Understanding OBRA and PPS Discharge Assessments: What NACs Need to Know

Listen to this article Your browser does not support the audio element. In the complex world of Minimum Data Set (MDS) assessment scheduling, discharge scenarios can often confuse even experienced interdisciplinary team (IDT) members. When a resident’s stay changes, due to either leaving the facility or a shift in payer …

ICD-10-CM Coding Spotlight Series – Part 5: Getting Ready for Summer: Obesity and BMI Coding

Listen to this article Your browser does not support the audio element. As summer approaches, many people begin thinking about health goals, wellness check-ins, and how to prepare for more outdoor activities in the warmer months. In the long-term care ICD-10 realm, preparation takes a different form: ensuring documentation and …

Leave of Absence versus Interrupted Stay: The Effect of EHR Census Decisions

Listen to this article Your browser does not support the audio element. Skilled nursing facilities (SNFs) frequently manage residents who temporarily leave the building or experience a break in Medicare Part A coverage. On the UB-04, these situations may look the same, often reflected as gaps in covered days or …

ICD-10-CM Coding Spotlight Series – Part 4: Slips, Trips, and Fragile Bones: Why Not All Fractures Are Created Equal

Listen to this article Your browser does not support the audio element. As winter gives way to spring, many are relieved to leave behind icy sidewalks and the inevitable steady number of fall-related injuries that come with them. Yet in long-term care, fractures do not simply disappear with the snow; …

ICD-10-CM Coding Spotlight Series – Part 3: Sweet Details Matter: Navigating Diabetes ICD-10-CM Coding

Listen to this article Your browser does not support the audio element. Seasonal celebrations often remind us how quickly small choices can add up. A little handful of candy or a few fruit jelly slices may seem insignificant, but piece by piece they do make an impact. In healthcare documentation …

ICD-10-CM Coding Spotlight Series – Part 2: Navigating Genitourinary Conditions in Long-Term Care

Listen to this article Your browser does not support the audio element. As National Kidney Month arrives in March, so does an important reminder: our kidneys work quietly every day, filtering waste, balancing fluids, and supporting overall health. Now is the perfect time for facility coders in long-term care (LTC) …

ICD-10-CM Coding Spotlight Series – Part 1: Coding with Heart: Navigating ICD-10-CM Cardiac Coding in Long-Term Care

Listen to this article Your browser does not support the audio element. February’s designation as American Heart Month offers an important opportunity to reflect on the role of cardiovascular health in long-term care (LTC). Cardiac conditions such as heart disease, hypertension (HTN), and heart failure are among the most frequently …

Simplifying the SNF ABN: Helping Residents Understand Their Options

When a resident’s Medicare Part A skilled stay ends, two types of resident notification processes may be required under the Beneficiary Notices Initiative: the standard denial process and the expedited appeal process. In the standard appeal process, the Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN) is an …

Back to PDPM Basics – Part 5: The NTA Component

The Non-Therapy Ancillary (NTA) component of the Patient-Driven Payment Model (PDPM) accounts for the medical complexity and resource-intensive services provided to residents in nursing facilities. This component is calculated using a combination of clinical diagnoses, active conditions, and specialized treatments or services documented in the Minimum Data Set (MDS) and, …

Back to PDPM Basics – Part 4: The Nursing Component – Clinically Complex, Behavioral Symptoms and Cognitive Performance, and Reduced Physical Function

The nursing component of the Patient-Driven Payment Model (PDPM) may appear straightforward: calculate a section GG Nursing Function Score and assign the resident to one of six nursing categories. But accuracy relies on a detailed understanding of coding rules, observation periods, and documentation requirements that determine both compliance and reimbursement …