OIG: Nursing Homes Failed To Report 43 Percent of Falls With Major Injury and Hospitalization Among Their Medicare-Enrolled Residents

DNS / MDS 3.0 and the RAI Process / NAC / Post-Acute Care News / Survey and Regulatory Compliance

Issued on 09/15/2025 | Posted on 09/18/2025 | Report number: OEI-05-24-00180 Report Materials Why OIG Did This Review What OIG Found Nursing homes failed to report 43 percent of falls with major injury and hospitalization among Medicare-enrolled residents, as required, in resident assessments. Nursing homes’ failure to report falls on MDS assessments leads to inaccurate fall …

Q&A: We had a resident on a Medicare Part A stay admit and discharge back to the hospital that same evening after a few hours. We could not assess much information during that brief amount of time. What are all the required MDS assessments that need to be completed on this resident? I know an entry tracker and an OBRA discharge, but do we need to also complete a 5-Day PPS?

MDS 3.0 and the RAI Process / NAC / Q&A

Question: We had a resident on a Medicare Part A stay admit and discharge back to the hospital that same evening after a few hours. We could not assess much information during that brief amount of time. What are all the required MDS assessments that need to be completed on …

Q&A: The new definition of a fall includes an overwhelming external force, but the definition of fracture related to a fall states, “Do not include fractures caused by trauma related to car crashes or pedestrian versus car accidents or impact of another person or object against the resident.” Does this instruction contradict the new definition of a fall?

MDS 3.0 and the RAI Process / NAC / Q&A

Question: The new definition of a fall includes an overwhelming external force, but the definition of fracture related to a fall states, “Do not include fractures caused by trauma related to car crashes or pedestrian versus car accidents or impact of another person or object against the resident.” Does this instruction …

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), …

Q&A: Can Isolation be coded for methicillin-resistant staphylococcus aureus (MRSA) on a wound?

MDS 3.0 and the RAI Process / NAC / Q&A

Question: Can Isolation be coded for methicillin-resistant staphylococcus aureus (MRSA) on a wound? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: No, the RAI User’s Manual specifically states that isolation cannot be coded for a wound infection. See page O-8 (bold text added for emphasis): Code only when the …

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 …

FY 2027 (CY 2025 Data) Revised SNF QRP MDS 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 Elements Used for Reporting Assessment-Based QMs and Standardized Patient Assessment Data Elements Affecting FY 2027 APU Determination and Data Collection and Final Submission Deadlines for FY 2027 posted The Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Overview of Data Elements Used for Reporting Assessment-Based Quality Measures …

Q&A: If an open area is found on day four after admission, is that still present on admission (7-day look-back period)? The definition of “present on admission” is “as close to admission as possible.”

MDS 3.0 and the RAI Process / NAC / Q&A

Question: If an open area is found on day four after admission, is that still present on admission (7-day look-back period)? The definition of “present on admission” is “as close to admission as possible.” Answer from Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: I do not think this would …

Q&A: A long-term resident went out to the hospital and returned on a skilled stay using his Managed Care plan. He has both a 5-Day and Annual scheduled for the same day, but at separate times. Do both of these get coded as “the first assessment” in A0310E?

MDS 3.0 and the RAI Process / NAC / Q&A

Question: A long-term resident went out to the hospital and returned on a skilled stay using his Managed Care plan. He has both a 5-Day and Annual scheduled for the same day, but at separate times. Do both of these get coded as “the first assessment” in A0310E? Answer from …