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 …
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 …
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 …
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 …
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 …
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 …
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 – …
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. …
Ah, the great mysteries of life. Which came first, the chicken or the egg? Is there intelligent life on other planets? Where do all the missing socks go? And of course, the enduring mystery: what is the interrupted stay policy? Interrupted stays may not happen often, and every skilled nursing …
