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 …
Nurse leaders who want to improve behavioral health management often get stuck in the “I don’t know where to start” or “I don’t know what that should look like” phase, points out Jacob Berelowitz, LNHA, LMSW, CPHQ, CCM, program director of the Center of Excellence for Behavioral Health in Nursing …
Facility policies serve as the backbone of consistent, safe, and compliant operations. Nursing homes rely on well-developed policies to guide staff, protect residents, and maintain compliance of care delivery that must follow state and federal regulations. The director of nursing services (DNS) plays a vital role in ensuring that facility …
Respiratory illness season is rapidly approaching once again, posing significant health concerns for vulnerable residents. The director of nursing services (DNS) must ensure facility staff can identify, manage, and help prevent these infections. Whether it’s influenza, pneumonia, respiratory syncytial virus (RSV), or COVID-19, early recognition, prompt intervention, and strong infection …
The nurse assessment coordinator (NAC) plays an essential role in capturing a resident’s cognitive status by coordinating and coding the Staff Assessment for Mental Status in the Minimum Data Set (MDS). The Brief Interview for Mental Status (BIMS) remains the preferred approach. But in certain situations, staff observations must be …
The importance of accurate coding of section GG, Functional Abilities, continues to grow as this data is used in care planning, Quality Measures, reimbursement, and regulatory compliance. The Centers for Medicare & Medicaid Services (CMS) released the final RAI User’s Manual, v1.20.1, in late August. It includes several clarifications for …
MDS section R (Health-Related Social Needs) is officially no more. The big news for nurse assessment coordinators (NACs) in the Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS) and Consolidated Billing Final Rule for Fiscal Year (FY) 2026, released on July 31, 2025, and published on Aug. 4, is …
The Centers for Medicare & Medicaid Services (CMS) released the Final Rule for the fiscal year (FY) 2026 Skilled Nursing Facility Prospective Payment System (SNF PPS), addressing several key recommendations submitted by the American Association of Post-Acute Care Nursing (AAPACN). AAPACN provided detailed input on rate setting, ICD-10 code mapping, …
Since the implementation of the Patient-Driven Payment Model (PDPM), nursing facilities have had to take a more nuanced approach to how a resident’s needs are assessed and documented. As discussed in part 1 of this series, Medicare payment, as well as Medicaid payment in many states, is determined using PDPM …
