FY 2025 Final MDS 3.0 Item Sets version 1.19.1 Effective Oct. 1, 2024

The final Minimum Data Set (MDS) 3.0 Item Sets version (v)1.19.1 are now available. The MDS Item Sets v1.19.1 will be effective beginning October 01, 2024. Items in sections A, B, D, GG, I, J, N, and O are affected. From https://www.cms.gov/medicare/quality/nursing-home-improvement/resident-assessment-instrument-manual

SNF QRP Quick Reference Guide

An updated Quick Reference Guide is now available. The Quick Reference Guide provides high-level information on the SNF Quality Reporting Program, including frequently asked questions and helpful links. PAC-SNF-QuickReferenceGuide-20240425 (PDF) From https://www.cms.gov/medicare/quality/snf-quality-reporting-program/submission-deadlines

Proposed Revisions to NOMNC/DENC for Medicare Advantage Effective 1/1/2025

1. Type of Information Collection Request: Revision of a currently approved collection; Title of Information Collection: Fast Track Appeals Notices: NOMNC/DENC; Use: The purpose of the NOMNC is to help a beneficiary/enrollee decide whether to pursue a fast appeal by a Quality Improvement Organization (QIO) and informs them on how …

SNF QRP: Achieving a Full APU Webinar Slides, Recording, and Q&A Document

The Centers for Medicare & Medicaid Services (CMS) hosted a webinar on March 26, 2024, to educate providers of current changes and to help them achieve a full Annual Payment Update (APU) in the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP). This webinar covered updates to the SNF QRP, Minimum Data …

PDPM Clinically Complex Nursing Qualifiers: Coding and Documentation Refresher

The Patient-Driven Payment Model (PDPM) includes four ways for a resident to classify into the Clinically Complex category of the Nursing payment component. If a resident has conditions or is receiving services that qualify for Extensive Services, Special Care High, or Special Care Low, but does not have a PDPM …

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, …

Seven Ways NACs Can Be Proactive With New Medicare Advantage Plan Rules

A skilled nursing facility (SNF) accepts a resident in a Medicare Advantage plan for admission after the plan provides a prior authorization. The resident receives skilled services for the allotted amount of time, and the nurse assessment coordinator (NAC) and the rest of the interdisciplinary team follow the plan’s rules. …

Q&A: Can a long-term care resident who exhausted his Medicare benefits three months ago, but continued to receive dialysis three times per week earn a new 100-day benefit period?

Question: A long-term care resident who is on dialysis three times per week exhausted his Medicare benefits and has been in the facility with Medicaid as the primary payer for the last three months. He recently had a new qualifying hospital stay but does he have a new 100-day benefit …

Q&A: Is the facility responsible for the expense of a family requested specialty enteral tube feeding formula for a resident on a Medicare Part A stay?

Question: Is the facility responsible for the expense of a family requested specialty enteral tube feeding formula for a resident on a Medicare Part A stay? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC The facility is responsible for the cost of the tube feeding formula. If the …