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 Centers for Medicare & Medicaid Services (CMS) implemented the Patient-Driven Payment Model (PDPM) in October 2019 for residents receiving Medicare Part A coverage in the skilled nursing facility (SNF). PDPM replaced the previous legacy payment model, the Resource Utilization Group (RUG-IV) system, still used by some state Medicaid agencies …
Accurate diagnosis coding is critical in nursing facilities (NFs) for care planning, reimbursement, and quality measurement. NF coders must understand ICD-10-CM conventions, general coding guidelines, and chapter-specific coding guidelines that affect how diagnoses are assigned. Coding guidance can be found in the ICD-10-CM Official Guidelines for Coding and Reporting for FY …
Backdating, or placing an earlier date than the actual date on a document, is only permissible in limited Minimum Data Set (MDS) scenarios. Has anyone asked the nurse assessment coordinator (NAC) to change the assessment reference date (ARD) of a 5-Day prospective payment system (PPS) assessment after day 8? Is …
Effective communication with residents in skilled nursing facilities (SNFs) is essential to understand their needs and preferences. In accordance with Appendix D of the Long-Term Care Facility Resident Assessment 3.0 User’s Manual (RAI User’s Manual) and the principles outlined in the Center for Medicare & Medicaid Services (CMS) Video on …
The International Classification of Diseases, Clinical Modification, 10th revision (ICD-10-CM), coding system is an essential tool needed to document and bill accurately for healthcare services in the long-term care (LTC) setting. Annual updates to both the coding guidelines and the actual codes reflect updated clinical practices, advancements in medical understanding, …
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 …
Since the start of the Patient-Driven Payment Model (PDPM) in October 2019, the International Classifications of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) has been thrust into the forefront of daily tasks for the nurse assessment coordinator (NAC). ICD codes were always applied in long-term care (before 2015, ICD-9-CM codes were …
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 …
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, …
