Q&A: Does providing drain care (emptying and dressing change) three times per week qualify as skilled care for Medicare Part A?

Billing and Reimbursement / NAC / Q&A

Question: Does providing drain care (emptying and dressing change) three times per week qualify as skilled care for Medicare Part A? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: Emptying the drain and completing a dressing change three times per week does not qualify for skilled care, but this …

Q&A: Who should enter and sign resident interview information when remote MDS support is used?

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

Question: When remote MDS support is used, may the remote MDS worker enter resident interviews documented in the medical record during the look-back period and sign the MDS for those sections, such as the BIMS and PHQ-2 to 9? Answer from Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: …

Q&A: Must the physician sign the Medicare certification on the resident’s admission date?

Billing and Reimbursement / NAC / Q&A

Question: Is it mandatory for the physician to sign the Medicare certification on the day of admission? If the resident is admitted late in the evening and is not seen by the physician until the following day, may the certification be signed the next day without a penalty? Answer from …

Are fractures from falls caused by overwhelming external force coded as fall-related major injuries?

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

Question: If a resident falls because they were pushed or struck by another resident or object and sustains a fracture, should the fracture be coded as a major injury related to a fall? On page J-33 it states we would not count it as a fracture related to a fall …

Q&A: Should a Significant Change in Status Assessment (SCSA) be completed for a resident who develops two new venous stasis ulcers?

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

Question: Should a Significant Change in Status Assessment (SCSA) be completed for a resident who develops two new venous stasis ulcers? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, CRC: What else has changed with this resident? The decline must impact more than one area of the resident’s health status, not …

Q&A: Can a long-standing Stage 4 pressure ulcer be reclassified as a Kennedy terminal ulcer (KTU)?

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

Question: A resident has had a Stage 4 pressure ulcer for years. The provider is now documenting the wound as skin failure/Kennedy terminal ulcer. Is this appropriate, and should the ulcer no longer be coded as a pressure ulcer? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: This ulcer …

Q&A: Can IV chemotherapy be excluded from consolidated billing during a Part A stay?

Billing and Reimbursement / NAC / Q&A

Question: Can IV chemotherapy be excluded from consolidated billing during a Part A stay? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, CRC: Exclusion for chemotherapy is based on the Healthcare Common Procedure Coding System (HCPCS) code as long as the chemotherapy is not delivered in the SNF. You certainly can …

Q&A: What costs should be included when explaining a SNF ABN to a resident?

Billing and Reimbursement / NAC / Q&A

Question: I have always thought that delivery of the SNF ABN (CMS – 10055) notice offers the Medicare recipient the opportunity to pay for the Medicare Part A services being cut. I was told the cost should only include the daily bed rate. How should I explain this notice to …

Q&A: If a resident revokes hospice services, does the ARD need to be scheduled to avoid coding hospice in O0110K?

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

Question: If a resident revokes hospice services, does the ARD need to be scheduled to avoid coding hospice in O0110K? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: The Significant Change in Status Assessment (SCSA) to come off hospice must be completed within 14 days of the end of …

Q&A: When must resident interviews be completed for the MDS?

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

Question: Please clarify when resident interviews need to be completed for the MDS? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: All resident interviews, including the Customary Routine/Activities, BIMS, PHQ-2 to 9, and Pain, must be completed in the 7-day look-back window of the MDS. Any non-interview …