Q&A: If hospital documentation supports a diagnosis of hip fracture as the initial encounter, do I need to query the physician for the subsequent encounter diagnosis to be used in the SNF?

Question: If a resident had a hospital stay for hip fracture repair, with no complications documented, and the hospital documentation supports a diagnosis of hip fracture as the initial encounter, do I need to query the physician for the subsequent encounter diagnosis to be used in the SNF? Answer: The …

Q&A: What are some best practices for collecting and documenting section GG?

Question: What are some best practices for collecting and documenting section GG? Answer: We trained our floor nurses to complete GG documentation daily on days 1-3, and our therapists also complete a GG assessment during the first 3 days, if the resident is on therapy caseload. Our MDS Coordinators open …

Q&A: A resident was picked back up on Medicare Part A during the 30-day window for a new Medicare Part A stay. Can the drug regimen review from the prior stay be used to code section N?

Question: We have a resident who admitted on Medicare Part A and a drug regimen review (DRR) was completed at that time. Skilled services ended a couple weeks later, and she remained in the facility on private pay. Following an Orthopedic appointment 20 days later, new orders were received, and …

Q&A: Where can I find resources to assist me with increasing COVID-19 vaccine and booster uptake?

There are several great resources for facility leaders to utilize. The Society for Post-Acute and Long-term Care Medicine (AMDA) has several great resources in their COVID-19 Vaccine Education Toolkit.  These resources are free to everyone, however, you will need to register with AMDA to access them. The Centers for Disease …

Q&A: If a mechanically altered diet is being trialed during a speech therapy visit to facilitate oral intake, could K0510C, mechanically altered diet, be coded on the MDS?

Question: We are seeking clarification on MDS item K0510C, mechanically altered diet. If a resident is being trialed on a mechanically altered diet or given thickened liquids provided during a speech therapy visit to facilitate oral intake, could K0510C, mechanically altered diet, be coded on the MDS if it was …

Q&A: A resident developed a new pressure ulcer while on leave of absence with family for Christmas. Is this considered “present on admission” or “in-house acquired”?

Question: A resident developed a new pressure ulcer while on leave of absence with family for Christmas. Is this considered “present on admission” or “in-house acquired”? Answer: Since we do not complete an OBRA Discharge assessment for LOAs, the resident remains “yours”, so any falls or development of problems, including …

Q&A: What is the requirement for physician certifications when a resident transitions from Managed care to Original Medicare Part A?

Question: A resident admitted under a managed care plan on December 15, but disenrolled and went to Original Medicare as of January 1. What is the requirement for physician certifications?   Answer: Restart Medicare physician certifications after the beneficiary disenrolls from Managed Care to Medicare. The first day of Original Medicare …

Q&A: What are the changes affecting SNFs in the updated blanket waiver that was recently released?

The COVID-19 Emergency Blanket Waivers for Health Care Providers that was updated and released on Nov 29, 2021 adds a new waiver that allows more flexibility in the education and training requirements for individuals serving as Directors of Food and Nutrition Services. Want to read more Q&As? Visit the AAPACN …

Q&A: Has anyone encountered surveyors requesting consents for assist bars/enabler bars used for functional mobility not posing as a restraint per the interdisciplinary team assessment?

Question: Has anyone encountered surveyors requesting consents for assist bars/enabler bars used for functional mobility not posing as a restraint per the interdisciplinary team assessment? Answer by Carol Maher, RN-BC, CPC, RAC-MT : A restraint assessment should be done when there are rails or “assist bars” on the bed. Depending …

Q&A: What is the CMS definition of elopement?

Question: ​ I am trying to find the CMS definition of elopement. What exactly do they call an elopement? Answer by Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: The State Operations Manual, appendix PP, clarifies:Elopement occurs when a resident leaves the premises or a safe area without authorization …