Question: Can Z codes be used as the admitting diagnosis on the claim? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC: Admission Diagnosis codes (Field Locator 69 on the claim) should be the code that is the reason the resident is being admitted to the facility, versus a lower …
Navigating Medicare Part A coverage in skilled nursing facilities (SNFs) is a matter of regulatory compliance. But it’s also a daily ethical test for facility staff and administrators. In many ways it depends on the honor system, and those responsible for billing and care case management must understand and apply …
In this LTC NAC Chat podcast episode, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist with AAPACN, discuss the Medicare appeals process in skilled nursing facilities. Additional Resources:
Podcast: Play in new window | Download (Duration: 23:04 — 14.1MB) | Embed
In the Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS) and Consolidated Billing Proposed Rule for Fiscal Year (FY) 2026, the Centers for Medicare & Medicaid Services (CMS) does not reveal any firm proposals for new quality measures (QMs). However, CMS does serve up a simple reminder for nurse …
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-20250508 (PDF) From https://www.cms.gov/medicare/quality/snf-quality-reporting-program/submission-deadlines
In this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist with AAPACN, discuss the sequencing of ICD-10-CM diagnosis coding. Additional Resources: AAPACN Articles: AAPACN Education: AAPACN Tool:
Podcast: Play in new window | Download (Duration: 16:12 — 10.3MB) | Embed
The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code assignment continues to be a bit of an enigma in the long-term care setting. Members regularly ask questions about ICD-10-CM coding in AAPACN’s online communities, as well as in post-education surveys, often confused about how to order the codes. …
FY 2026 SNF VBP Program Fact Sheet (PDF) From https://www.cms.gov/medicare/quality/nursing-home-improvement/value-based-purchasing (also updated with FY 2026 information) SNF VBP Program: FY 2026 Incentive Payment Multiplier Calculation Infographic (PDF). From https://www.cms.gov/medicare/quality/nursing-home-improvement/value-based-purchasing/scoring-methodology-payment-adjustment
The Centers for Medicare & Medicaid Services (CMS) does not propose any new quality measures (QMs) for the pay-for-performance Skilled Nursing Value-Based Purchasing program (SNF VBP) in the Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS) and Consolidated Billing Proposed Rule for Fiscal Year (FY) 2026. However, three QMs …
Most methods for auditing Patient-Driven Payment Model (PDPM) reimbursement focus on impacts to the HIPPS code. However, AAPACN’s PDPM Audit by MDS Section tool uses an approach that can result in identifying missed opportunities for items that didn’t directly impact the HIPPS code. Nurse assessment coordinators can use this tool …
