Q&A: What assessments should my facility be completing for residents who are readmitted?

Question: What assessments should my facility be completing for residents who are readmitted? Answer from Michelle Stuercke, DNP, MSN, MPH, LNHA:  It often happens that residents have a change in their fall risk, skin risk, etc., after a hospitalization and that is why we have them do all of the …

Writing MDS Supplemental Notes: How NACs Can Ace This Role

The COVID-19 pandemic is quite diminished but still a concern in some nursing homes due in part to SARS-CoV-2 variants, as well as unvaccinated staff. With the public health emergency worsening the already significant staffing shortage, simply relying on the documentation in the electronic medical record (EMR) may not be …

Avoid These 5 Common Mistakes NACs Make Coding I0020B

by Carol Maher, RN-BC, RAC-MTA, RAC-MT, CPC ICD-10-CM coding is not a skill nursing school conveys to students, yet it is one that nurse assessment coordinators (NACs) must acquire to perform their diagnosis coding duties competently. Medicare’s transition to the Patient-Driven Payment Model (PDPM) on October 1, 2019, elevated the …

Care Area Assessments: Don’t Let CAAs Be the Missing Link in the RAI Process

The care area assessment (CAA) process sometimes mistakenly gets lumped under the “required but not critical to resident care” label of regulatory paperwork. While working the CAAs is indeed a mandatory step in the Resident Assessment Instrument (RAI) process for OBRA comprehensive MDS assessments, it’s also a crucial link between …

Q&A: Do I need to complete a Significant Change in Status Assessment (SCSA) for a resident who had expected improvements in in all ADLs, but discharge is now delayed?

Question: We had a resident come in with a leg fracture four months ago. At that time, he required extensive assist. He worked with therapy and became independent in functional activities by the end of his Medicare stay. His Quarterly assessment is now due. He has an active discharge plan; …

Appendix B RAI User’s Manual State RAI Coordinator Contact List (5/21)

The May update of Appendix B to the RAI 3.0 User’s Manual contains changes to the list of State RAI Coordinators, MDS Automation Coordinators, RAI Panel members, and CMS Locations [i.e., regional office] contacts. To ensure accurate formatting, use a current version of Adobe Acrobat Reader to view this PDF. Web-based or mobile browser …

H0400 – H0600: Keys to Coding Bowel MDS Items

As a group, the bowel MDS items H0400 (Bowel Continence), H0500 (Bowel Toileting Program), and H0600 (Bowel Patterns) impact nursing homes on multiple levels, including the following: The Nursing Home Quality Initiative Quality Measures (NHQI QMs); The Skilled Nursing Facility Quality Reporting Program Quality Measures (SNF QRP QMs); The annual …

Q&A: A patient admitted under Original Medicare Part A. Within a couple of hours, his family decided to take him home. What assessments are needed?

Question: A patient admitted under Original Medicare Part A. Within a couple of hours, his family decided to take him home. What assessments are needed? Answer from Carol Maher, RN-BC, CPC, RAC-MT: Since the resident discharged to a non-Medicare setting on the day of admission, the 5-Day PPS can be …

Q&A: A resident returned following a hip fracture from a fall. Would his primary diagnosis be the S-code for the fracture, or the Z-code for aftercare?

Question: A resident returned following a hip fracture from a fall. Would his primary diagnosis be the S-code for the fracture, or the Z-code for aftercare? Answer from Jennifer LaBay RN, RAC-MT, RAC- MTA, CRC: Z codes for after care are never used with a fracture. The 7th character of …

Cognitive & Mood Assessment Four-Course Training Series for SNFs (5/21)

By CMS The Centers for Medicare & Medicaid Services (CMS) is offering web-based training that provides an overview of the general and key clinical considerations important for conducting standardized cognitive and mood assessments. This four-course series is designed for providers in the Skilled Nursing Facility (SNF) setting. The courses contained …