Q&A: Does the primary diagnosis that physical therapy and occupational therapy use need to match the primary ICD-10 code used by nursing?

Question: Does the primary diagnosis that physical therapy and occupational therapy use need to match the primary ICD-10 code used by nursing?     Answer: Often confusion stems from the terms used across different disciplines. Therapists use medical and treatment diagnoses, while the SNF uses other terms, such as admission diagnosis, …

Q&A: How will the 30-day window rule work under PDPM with the new Interrupted Stay Policy?

Question: Under RUG-IV PPS, if the resident returns to a skilled level of care within 30 days the reason for skilled care would have to be something that was present/treated during the first qualifying hospital stay or developed during the skilled period. How does that work with PDPM and the Interrupted …

Section GG Under PDPM: Issues to Discuss With Your NAC

To date, the accuracy of section GG (functional abilities and goals) hasn’t mattered from a payment perspective. Section GG doesn’t affect payment under the RUG-IV case-mix classification system, and the Skilled Nursing Facility Quality Reporting Program (SNF QRP) only penalizes providers financially for failing to meet the data submission threshold …

Responding to ADRs Tool

An Additional Development Request or Additional Documentation Request letter can cause a lot of stress in the SNF if there’s not a process in place to respond to it. Use this Responding to ADRs Tool to help your team more confidently approach medical reviews.  For permission to use or reproduce this …

Part A Certs/Recerts: Learn the Rules First-Hand

In many skilled nursing facilities (SNFs), the responsibility for obtaining Medicare Part A physician or nonphysician practitioner certifications/recertifications (certs/recerts) for skilled care has shifted to the nurse assessment coordinators (NACs) from medical records. “But often, the NACs or other staff members who are responsible for certs/recerts learned how to fill …

Guided by the MOON? Not a Good Idea

Since March 8, all hospitals and critical-access hospitals are required to issue the Medicare Outpatient Observation Notice (MOON) to fee-for-service Medicare and Medicare Advantage beneficiaries who receive observation services as outpatients for more than 24 hours. The MOON informs these patients that they are outpatients receiving observation services, not inpatients …