Question: If a resident on Medicare Part A admits and discharges to home on the same day, can we bill Medicare for that day? Answer from Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: If a Medicare resident discharges to a non-Medicare participating location (home, expires) the same day …
The Centers for Medicare & Medicaid Services (CMS) initiated data validation audits to evaluate the accuracy of quality measure data elements used in the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) and the Value-Based Purchasing (VBP) program. The SNF Validation Audit Checklist guides SNFs through the data validation audit …
The Centers for Medicare & Medicaid Services (CMS) recently released the Minimum Data Set (MDS) 3.0 Quality Measures (QM) User’s Manual, version (V)18.0, which will go into effect Jan. 1, 2026. This update contains the re-specification of the Long Stay Antipsychotic Measure to include Medicare and Medicaid claims and encounter data, in …
When a resident’s Medicare Part A skilled stay ends, two types of resident notification processes may be required under the Beneficiary Notices Initiative: the standard denial process and the expedited appeal process. In the standard appeal process, the Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN) is an …
Question: Can I code a diagnosis of pneumonia when the nurse practitioner initiated antibiotics for a documented reason of pneumonia, but there was not a chest x-ray completed to confirm the diagnosis? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: If the physician/extender diagnosed the resident with pneumonia after …
Question: What date would be used in A2400C (Medicare end date) for an unplanned discharge to the hospital when the assessment is a combined a 5-Day, OBRA discharge, and a PPS discharge? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: The Medicare end date would be the date of …
Question: Can we still use dementia as a primary diagnosis for our long-term residents? Our facility was recently told we can no longer use the dementia diagnosis (F03.90) although it maps to medical management? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: If there is no known cause of …
AAPACN’s Weight Loss/Gain Calculation Worksheets and Documentation Tip Sheets to Support MDS Coding helps clinicians accurately calculate and document weight changes to support compliant MDS section K coding. This easy-to-use resource outlines how to identify the correct 30- and 180-day weights, apply required calculation formulas, determine physician-prescribed weight changes, and …
The expected October Care Compare refresh was delayed during the government shutdown, but it was finally refreshed on Nov. 30, 2025. The Centers for Medicare & Medicaid Services (CMS) outlined key updates also included with this refresh: Note: The Medicare Spending Per Beneficiary claims-based measure is based on data from Quarter …
Understanding and accurately coding E0800, Rejection of Care, is essential both to reflect the resident’s behavior patterns and to ensure the care plan captures both the resident’s behaviors and his or her preferences. Misinterpreting rejection can lead to coding errors that distort the resident’s needs and obscure opportunities for effective …
