A Closer Look at the Medicare Part A Presumption of Coverage

Skilled nursing facility (SNF) staff must understand the intricate guidelines that regulate Medicare Part A coverage for SNF stays. Several technical requirements must be met before a resident qualifies for a Medicare Part A SNF stay. For example, the resident must have benefit days available, meet the 3-day qualifying hospital …

Tricky NAC Issues Even Some Experts Miss

Nurse assessment coordinators (NACs) definitely experience variety in their jobs, to state the obvious. Management and completion of the Minimum Data Set/Resident Assessment Instrument (MDS/RAI) process, Medicare management, and ICD-10-CM coding are just a few of the areas they are expected to master in their role. With these responsibilities alone, …

iQIES Essentials for the Nurse Assessment Coordinator

In the ever-evolving realm of healthcare data management, the transition of the Minimum Data Set (MDS) submission process to the Internet Quality Improvement and Evaluation System (iQIES) in April 2023 marked a significant milestone for skilled nursing facilities (SNFs). Replacing the outdated Quality Improvement and Evaluation System Assessment and Submission …

Navigating the 2024 Landscape: Updates and Changes in Medicare Impacting Skilled Nursing Facilities

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 …

Putting the Significant Change in Status Assessment Criteria into Clinical Practice

The Significant Change in Status Assessment (SCSA) has been a federal requirement since the inception of the Resident Assessment Instrument (RAI) process that resulted from the Omnibus Budget Reconciliation Act of 1987. The specifications of how to complete this assessment are described in chapter 2 of the RAI User’s Manual …

Preparing for Success with ICD-10-CM Changes Oct. 1: How the Facility Coder and Provider Can Ensure Accurate Diagnosis Codes

Effective International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM) coding relies on meticulous clinical documentation. It’s not just about assigning codes; it’s about ensuring consistent and comprehensive documentation that substantiates every facet and the specificity of a diagnosis. This documentation should originate from a provider, that is, a physician …

Accurate PDPM Reimbursement: Four Areas of Focus to Shore Up MDS Documentation

The Patient-Driven Payment Model (PDPM) has been the case-mix classification model used for Medicare Part A skilled nursing facility (SNF) reimbursement since October 2019. Although this payment system has been in place for nearly four years for Medicare payment, some states have recently transitioned to PDPM for Medicaid payment. That …

How Will October 2023 MDS Changes Impact PDPM and Medicare Payment?

Many changes are coming to the Minimum Data Set (MDS) effective Oct. 1, 2023. The Centers for Medicare & Medicaid Services (CMS) released the draft of the Long-Term Care Resident Assessment Instrument (RAI) User’s Manual version 1.18.11 in April with a final manual expected in August. Several of the MDS …

Deep Dive into ICD-10-CM: Misunderstood Coding Guidelines

Diagnosis accuracy, long a critical component of the MDS, is escalating in importance. With the recently released draft Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User’s Manual version 1.18.11, which will become effective October 1, 2023, the Centers for Medicare & Medicaid Services (CMS) is increasing its scrutiny of …

Person-Centered Fall Prevention Interventions: Beyond Rehab Screen and 15-Minute Checks

The Centers for Disease Control and Prevention (CDC) cites falls as the leading cause of injury-related death in adults aged 65 and older (CDC, 2023). It is imperative that nursing facility staff identify fall risk in their residents and care plan accordingly. A fall risk assessment can help to identify …