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

Article / Billing and Reimbursement / NAC

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

Article / MDS 3.0 and the RAI Process / NAC

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?

Article / Billing and Reimbursement / MDS 3.0 and the RAI Process / NAC

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

Article / MDS 3.0 and the RAI Process / NAC

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

Article / Clinical Care Solutions / NAC

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 …

Back to Basics: Returning to Pre-Pandemic Medicare Regulatory Compliance

Article / Billing and Reimbursement / NAC

Since March of 2020, skilled nursing facilities (SNFs) have relied on two distinct waivers related to technical eligibility for Medicare. Due to the COVID-19 Public Health Emergency (PHE), temporary changes related to the 3-day qualifying hospital (QHS) stay and the benefit period appear in the MLN Matters document SE20011 – …

Medical Review Audits and Regulatory Compliance: It Takes a Village

Article / MDS 3.0 and the RAI Process / NAC / Survey and Regulatory Compliance

Long-term care is one of the most regulated settings in this country. The interpretive guidance in Appendix PP of the State Operations Manual, which surveyors apply during an onsite survey, is 856 pages long—and that is just a small fraction of the regulatory mandates that apply to long-term care facilities. …

Back to Basics: Daily and Weekly Tasks of a Nurse Assessment Coordinator

Article / MDS 3.0 and the RAI Process / NAC

Nurse assessment coordinators (NACs) new to the job often receive guidance from a mentor during their first two weeks in the role. That mentor might lead the new NAC step by step through all the functions necessary to manage the resident assessment instrument (RAI) process. Ideally, the NAC would continue …

Uncover Unusual Contributors to Fall Risk

Article / Clinical Care Solutions / Therapist

The RAI User’s Manual states that “A previous fall, especially a recent fall, recurrent falls, and falls with significant injury are the most important predictors of risk for future falls and injurious falls” (CMS, 2019, p. J-27). However, there are many more items that must be considered when assessing a …