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 …

Q&A: A resident was admitted skilled, under managed Medicare, on 11/28. He transferred from managed care to traditional Medicare Part A on 12/29. Are we required to complete another 5-Day for the Medicare stay starting 12/29?

Question: A resident was admitted skilled, under managed Medicare, on 11/28. He transferred from managed care to traditional Medicare Part A, on 12/29. Are we required to complete another 5-Day for the Medicare stay starting 12/29? Answer from Kim Steele, RN, WCC, RAC-CT, RAC-CTA: While the benefit day count (only …

Q&A: Can staff interviews for the PPS discharge assessment be performed after the ARD date or do all the interviews need to be “dashed” since they were not performed?

Question: We have a resident on traditional Medicare Part A who was issued a NOMNC on 12/22, with a last covered day of 12/24. Can staff interviews for the PPS discharge assessment be performed after the ARD date or do all the interviews need to be “dashed” since they were …

Q&A: A resident was unable to complete the PHQ-2 interview, therefore my software did not allow us to complete the staff interview. Is this correct? 

Question: A resident was unable to complete the PHQ-2 interview, therefore my software did not allow us to complete the staff interview. Is this correct?  D0100 was coded as “Yes”, interview should be conducted. D0150 A1 and B1 were both coded “9” – no response. Is it accurate that we …

Q&A: While most facilities require two-person assist with stand lift transfers, is there any guidance in the RAI User’s Manual regarding when a stand lift is used with one staff assist?

Question: While most facilities require two-person assist with stand lift transfers, I have found that not all do. The RAI User’s Manual only addresses a stand lift transfer with two helpers as dependent. Is there any guidance in the RAI User’s Manual regarding when a stand lift is used with …