FY 2025 Final MDS 3.0 Item Sets version 1.19.1 Effective Oct. 1, 2024

The final Minimum Data Set (MDS) 3.0 Item Sets version (v)1.19.1 are now available. The MDS Item Sets v1.19.1 will be effective beginning October 01, 2024. Items in sections A, B, D, GG, I, J, N, and O are affected. From https://www.cms.gov/medicare/quality/nursing-home-improvement/resident-assessment-instrument-manual

PDPM Clinically Complex Nursing Qualifiers: Coding and Documentation Refresher

The Patient-Driven Payment Model (PDPM) includes four ways for a resident to classify into the Clinically Complex category of the Nursing payment component. If a resident has conditions or is receiving services that qualify for Extensive Services, Special Care High, or Special Care Low, but does not have a PDPM …

Tricky NAC Issues Even Some Experts Miss

Nurse assessment coordinators (NACs) definitely experience variety in their jobs, to state the obvious. Management and completion of the Minimum Data Set/Resident Assessment Instrument (MDS/RAI) process, Medicare management, and ICD-10-CM coding are just a few of the areas they are expected to master in their role. With these responsibilities alone, …

Seven Ways NACs Can Be Proactive With New Medicare Advantage Plan Rules

A skilled nursing facility (SNF) accepts a resident in a Medicare Advantage plan for admission after the plan provides a prior authorization. The resident receives skilled services for the allotted amount of time, and the nurse assessment coordinator (NAC) and the rest of the interdisciplinary team follow the plan’s rules. …

MDS Tools to Make the NAC’s Job Easier

In this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Jessie McGill, RN, BSN, RAC-MT, RAC-MTA, and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialists for AAPACN, discuss AAPACN tools that make the nurse assessment coordinator’s (NAC’s) job easier. Additional Resources:

Skilled Nursing Care & Skilled Therapy Services to Maintain Function or Prevent or Slow Decline: CMS Reminder

Medicare covers skilled nursing care and skilled therapy services under skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care to maintain function or to prevent or slow decline, as long as: Visit the Jimmo Settlement Agreement webpage for more information.

Navigating the 2024 Landscape: Updates and Changes in Medicare Impacting Skilled Nursing Facilities

The year 2024 brings a plethora of updates to the Medicare program, several significantly impacting skilled nursing facilities (SNFs). SNF staff must stay well informed about these updates to ensure proper billing and adequate coverage for a beneficiary’s skilled stay. This comprehensive article delves into key updates, encompassing changes in …

Expedited Determination Notices: Keys to Avoiding Financial Liability, Survey Issues

The expedited determination beneficiary notification process covers a lot of ground in skilled nursing facilities (SNFs), affecting residents in the fee-for-service (FFS) Medicare Part A program and Medicare Advantage plans, as well as residents who receive Part B rehabilitation therapies under consolidated billing, says Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, …

SNF QRP and SNF VBP Claims-Based Measure Manual and Accompanying Files – Available

This document presents technical specifications for the production of Medicare fee-for-service (FFS) claims-based measures (CBMs) for the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) and Value-Based Purchasing (VBP) program maintained by the Centers for Medicare & Medicaid Services (CMS). The measures are intended to promote informed decisions among Medicare …