Infusion Therapy: Solve These Clinical and Documentation Issues to Provide Better Care

Infusion therapy services are so inherently complex that the Centers for Medicare & Medicaid Services (CMS) identifies “intravenous or intramuscular injections and intravenous feeding” and “enteral feeding that comprises at least 26 percent of daily calorie requirements and provides at least 501 milliliters of fluid per day” as two of …

Effective Business Case Development for Budget Wins and Better Care Outcomes

The phrase “budget development time” often elicits moans and groans from facility leadership. During this process, leadership usually asks the director of nursing services (DNS) if he or she has any requests of items to include in the budget. Often, the DNS makes a list of nursing department wants and …

Accurate PDPM Reimbursement: Four Areas of Focus to Shore Up MDS Documentation

The Patient-Driven Payment Model (PDPM) has been the case-mix classification model used for Medicare Part A skilled nursing facility (SNF) reimbursement since October 2019. Although this payment system has been in place for nearly four years for Medicare payment, some states have recently transitioned to PDPM for Medicaid payment. That …

RAI Manual v1.18.11 Surprises: Standout Issues in Sections D and K

Note: This is the second in a series of articles reviewing key issues in the draft v1.18.11 Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual that could prove to be disruptive for busy nurse assessment coordinators (NACs). The first article was RAI Manual v1.18.11 Surprises: Section M and N …

Psychotropic Medications in the Skilled Nursing Facility: How to Manage the Process

The use of psychotropic medications in the skilled nursing facility (SNF) is a controversial issue with implications for resident, regulatory, and financial outcomes. The many requirements can be confusing, especially for a relatively new director of nursing services (DNS). This article reviews psychotropic medication requirements and offers tips to manage …

F609 Abuse/Crime Reporting Obligations: Keys to Success

Nursing homes face significant risk and liability under F-tag 609 (Reporting of Alleged Violations), says Janet Feldkamp, RN, BSN, LNHA, CHC, JD, a partner in the Benesch Healthcare + Practice Group at Benesch, Friedlander, Coplan & Aronoff in Columbus, OH. “This risk is more than just regulatory. There may be …

Develop an Action Plan for CMS’s Schizophrenia MDS Audits

Written by: Jessica Stucin, RN, BSN, LNHA, RAC-CT, Assistant Director of Education, MDS Consultants On Jan. 18, 2023, the Centers for Medicare & Medicaid Services (CMS) announced they will be conducting offsite audits in nursing homes for assessment accuracy and coding of residents with a diagnosis of schizophrenia. Along with …

RAI Manual v1.18.11 Surprises: Section M and N Updates Include Course Corrections

Note: This is the first in a series of articles reviewing key issues in the draft v1.18.11 Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual that could prove to be disruptive for busy nurse assessment coordinators (NACs). Even seemingly small changes to the draft RAI User’s Manual coding instructions …

Using New MDS Items Beyond the MDS

Several new items added or revised on the Minimum Data Set (MDS) this October are considered social determinants of health (SDOHs): ethnicity, race, language, transportation, health literacy, and social isolation. SDOHs are nonmedical factors that can affect health outcomes. On the MDS, these items are collected directly from the resident. …

OSA Crash Course: Keys to Navigating this Medicaid-Only Payment Assessment

In a number of Medicaid case-mix states, the MDS v1.18.11 item sets won’t be the only MDS item sets that are implemented on Oct. 1, 2023—a fact that should temper some excitement about certain MDS items, such as section G (Functional Status), “going away,” suggests Scott Heichel, RN, RAC-MT, RAC-CTA, …