a facility may be eager to get the NAC started with MDS completion, it may not be the best course of action for a NAC new to the role. Proper training is essential to ensure accuracy and support the new NAC’s long-term success.

AAPACN’s 10-Week Nurse Assessment Coordinator Orientation Guide offers role-specific training with a realistic timeline that is not too overwhelming. It allows time for training and instruction on the RAI User’s Manual, minimum data set (MDS) completion, Care Area Assessment (CAA) and care plan completion, and Medicare Part A management. Training should be led by a preceptor well versed in all aspects of the position, either the organization’s RAI expert or an outside resource. AAPACN has several online training modules to guide new NACs and let them learn at their own pace.

MDS Coding, CAAs, Care Plans, and MDS Scheduling

AAPACN’s 10-part online training, MDS Essentials, provides step-by step instruction for each section of the MDS, with interactive practice coding and knowledge checks as well as the rationale for each choice. However, one session of training alone is not enough. The RAI User’s Manual must be reviewed closely as the new NAC begins coding assessments. The MDS Essentials training also explains how to use the manual for future reference. As each section of the MDS is completed, the new NAC reviews the section and the examples in the manual. This in-depth review helps assure the correct framework for assessment accuracy, a key component of the RAI process.

A module introducing MDS scheduling focuses on federal scheduling requirements for the Omnibus Budget Reconciliation Act of 1987 (OBRA) and the Prospective Payment System (PPS). But it does not include any state-specific scheduling requirements, which must also be part of the training.

MDS Essentials introduces CAAs and care planning, but for a deeper dive into the subject, the NAC can also explore AAPACN’s CAA Training for the IDT. This on-demand workshop lists examples of the 20 different CAAs and explains how to proceed from CAAs to care planning.

Medicare Management

The new NAC may be in charge of Medicare Part A management, depending on facility organization, either at the outset or later on. But it is critical to identify who is responsible for this important oversight because a misstep can be very costly to the facility.

If the facility hires a new NAC or Medicare case manager to handle this task, training can be facilitated via AAPACN’s Medicare Basic Training course. It begins with the basic requirements of Medicare, teaching new hires how to manage the process. The training then moves on to more comprehensive instruction of key aspects of the Medicare Part A program, such as the physician certification/recertification process, skilled nursing requirements, and beneficiary notices requirements.

New Medicare case managers must become familiar with the Internet-only Manuals (IOMs) published by the Centers for Medicare & Medicaid Services (CMS), referenced extensively in AAPACN’s Medicare Basic Training. These manuals contain the federal regulations that SNF staff are required to know and uphold as Medicare/Medicaid providers. Chapter 8 of the Medicare Benefit Policy Manual relates specifically to Medicare Part A coverage in the skilled nursing facility (SNF) setting. Information on technical requirements of Medicare Part A coverage in a SNF and how to define skilled care can be found here. This manual should be referenced regularly when determining skilled coverage for residents.

After Orientation

Once initial training is complete, the new NAC begins the job. There is no “right” way to do this job. Every NAC eventually discovers a unique approach that fulfills the responsibilities of the position. But at the outset, it may be useful to have a preset schedule of tasks that need completion. AAPACN’s Sample Task List for the Nurse Assessment Coordinator offers some useful structure in the beginning. Even if other NACs have shared a similar task list or sample schedules, it may be beneficial to review as many as possible because everyone’s style and needs at the job may be a little different.

These are some of the standard daily tasks described in this tool:

  • Review schedule for daily meetings
  • Review census changes
  • Schedule MDS scripted interviews for completion
  • Schedule time for RAI completion

Some standard weekly tasks may include the following:

  • Prepare the MDS schedule for the team
  • Schedule and attend weekly meetings such as Medicare meetings or care plan conferences
  • Transmit MDS assessments to the Internet Quality Improvement and Evaluation System (iQIES)

NAC’s Role in Quality Assurance

To complete an MDS accurately, the NAC must review the full medical record for the observation period, an obligation that puts the NAC in an inadvertent quality assurance (QA) auditor role. As the chart is reviewed, the NAC may find concerns in the medical record that require the attention of other staff members. For example, the NAC may find that certified nursing assistant (CNA) documentation is missing on certain shifts or days. The NAC should report this information to the appropriate team member for follow-up.

AAPACN’s Medical Record Alert Sheet is a uniform way to communicate compliance issues identified during the MDS/RAI completion process. The NAC does not make the correction but is responsible to notify the appropriate team members when an oversight is discovered.

In addition to individual chart QA, the NAC contributes to facility quality by participating in the QAPI committee that reviews facility Quality Measure and Five-Star ratings. The new NAC may not be part of this process at the outset but must understand the RAI process is an integral part of this review. AAPACN’s Five-Star QMs On-Demand Workshop offers additional training on this aspect of the NAC’s role.

Realistic Expectations and Support

No one expects the new NAC to remember everything learned in the initial training. It may take several months to a year for the NAC to gain confidence in all aspects of the job. One way to help this process is to seek support and resources, possibly connecting with other NACs and asking questions. The MDS General Discussion listserv in the AAPACN Connect community is a great place to link up with other NACs and RAI experts across the country. Although networking is encouraged, the source of the information should always be verified in a CMS manual or regulation.

When a question remains about MDS coding that is not clarified in the manual, the NAC can reach out to the state RAI coordinator. Contact information is listed in Appendix B of the RAI User’s Manual, updated regularly in the Downloads section of the CMS RAI webpage.

Here are some additional helpful AAPACN resources for the new NAC:

Education

Not sure where to start? Take the short quiz “AAPACN Education Guide: Where Should I Start?” or review AAPACN’s “Learning Timeline for AAPACN Education and Resources.”

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Tools

This AAPACN resource is copyright protected. AAPACN individual members may download or print one copy for use within their facility only. AAPACN facility organizational members have unlimited use only within facilities included in their organizational membership. Violation of AAPACN copyright may result in membership termination and loss of all AAPACN certification credentials. Learn more.