Mastering the Discharge Function Score for Skilled Nursing Facilities

Article / Clinical Care Solutions / MDS 3.0 and the RAI Process / NAC

By Greg Seiple Discharge planning is an essential component of patient care in skilled nursing facilities. But how do healthcare professionals determine when a resident is ready to leave and manage daily activities independently? Enter the Discharge Function Score—a critical tool in evaluating a resident’s ability to function outside of …

Q&A: A resident was recently admitted with multiple fractures related to an ATV accident. Is it appropriate to use Z47.89, Encounter for other orthopedic aftercare, as the principal diagnosis code?

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

Question: A resident was recently admitted with multiple fractures related to an ATV accident. Is it appropriate to use Z47.89, Encounter for other orthopedic aftercare, as the principal diagnosis code?    Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: You cannot use aftercare Z codes when related to injuries …

Q&A: I am confused with what can be included at O0110A1, chemotherapy while a resident. A resident is currently receiving Ibrance, as part of her cancer treatment. Can I code oral chemotherapy? 

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

Question: I am confused with what can be included at O0110A1, chemotherapy while a resident. A resident is currently receiving Ibrance, as part of her cancer treatment. Can I code oral chemotherapy?  Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: Ibrance is a kinase inhibitor used to treat breast …

Q&A: A resident recently admitted to us with over 20 pressure ulcers and 10 of these are deep tissue pressure injuries. M0300 only allows us to enter a single digit amount 0-9 on the MDS. How do we code when it is 10 or more?

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

Question: A resident recently admitted to us with over 20 pressure ulcers and 10 of these are deep tissue pressure injuries. M0300 only allows us to enter a single digit amount 0-9 on the MDS. How do we code when it is 10 or more? Answer from Carol Maher, RN, …

GG0130 and GG0170: Using Clinical Judgment to Establish Usual Performance

Article / MDS 3.0 and the RAI Process / NAC

The ability to exercise clinical judgment to define usual performance in MDS items GG0130 (Self-Care) and GG0170 (Mobility) offers nursing homes unprecedented opportunity to impact quality measures (QMs), says Rosanna Benbow, RN, CCM, ICC, IP, DNS-CT, QCP, RAC-CTA, regional director of operations at Proactive LTC Consulting in Evansville, IN. “You …

OIG: Nursing Facility Industry Segment-Specific Compliance Program Guidance

Billing and Reimbursement / DNS / MDS 3.0 and the RAI Process / NAC / Post-Acute Care News / Survey and Regulatory Compliance

From https://oig.hhs.gov/compliance/nursing-facility-icpg/ The Nursing Facility ICPG—together with OIG’s General Compliance Program Guidance (GCPG) that applies to all individuals and entities involved in the health care industry—serves as OIG’s updated and centralized source of voluntary compliance program guidance for nursing facilities. Nursing facilities can use the ICPG to help identify their own risks and …

CMS QSEP Appendix PP Training for Feb. 24, 2025 Implementation Is Now Available

Clinical Care Solutions / DNS / MDS 3.0 and the RAI Process / NAC / Post-Acute Care News / Survey and Regulatory Compliance

To register at QSEP and take the course, you just need to provide an email address. https://qsep.cms.gov Course information Long Term Care Appendix PP Regulatory and Interpretive Guidance Updates – Effective February 2025 15 mins  Launch Training Description This course consists of three presentations by the Division of Nursing Homes …

SNF ABN Update: What Changed and How to Keep the Process Running Smoothly

Article / Billing and Reimbursement / MDS 3.0 and the RAI Process / NAC

Effective Oct. 31, 2024, skilled nursing facilities (SNFs) now are required to use an updated Skilled Nursing Facility Advance Beneficiary Notice of Noncoverage (SNF ABN), also known as form CMS-10055, and the corresponding revised instructions to provide financial liability notifications to residents under fee-for-service (FFS) Medicare Part A. Note: The …

Q&A: I completed the pain interview with the resident two days before the ARD and he reported no pain. How do I code this when it conflicts with other medical record documentation?

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

Question: I completed the pain interview with the resident two days before the ARD and he reported no pain. How do I code this when it conflicts with other medical record documentation? Answer from Jeff Taylor: Follow the manual for both items. One reflects what the resident told you in the …

Q&A: Would it be considered a delusion if a resident who has dementia states that they have a girlfriend in the absence of one, needs to go find their parents/spouse who are deceased, or needs to go find their truck so that they may go home?

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

Question: Would it be considered a delusion if a resident who has dementia states that they have a girlfriend in the absence of one, needs to go find their parents/spouse who are deceased, or needs to go find their truck so that they may go home? Answer from Jeff Taylor: …