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 when and why the SNF Advanced Beneficiary Notice should be used.
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Question: If a resident on Medicare Part A admits and discharges to home on the same day, can we bill Medicare for that day? Answer from Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: If a Medicare resident discharges to a non-Medicare participating location (home, expires) the same day …
When a resident’s Medicare Part A skilled stay ends, two types of resident notification processes may be required under the Beneficiary Notices Initiative: the standard denial process and the expedited appeal process. In the standard appeal process, the Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN) is an …
Question: Can we still use dementia as a primary diagnosis for our long-term residents? Our facility was recently told we can no longer use the dementia diagnosis (F03.90) although it maps to medical management? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: If there is no known cause of …
Implementation Date 2026-01-05 CR # 14250 Publication # 100-04 Transmittal Year 2025 Downloads
With so many Quality Measures originating from three different payment initiative programs, it’s a lot to keep track of. AAPACN’s At-a-Glance QM, QRP, and VBP tool organizes all of the measures for you. This tool has been updated with the MDS 3.0 Quality Measures User’s Manual Version 17.0 (January 2025), the Five-Star …
Nearly All Skilled Nursing Services Provided by Pinnacle Multicare Nursing and Rehabilitation Center Did Not Meet Medicare Payment Requirements Issued on 11/14/2025 | Posted on 11/18/2025 | Report number: A-02-22-01017 Report Materials Why OIG Did This Audit What OIG Found What OIG Recommends We made three recommendations to Pinnacle, including that it refund to the Medicare …
This communication pertains to the Fiscal Year (FY) 2028 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program performance standards for the Number of Hospitalizations per 1,000 Long Stay Resident Days (Long Stay Hospitalization) measure which the Centers for Medicare & Medicaid Services (CMS) published in the FY 2026 SNF Prospective Payment …
Question: A resident was skilled under Medicare Part A and exhausted benefits. We completed a Significant Change in Status Assessment to capture the improvement before the end of the stay. Should I have completed an IPA or something else with the significant change MDS? Answer from Jessie McGill RN, BSN, …
The Non-Therapy Ancillary (NTA) component of the Patient-Driven Payment Model (PDPM) accounts for the medical complexity and resource-intensive services provided to residents in nursing facilities. This component is calculated using a combination of clinical diagnoses, active conditions, and specialized treatments or services documented in the Minimum Data Set (MDS) and, …
