Uncover Unusual Contributors to Fall Risk

The RAI User’s Manual states that “A previous fall, especially a recent fall, recurrent falls, and falls with significant injury are the most important predictors of risk for future falls and injurious falls” (CMS, 2019, p. J-27). However, there are many more items that must be considered when assessing a …

2023 Annual Update of Part B Therapy Per-Beneficiary Threshold Amounts (11/22)

The purpose of this Change Request (CR) is to update the annual per beneficiary incurred expenses amounts now called the KX modifier thresholds and related policy for calendar year 2023. These amounts were previously associated with the financial limitation amounts that were more commonly referred to as “therapy caps,” before …

Involve the Therapy Team to Address Changes in Condition and Improve Resident Outcomes in Nursing Homes

By Liz Barlow, RN, CRRN, RAC-CT, DNS-CT, AVP Clinical Innovation, Synchrony Rehab At the end of August, the Centers for Medicare & Medicaid Services (CMS) held a National Provider Stakeholder call to review some of the recent COVID updates. CMS commented that data collected, along with nursing home surveys, are …

ADR Successful Outcomes with Part B Therapy Audits

In nursing facilities, one of the primary regulatory requirements from Appendix PP of the State Operations Manual is that goods and services are provided to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident (§483.24 Quality of Life). One intervention frequently used is Medicare Part …

Top 5 Facts NACs Need to Know About the CY 2021 Medicare Physician Fee Schedule Final Rule

On Dec. 2, 2020, the Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) Final Rule. However, on Dec. 21, 2020, Congress passed the Consolidated Appropriations Act, 2021 and it was signed into law by the President on Dec. 27, 2020, …

2021 Annual Update to the Therapy Code List (1/21)

I. SUMMARY OF CHANGES: This Change Request (CR) updates the list of codes that sometimes or always describe therapy services. The additions, changes, and deletions to the therapy code list reflect those made in the Calendar Year (CY) 2021 Current Procedural Terminology (CPT) and Level II Healthcare Common Procedure Coding …

How Therapy Can Support Reimbursement and Care Planning

In the COVID-19 pandemic, some states now are seeing a decrease in cases, while others have continued growth, especially in rural and suburban areas. Much of the COVID-19 response is becoming localized to meet these varying caseloads, but one consistent factor nationwide for nursing homes is the continuing need for …

Q&A: Following an interrupted stay, do we code the original therapy start date or do we code when therapy re-started on following the reentry?

Question: A Medicare Part A resident returned to the SNF during the interruption window to continue their Medicare stay. Therapy originally started before the interruption, but the 5-Day ARD is after the resident returned. Do we code the original therapy start date or do we code when therapy re-started on …

Master the Complexities of Dysphagia Coding Under PDPM

Dysphagia coding plays a key role in the Patient-Driven Payment Model (PDPM) through both section I (Active Diagnoses) and section K (Swallowing/Nutritional Status) of the MDS. Here are the keys to getting it right:   Don’t assume IDT members understand PDPM Sometimes nurse assessment coordinators (NACs) assume that speech-language pathologists …

Section G vs. GG and the Importance of Collaboration between Therapy and Nursing under PDPM

In this podcast, AANAC curriculum development specialist, Jessie McGill, RN, RAC-MT, RAC-MTA, discusses the differences between section G and GG and how nursing and therapy must collaborate for success under PDPM.