Q&A: The SNF QRP Data Validation Audit notification letter requested Admission and Discharge assessments. What assessments should be submitted?

Billing and Reimbursement / NAC / Q&A

Question: The Skilled Nursing Facility Quality Reporting Program (SNF QRP) Data Validation Audit notification letter requested Admission and Discharge assessments. What assessments should be submitted? Answer from Jessie McGill RN, BSN, RAC-MTA, RAC-MT: On the notification letter, there are instructions for the “MDS Assessment Type is Admission” or a “Discharge.” …

Q&A: When a resident is discharged to the hospital and admitted with a diagnosis of UTI. Does the UTI get coded on the discharge return anticipated MDS? 

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

Question: When a resident is discharged to the hospital and admitted with a diagnosis of UTI. Does the UTI get coded on the discharge return anticipated MDS?  Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: If the diagnosis of UTI did not occur until the resident was at the …

Q&A: How do I code the “Will [care area] be addressed in the care plan” question when a resident discharges return not anticipated before the care plan is complete?  

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

Question: How do I code the “Will [care area] be addressed in the care plan” question when a resident discharges return not anticipated before the care plan is complete?   Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: Federally, if the care plan was not completed because the resident …

Q&A: Is a Significant Change in Status Assessment (SCSA) required for a new pressure ulcer?

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

Question: Is a Significant Change in Status Assessment (SCSA) required for a new pressure ulcer? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: A Significant Change in Status Assessment is required if there are two or more areas of decline or improvement that will not resolve on its own …

Q&A: When a resident changes payers from Medicare Advantage to Traditional Medicare, are the Medicare Advantage days subtracted from the Medicare 100-day benefit period?

Billing and Reimbursement / NAC / Q&A

Question: When a resident changes payers from Medicare Advantage to Traditional Medicare, are the Medicare Advantage days subtracted from the Medicare 100-day benefit period? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: Yes, days billed under Medicare Advantage are subtracted from the resident’s 100-day benefit period. This AAPACN resource …

Q&A: If a Discharge – return not anticipated was completed for a resident discharge against medical advice (AMA), and he returned less than 30 days later, is a new OBRA Admission assessment required?

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

Question: If a Discharge – return not anticipated was completed for a resident discharge against medical advice (AMA), and he returned less than 30 days later, is a new OBRA Admission assessment required? Answer from Jessie McGill RN, BSN, RAC-MTA, RAC-CTA: When the OBRA discharge is named “Return not anticipated” …

Q&A: A resident has a healing pressure ulcer that was described as “100% epithelial, with slow blanching erythema” during the ARD window. Would this still be coded as a pressure ulcer?  

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

Question: A resident has a healing pressure ulcer that was described as “100 % epithelial, with slow blanching erythema” during the ARD window. Would this still be coded as a pressure ulcer?   Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: Code the ulcer as present unless completely healed …

Q&A: If a resident is losing weight and ordered supplements as an intervention, can we code as a therapeutic diet?

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

Question: If a resident is losing weight and ordered supplements as an intervention, can we code as a therapeutic diet? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC:If the supplements were ordered by a physician or physician extender (as allowed in your state) to increase nutrients in the diet …

Q&A: If a resident on Medicare Part A admits and discharges to home on the same day, can we bill Medicare for that day?

Billing and Reimbursement / NAC / Q&A

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 …

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 …