Deep Tissue Injury: Section M Assessment and Coding Tips

Pressure-related deep tissue injury (DTI) coded in M0300G (Unstageable Pressure Injuries Related to Deep Tissue Injury) does not play a role in Medicare payment under the Patient-Driven Payment Model (PDPM). While DTI is an unstageable pressure ulcer/injury, only ulcers that are unstageable due to slough and/or eschar (MDS item M0300F1) …

Keys to Competencies in Infection Prevention and Control

Under F-tag 726 (Competent Nursing Staff) in Appendix PP of the State Operations Manual, nursing staff, including registered nurses (RNs), licensed practical or vocational nurses (LPNs/LVNs), and certified nursing assistants (CNAs), must have “the competencies and skill sets necessary to provide nursing and related services to meet the residents’ needs …

Respiratory Outbreak! How to Protect the MDS and Capture Key Assessment Data

With the influenza season in full swing plus the ongoing peaks and valleys of COVID-19 and respiratory syncytial virus (RSV) outbreaks across the United States, nurse assessment coordinators (NACs) should take steps both to protect the MDS process and to capture relevant clinical events on MDS assessments when a respiratory …

Reducing Post-Discharge Hospital Readmissions: Set Up the Resident for Success

Like in-house hospital readmissions, post-discharge hospital readmissions can affect provider performance in the Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP), says Carol Hill, MSN, RN, LNHA, RAC-MT, RAC-MTA, DNS-MT, QCP-MT, CPC, president of Hill Educational Services in Warrior, AL. “With the Skilled Nursing Facility 30 Day All-Cause Readmission Measure …

Expedited Determination Notices: Keys to Avoiding Financial Liability, Survey Issues

The expedited determination beneficiary notification process covers a lot of ground in skilled nursing facilities (SNFs), affecting residents in the fee-for-service (FFS) Medicare Part A program and Medicare Advantage plans, as well as residents who receive Part B rehabilitation therapies under consolidated billing, says Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, …

Communication Basics: How Nurse Leaders Can Build a Two-Way Street

A top-down or autocratic management style is becoming increasingly outdated for dealing with today’s healthcare workforce in non-emergent situations. Other leadership styles, such as transformational leadership, often work better to help staff feel valued, supported, and satisfied in their job—and to give them the sense of ownership in creating positive …

Speak Up! Improve Communication to Bolster the MDS Process

Effective communication is the glue holding the MDS process together, says Stacy Grondel, BSN, RN, RAC-MT, CMAC, QCP. director of reimbursement operations at QRM in Addison, TX. “The nurse assessment coordinator (NAC) who is a strong communicator can develop better working relationships with the interdisciplinary team and executive leadership—and establish …

In-House Hospital Readmissions: How to Prevent Upward Trends

The average cost of a hospital readmission is 12.4 percent higher than the average cost of the original hospital admission ($16,300 vs. $14,500), according to a 2023 analysis by the Agency for Healthcare Research and Quality (AHRQ). At the same time, hospital readmissions from skilled nursing facilities (SNFs) remain relatively …

Coding Hallucinations and Delusions on the MDS: Keys to Accuracy and Better Care Plans

MDS items E0100A (Hallucinations) and E0100B (Delusions) are qualifiers for the Behavioral Symptoms and Cognitive Performance category in the nursing component of the Patient-Driven Payment Model (PDPM). Even more importantly, these conditions that form the core of E0100 (Potential Indicators of Psychosis) can indicate an acute medical condition—or result in …

Nonpharmacological Pain Management: How Nursing and Therapy Can Collaborate

Historically, pain is underassessed and undertreated in the geriatric population, says Liz Barlow, RN, CRRN, RAC-CT, DNS-CT, QCP, vice president of marketing at Synchrony Health Services in Louisville, KY. “Up to 75 percent of community-dwelling people over the age of 65 in the United States report experiencing chronic pain.” The …