Q&A: Can I code a diagnosis of pneumonia when the nurse practitioner initiated antibiotics for a documented reason of pneumonia, but there was not a chest x-ray completed to confirm the diagnosis?

MDS 3.0 and the RAI Process / NAC / Q&A

Question: Can I code a diagnosis of pneumonia when the nurse practitioner initiated antibiotics for a documented reason of pneumonia, but there was not a chest x-ray completed to confirm the diagnosis? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: If the physician/extender diagnosed the resident with pneumonia after …

Q&A: What date would be used in A2400C (Medicare end date) for an unplanned discharge to the hospital when the assessment is a combined a 5-Day, OBRA discharge, and a PPS discharge?

MDS 3.0 and the RAI Process / NAC / Q&A

Question: What date would be used in A2400C (Medicare end date) for an unplanned discharge to the hospital when the assessment is a combined a 5-Day, OBRA discharge, and a PPS discharge? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: The Medicare end date would be the date of …

Q&A: Can we still use dementia as a primary diagnosis for our long-term residents?

Billing and Reimbursement / NAC / Q&A

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 …

Q&A: 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?

Billing and Reimbursement / NAC / Q&A

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, …

Q&A: If the stay is only 15 days, how do I calculate the 30-day weight loss for section K?

MDS 3.0 and the RAI Process / NAC / Q&A

Question: If the stay is only 15 days, how do I calculate the 30-day weight loss for section K?  Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: You use the weight that is closest to 30 days before the date the current weight was measured-—the weight coded on the …

Q&A: What ARD is used for a Death in Facility record if the resident expires before midnight, but the mortuary did not pick up until after midnight?  

MDS 3.0 and the RAI Process / NAC / Q&A

Question: What ARD is used for a Death in Facility record if the resident expires before midnight, but the mortuary did not pick up until after midnight?   Answer from Jeff Taylor: The actual time/date of death.   The death certificate should specify both when death was pronounced and either the …

Q&A: Can the physician certification be met through a detailed order versus a separate certification form?

Billing and Reimbursement / NAC / Q&A

Question: Can the physician certification be met through a detailed order versus a separate certification form?   Answer from Jessie McGill RN, BSN, RAC-MTA, RAC-MT: CMS does not mandate a specific form or format, but to meet the requirements, the certification must have all the required information. This is found …

Q&A: We have a resident that had a qualifying hospital stay (QHS), then went to an LTACH for more than 30 days. Can the resident utilize their Medicare benefits since the transfer from acute hospital to SNF is more than 30 days?

Billing and Reimbursement / NAC / Q&A

Question: We have a resident that had a qualifying hospital stay (QHS), then went to a long-term acute care hospital (LTACH) for more than 30 days. Can the resident still utilize their Medicare benefits in our skilled nursing facility (SNF) or not, since the transfer from acute hospital to SNF …

Q&A: What is the look-back period for K0100? The RAI User’s Manual does not mention the look-back period or if this can include days during the hospital stay?

MDS 3.0 and the RAI Process / NAC / Q&A

Question: What is the look-back period for K0100? The RAI User’s Manual does not mention the look-back period or if this can include days during the hospital stay? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: When a look-back period is not specifically mentioned, the look-back is 7 days. …

Q&A: Is there a specific table that shows which items if dashed will count against us for the Skilled Nursing Facility Quality Reporting Program (SNF QRP)?

NAC / Q&A / QAPI and Quality Initiatives

Question: Is there a specific table that shows which items if dashed will count against us for the Skilled Nursing Facility Quality Reporting Program (SNF QRP)? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: Yes, CMS releases a document for each fiscal year (FY). The current document, Skilled Nursing …