On November 14, 2025, the Centers for Medicare & Medicaid Services (CMS) released the 2026 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2026 Medicare Part D income-related monthly adjustment amounts. Medicare Part A Premium and Deductible Medicare Part A covers inpatient …
The Centers for Medicare & Medicaid Services (CMS) is increasing quality of care for Medicare beneficiaries while significantly reducing unnecessary spending and promoting payment accuracy. The calendar year (CY) 2026 Medicare Physician Fee Schedule (PFS) final rule advances primary care management through improved quality measures, reduces waste and unnecessary use of skin substitutes, and …
Question: Can the physician certification be met through a detailed order versus a separate certification form? Answer from Jessie McGill RN, BSN, RAC-MTA, RAC-MT: CMS does not mandate a specific form or format, but to meet the requirements, the certification must have all the required information. This is found …
Question: We have a resident that had a qualifying hospital stay (QHS), then went to a long-term acute care hospital (LTACH) for more than 30 days. Can the resident still utilize their Medicare benefits in our skilled nursing facility (SNF) or not, since the transfer from acute hospital to SNF …
The nursing component of the Patient-Driven Payment Model (PDPM) may appear straightforward: calculate a section GG Nursing Function Score and assign the resident to one of six nursing categories. But accuracy relies on a detailed understanding of coding rules, observation periods, and documentation requirements that determine both compliance and reimbursement …
The ICD-10-CM Coding Convention Terminology Quick Reference Guide provides a concise reference to key ICD-10-CM coding terminology and conventions for long-term care nurse assessment coordinators and coders. This guide simplifies complex terms and coding rules including clear definitions of common terms, a list of important abbreviations, and key coding conventions. …
This release was updated to support FY2026 ICD-10 codes which are used with MDS assessments with a target date on or after October 1, 2025. As part of this release, 487 clinical category mappings were added, 28 clinical category mappings were removed, and 34 clinical category mappings were modified. Additionally, 3 …
The Skilled Nursing Facility Quality Reporting Program (SNF QRP) Measure Calculations and Reporting User’s Manual v7.0 and accompanying files are now available. These materials serve as an update to the specifications used to calculate quality measures that are included in the SNF QRP and will be effective beginning October 1, 2025. The …
MDS item J2100 (Did the Resident Have a Major Surgical Procedure During the Prior Inpatient Hospital Stay That Requires Active Care During the SNF Stay?) is the gateway question for receiving enhanced reimbursement in the Physical Therapy (PT) and Occupational Therapy (OT) payment components of the Patient-Driven Payment Model (PDPM), …
The calculation for the nursing component of the Patient-Driven Payment Model (PDPM) can look deceptively simple. The two steps entail calculating a section GG nursing function score and then placing the resident into one of six nursing categories. But completing these two steps correctly requires understanding a number of coding …
