Q&A: An audit found a missed Significant Change in Status Assessment (SCSA) after a hospice election. The resident is still in the facility. Is an SCSA still needed?

Question: An audit found a missed Significant Change in Status Assessment (SCSA) after a hospice election. The resident is still in the facility. Is an SCSA still needed? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: Yes, you would need to open the SCSA. The ARD can …

Q&A: If a resident is dependent on staff for functional items in section GG and they also had a decline in their bowel or bladder status, will they trigger for the New or Worsened Bowel and Bladder measure?

Question: If a resident is dependent on staff for functional items in section GG and they also had a decline in their bowel or bladder status, will they trigger for the New or Worsened Bowel and Bladder measure? Answer from Jessie McGill, RN, BSN, RAC-CTA, RAC-MTA:The QM 3.0 User’s Manual …

Q&A: When a resident is admitted to the nursing facility for hospice services, do we have to use the admitting hospice diagnosis as the primary diagnosis?

Question: When a resident is admitted to the nursing facility for hospice services, do we have to use the admitting hospice diagnosis as the primary diagnosis? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC:Your team should determine the diagnosis that best reports the main reason the resident is …

Q&A: If a resident on a Medicare Part A stay leaves the facility on a leave of absence (LOA) with the family and is back in the facility after two midnights, are any assessments required?

Question: If a resident on a Medicare Part A stay leaves the facility on a leave of absence (LOA) with the family and is back in the facility after two midnights, are any assessments required? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC:A temporary home visit does not require …

Q&A: Are we required to complete physician certifications and recertifications for Medicare Advantage or just for Original Medicare? Where is the source guidance?

Question: Are we required to complete physician certifications and recertifications for Medicare Advantage or just for Original Medicare? Where is the source guidance? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: It is required for Original Medicare. As far as Medicare Advantage or replacement plans, it’s up to …

Q&A: For the “Admission Performance” in section GG, if therapy is started on day two and the resident’s performance improved on day two, do we still have to code their baseline usual functions from day one data?

Question: I have a question about coding Functional Abilities in section GG for self-care and mobility on admission for a Medicare A resident. When the RAI User’s Manual states this is to reflect the resident’s usual performance at baseline, does this mean that if therapy is started on day two …

Q&A: If a resident is discharged to the hospital on day 14, does an Admission MDS need to be completed?

Question: If a resident is discharged to the hospital on day 14, does an Admission MDS need to be completed? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: Per the Federal rules in the RAI User’s Manual, no. If the resident is not in the facility through …

Q&A: When does the Pain Assessment interview need to be conducted? 

Question: When does the Pain Assessment interview need to be conducted?  Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: The questions must be asked during the 7-day observation period, but the resident must answer based on the past 5 days from when the questions were asked. CMS provided the …

Q&A: Is there a standard letter or beneficiary notice that we have to use when a resident exhausts Medicare benefits?

Question: Is there a standard letter or beneficiary notice that we have to use when a resident exhausts Medicare benefits?  Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: No, there isn’t a required notice when benefits exhaust. CMS has stated that the SNF ABN can be used as a …

Q&A: A resident was admitted to the hospital while on a leave of absence (LOA). He had a qualifying hospital stay and was readmitted to our SNF on Medicare Part A. What date do I use for the OBRA Discharge Assessment?

Question: A resident was admitted to the hospital while on a leave of absence (LOA). He had a qualifying hospital stay and was readmitted to our SNF on Medicare Part A. What date do I use for the OBRA Discharge Assessment? Answer from Jeff Taylor: I use the date they …