Question: If a resident develops a blood blister or pressure ulcer but has no other decline in ADLs, cognition, or condition, is a Significant Change in Status Assessment (SCSA) required? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: A new pressure ulcer is one area of decline. We are …
From https://www.cms.gov/medicare/payment/prospective-payment-systems/skilled-nursing-facility-snf/list-federal-regulations/cms-1843-p DRAFT SNF QRP New and Modified Items with a Proposed Effective Date of October 1, 2031: FY27_Proposed_Rule_SNF_All_Payer_draft_mockups_MDS__508.pdf (PDF) From https://www.cms.gov/medicare/quality/snf-quality-reporting-program/measures-and-technical-information Draft MDS re: proposed removal of MDS item O0350 on Oct. 1, 2027: CMS-10387 from https://www.cms.gov/regulations-and-guidance/legislation/paperworkreductionactof1995/pra-listing-items/cms-10387
In this LTC NAC Chat podcast episode, Sarah Becker, RN, Director of Clinical Reimbursement for Proactive LTC Consulting, and Christine Twombly, RN, RAC-MT, RAC-MTA, CQP, CRC, break down the updated CMS guidance on Falls with Major Injury and what it means for MDS coding, Quality Measures, survey outcomes, and resident …
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Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2027 Filed on: 04/02/2026 at 5:15 pm Scheduled Pub. Date: 04/07/2026 PDF 114 Pages (397 KB) Permalink Fact sheet Fiscal Year (FY) 2027 Skilled Nursing Facility Prospective Payment System Proposed …
Question: A dialysis patient is going out of the facility for dialysis. We use the appropriate N18 code, but would Z99.2 be excluded since dialysis isn’t provided in-house? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: The resident remains your SNF’s resident while receiving dialysis. Coding should reflect the …
Question: We have a patient who is on hospice but elected to be sent out over the weekend for an acute illness, so he revoked his hospice status. He came back less than 24 hours later. If he is picked back up on hospice within the next day or two, …
Question: If a resident has a fall that causes a hairline clavicle fracture, is that automatically considered a major injury? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC:Yes, any traumatic fracture related to a fall is a fall with major injury—even a finger or toe. This AAPACN resource is …
The Centers for Medicare & Medicaid Services (CMS) is publishing an errata change table document to the Minimum Data Set (MDS) 3.0 Quality Measures (QM) User’s Manual v18.0, related to the clarification of details for the Long-Stay Antipsychotic measure in Chapter 1, Section 6. This errata is being issued to …
Medicare Claims Quality Measures Quality measures that are based on Medicare claims data. Each row contains a specific quality measure for a specific nursing home and includes the risk-adjusted score. Last Modified: March 1, 2026 Released: March 25, 2026 Planned Update: April 29, 2026 Download Ownership A list of ownership information for currently …
Question: A resident’s last therapy day was on 3/5. He didn’t go home until the afternoon of the next day, 3/6. Can I combine the OBRA Discharge and the PPS Discharge assessments, or since the last covered day and physical discharge are different days, do they need to be done …
