Q&A: Where can I find information regarding staffing on the AAPACN website?

Question: Where can I find information regarding staffing on the AAPACN website? Answer from Scott Hammond: Use the word “staffing” in the search feature on the AAPACN website. This provides the user with various articles and resources on staffing. There is also a new AAPACN Staffing Tool available for purchase …

Q&A: A resident on Medicare Part A for skilled therapy could not participate with therapy for a few consecutive days due to a clinical condition. Can he remain on skilled care during those days?

Question: A resident on Medicare Part A for skilled therapy could not participate with therapy for a few consecutive days because his Hemoglobin and Hematocrit were too low and he received blood transfusions. Will the transfusions cover him for skilled nursing during the days he missed therapy? Answer from Carol …

Q&A: When a resident who elected hospice switches to a different hospice company, is a Significant Change in Status Assessment required?

Question: When a resident who elected hospice switches to a different hospice company, is a Significant Change in Status Assessment required? Answer from Janine Cortesa, RN: RAI User’s Manual, page 2-23:  An SCSA is required to be performed when a terminally ill resident enrolls in a hospice program (Medicare-certified or …

Q&A: Can someone clarify the guidelines or protocol to use sepsis as the principal diagnosis in MDS?

Question: Can someone clarify the guidelines or protocol to use sepsis as the principal diagnosis in MDS? Answer from Jeff Taylor: This is what I follow from the blog post, “Conquer Coding for Sepsis and SIRS” from AAPC: Coding tips: Per ICD-10-CM guideline I.C.1.d.4, if a patient is admitted with localized …

Q&A: What can nursing do to improve residents triggering for low-risk incontinence?

Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: Nursing should complete a thorough assessment, including a 3-day diary recording the times the resident has been incontinent, the times the resident was continent, and the times the resident was assisted to the toilet and was successfully continent. Look for patterns …

Q&A: Has the 3-day qualifying hospital stay waiver expired?

Question: Has the 3-day qualifying hospital stay waiver expired? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC: It has not. The 3-day qualifying hospital stay waiver is still ongoing; however, many other temporary waivers have been expired or are set to expire in early June. https://www.cms.gov/files/document/covid-19-emergency-declaration-waivers.pdf SNF information starts …

Q&A: When should a urinary tract infection (UTI) be coded at MDS item I2300?

Question: I have a resident with an increase in confusion and a UA with C&S showing >=100,000 CFU/mL of Klebsiella. He has no other noted symptoms and advanced dementia, so he is unable to describe any if he has symptoms. He does not have a catheter. The physician has diagnosed …

Q&A: Should I complete an interim payment assessment (IPA) for a SNF resident who now tests positive for COVID and is newly receiving isolation for the active infection?

Question: I have two residents in my facility that admitted skilled on Medicare Part A and they have since both tested positive for COVID-19. My administrator would like to claim the isolation days and has asked me to complete an IPA for both. The residents have had no changes in function …

Q&A: Do 48-hour care plan meetings need to be completed for readmissions?

Question: Do 48-hour care plan meetings need to be completed for readmissions? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC [email protected]: Assuming the resident already had the Admission MDS completed on their original stay, no new baseline care plan or meeting is required upon readmission because the comprehensive …

Q&A: Does an inpatient rehab stay count toward a qualifying hospital stay for Medicare coverage?

Question: We have a referral for a resident with Medicare Part A who has been in an inpatient rehab facility (IRF) for six weeks. Is the IRF still considered acute and can qualify for the 3-day qualifying hospital stay (QHS)? Answered by Janine Cortesa RN, BSN: Acute inpatient rehab facilities …