Q&A: We have a resident that had a qualifying hospital stay (QHS), then went to an LTACH for more than 30 days. Can the resident utilize their Medicare benefits since the transfer from acute hospital to SNF is more than 30 days?

Billing and Reimbursement / NAC / Q&A

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 …

Back to PDPM Basics – Part 4: The Nursing Component – Clinically Complex, Behavioral Symptoms and Cognitive Performance, and Reduced Physical Function

Article / Billing and Reimbursement / MDS 3.0 and the RAI Process / NAC

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 …

ICD-10-CM Coding Convention Terminology Quick Reference Guide

Billing and Reimbursement / NAC / Tool

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. …

PDPM Grouper JAR Package V2.4000

Billing and Reimbursement / DNS / MDS 3.0 and the RAI Process / NAC / Post-Acute Care News

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 …

SNF QRP Measure Calculations and Reporting User’s Manual V7.0, Change Table, Risk Adjustment and Imputation Appendix Files, and HCC ICD-10 Crosswalks

Billing and Reimbursement / DNS / MDS 3.0 and the RAI Process / NAC / Post-Acute Care News / QAPI and Quality Initiatives

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 Feeds Into PDPM: Learn What’s at Stake and How to Boost Accuracy

Article / Billing and Reimbursement / MDS 3.0 and the RAI Process / NAC

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), …

Back to PDPM Basics – Part 3: The Nursing Component – Extensive Services and Special Care

Article / Billing and Reimbursement / NAC

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 …

PDPM At-a-Glance Tool

Billing and Reimbursement / DNS / NAC / Tool

The PDPM At-a-Glance tool breaks down the complex methodology of each component used in the Patient-Driven Payment Model—physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), non-therapy ancillaries (NTA), and nursing. This tool provides key payment information organized to provide the nurse assessment coordinator (NAC) with quick access to understanding …

FY 2028 (CY 2026 Data) SNF QRP Reporting Requirements and Data Submission Deadlines

Billing and Reimbursement / DNS / MDS 3.0 and the RAI Process / NAC / Post-Acute Care News

SNF QRP Data Collection and Final Submission Deadlines The SNF QRP Data Collection and Final Submission Deadlines have been updated to provide the data collection time frames and final submission deadlines for the FY 2028 SNF QRP.  From https://www.cms.gov/medicare/quality/snf-quality-reporting-program/submission-deadlines SNF QRP Data Elements Used for Reporting Assessment-Based QMs and Standardized Patient …