Part A Basics: 30-Day Transfers and the Medical Appropriateness Exception

The 30-day transfer rule and its medical appropriateness exception typically don’t come up on a daily basis in skilled nursing facilities (SNFs), yet these requirements—and flexibilities—are a key component of the fee-for-service Medicare Part A rules for SNF coverage in chapter 8, “Coverage of Extended-Care (SNF) Services Under Hospital Insurance,” …

Dementia Care: Keys to Implementing Technologies Effectively and Responsibly

Using technologies to engage residents with dementia is becoming increasingly common in nursing homes across the country. Local news shows are peppered with segments on facilities using dancing robots, robotic cats, and other technologies that are designed to improve the quality of life for these residents. However, providers must proceed …

Fall Prevention and Management: How the Consultant Pharmacist Can Add Value

F-tag 689 (Free of Accident Hazards/Supervision/Devices) was the top immediate jeopardy (IJ) citation nationwide—and the second most-frequent citation overall—in calendar year (CY) 2023, and that citation pattern is being maintained so far in CY 2024, according to QCOR data accessed May 7, 2024. Falls are a frequent driver of F689 …

Beyond Physical Function: Psychosocial Needs of Residents Post-Stroke

Stroke is a common issue among residents in long-term care facilities. When caring for this population, staff often focus on physical issues, yet post-stroke residents often have emotional or behavioral changes as well. It is important for staff to understand how a stroke can affect residents’ psychosocial well-being. By recognizing …

Late or Missed PPS 5-Day Assessments: Know the Consequences and How to Avoid Them

Many new nurse assessment coordinators (NACs)—and even some experienced ones—don’t understand what counts as a late MDS assessment, what counts as a missed MDS assessment, or what the financial ramifications are for late vs. missed assessments in the Skilled Nursing Facility Prospective Payment System (SNF PPS), says Robin Hillier, CPA, …

Quality Measure IQ Series: Long-Stay Falls Measures

Someone with an intelligence quotient (IQ) of 130 may be considered above average for intelligence but still not understand the complexities of the MDS 3.0 Quality Measures (QMs). This series of articles on QMs will improve the QM IQs of healthcare professionals in long-term care, starting here with two long-stay …

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, …

Physician Services: How to Level Up From F-Tag Compliance to Better Quality of Care

In calendar year 2023, F712 (Physician Visits – Frequency/Timeliness/Alternate Nonphysician Practitioners (NPPs)) was the most frequently cited F-tag among the six physician services citations—and only 0.8 percent of nursing homes received that citation, according to QCOR data released April 10, 2024. For immediate jeopardy citations, F710 (Resident’s Care Supervised by …

Improving Resident Outcomes Through Collaboration

Improving resident outcomes is a top priority for nursing home teams. Outcomes, good or bad, not only affect the residents and their families but also influence the facility’s Quality Measures (QMs), Five-Star ratings, and regulatory results. Collaboration is key to achieving improvement, or at the very least, preventing decline. This …