Jessie McGill, RN, RAC-MT, RAC-MTA Every spring, the Centers for Medicare & Medicaid Services (CMS) releases the notice of proposed rulemaking (NPRM) for the next fiscal year’s (FY’s) payment policies and rates. This provides an …
The COVID-19 pandemic is quite diminished but still a concern in some nursing homes due in part to SARS-CoV-2 variants, as well as unvaccinated staff. With the public health emergency worsening the already significant staffing …
Urinary incontinence (UI), defined as any involuntary leakage of urine, affects over half the population living in post-acute long-term care (PALTC) and costs an estimated 5.5 billion annually, according to the Society for Post-Acute and …
“Against medical advice” (AMA) is a term that nursing homes use to describe a resident unexpectedly leaving the facility in a self- or representative-initiated discharge that is inconsistent with their identified care needs. “Some providers …
by Carol Maher, RN-BC, RAC-MTA, RAC-MT, CPC ICD-10-CM coding is not a skill nursing school conveys to students, yet it is one that nurse assessment coordinators (NACs) must acquire to perform their diagnosis coding duties …
The care area assessment (CAA) process sometimes mistakenly gets lumped under the “required but not critical to resident care” label of regulatory paperwork. While working the CAAs is indeed a mandatory step in the Resident …
Hand hygiene has always been a primary focus of infection prevention, but due to the COVID-19 pandemic, it is under intense scrutiny. Even though the skill of hand hygiene is straightforward and easy to learn, …
Falls are common in nursing homes—they are a driver of surveyor citations under F-tag 689 (Free of Accident Hazards/Supervision/Devices), which is consistently among the top three survey citations nationwide, according to the S&C QCOR online …
By Liz Barlow, RN, CRRN, RAC-CT, DNS-CT With the onset of the COVID-19 public health emergency (PHE), skilled nursing facilities (SNFs) have been focused on infection control, staffing, and heightened patient care. But as facilities …
As a group, the bowel MDS items H0400 (Bowel Continence), H0500 (Bowel Toileting Program), and H0600 (Bowel Patterns) impact nursing homes on multiple levels, including the following: The Nursing Home Quality Initiative Quality Measures (NHQI …
While many nursing homes thankfully are no longer in crisis staffing mode, recruiting staff remains a top priority in a highly competitive job market. “Staff recruitment breaks down into meeting two overarching challenges,” says Julie …
“Across the country, the high rate of turnover in long-term care is a serious workforce problem,” says Dr. Linda Shell, DNP, MA, BSN, DNS-CT, Chief Learning Officer, LindaShell.com. “The cost associated with this turnover—the organizational …
The past year has brought a multitude of changes for everyone, but especially those in nursing homes. While the public health emergency (PHE) situation continues to evolve, the Centers for Medicare & Medicaid Services (CMS) …
We have all struggled with a stubborn knot or tangle at some point in our lives—whether it’s your kids’ shoelaces, your earbud cord, a garden hose, or even a fishing line. If you are a …
Traditional fee-for-service Medicare Part A is a national program with a core set of program guidance from the Centers for Medicare & Medicaid Services (CMS) in the Internet-Only Manuals and the Long-Term Care Facility Resident …
The 2021 AAPACN Conference featured a highly-anticipated session, “ReFOCUS: 2021 CMS Regulatory Updates,” in which representatives from the Centers for Medicare & Medicaid Services (CMS) shared their insights on current regulatory challenges and future regulatory …
Mental and behavioral healthcare is one of many resident care needs that transitioned to telehealth (i.e., telephone or video visits) in nursing homes during the COVID-19 pandemic. The U.S. Department of Health and Human Services, …
By Liz Barlow, RN, CRRN, RAC-CT, DNS-CT – April 20, 2021 The federal government focuses intently on preventing fraud, waste, and abuse within the Medicare system. As a part of those efforts, the Program for Evaluating Payment …
MDS item O0100 (Special Treatments, Procedures, and Programs) has 12 sections with two columns (24 total subitems) that identify specific services the resident received either while not a resident (column 1) or while a resident (column …
The safety of residents is a top priority for a skilled nursing facility (SNF). But how does one promote safety in such a dynamic environment? Three critical steps the director of nursing services (DNS) and …
While areas of concern related to medication administration (i.e., medication pass or med pass) are specific to each facility, there are certain common issues. Directors of nursing services (DNSs) can use the following tips to …
On April 8, the Centers for Medicare & Medicaid Services (CMS) released for public inspection the Fiscal Year (FY) 2022 Proposed Rule for the Skilled Nursing Facility Prospective Payment System (SNF PPS) and Consolidated Billing, …
Although the Centers for Medicare & Medicaid Services’ (CMS) beneficiary notices have been part of Medicare regulations for a long time, they can still be cited during any survey. Lengthy discussions in the AANAConnect LTC …
Observation and assessment of a resident’s condition is a skilled service under Medicare Part A that many nurse assessment coordinators (NACs) and Medicare case managers hesitate to use because it’s not a direct skilled nursing …
It’s hard to believe that it has been a year since the first nursing home resident contracted the novel coronavirus. Our way of living changed drastically, especially in long-term care. In-person visitation ended, and residents …
While data on hospital readmissions of skilled nursing facility (SNF) residents who have had COVID-19 following SNF discharge currently remains scarce, at least one study indicates the need for careful management of the discharge planning …
The Patient-Driven Payment Model (PDPM) uses 161 MDS items to establish the five case-mix adjusted components. Some of these 161 items will have supporting documentation easily found in the medical record, but other items may …
MDS item M1200 (Skin and Ulcer/Injury Treatments) in section M (Skin Conditions) can impact payment under the Patient-Driven Payment Model (PDPM) in the Medicare Part A skilled nursing facility prospective payment system (SNF PPS), as …
“Heroes work here.” It was a common theme in the early days of the pandemic. Signs were placed in front of the facility, and people would cheer and line the streets as healthcare personnel went …
Long-term care is in a difficult state right now, acknowledges Jessie McGill, RN, RAC-MT, RAC-MTA, curriculum development specialist at AAPACN. “It has been a full year of battling COVID-19. The pandemic heavily impacted residents, staff, and …
Chronic conditions and comorbidities are common among both long-term residents and short-term patients in skilled nursing facilities (SNFs). However, when the symptoms from these chronic conditions become part of the resident’s normal routine, they may …
MDS items N2001 (Drug Regimen Review), N2003 (Medication Follow-up), and N2005 (Medication Intervention) are the primary drivers of the Skilled Nursing Facility Quality Reporting Program (SNF QRP) Quality Measure (QM), Drug Regimen Review Conducted With …
One year. When asked how long it takes a new nurse assessment coordinator (NAC) to fully learn the job, I say at least one year. The nuances of the Resident Assessment Instrument (RAI) and Minimum …
The Confusion Assessment Method (CAM) is a standardized cognitive assessment that determines whether a resident has signs and symptoms of delirium. The CAM is located in MDS item C1310 (Signs and Symptoms of Delirium), which …
There is a phenomenon of hostility among nurses and certified nursing assistants (CNAs), commonly referred to as “nurses eating their young.” This incivility is pervasive, often seen as a rite of passage, and directed at …
As the COVID-19 pandemic eases, directors of nursing services (DNSs) may want to turn their attention to the care area assessments (CAAs) in the Resident Assessment Instrument (RAI) process, suggests Barbara Bates, RN, MSN, RAC-CT, …
Accepting a new position as the director of nursing services (DNS) often begins with excitement for the new challenges and many opportunities to make a positive difference. However, in the first few days and weeks, …
Effective Communication: Get the Nursing Team on the Right Track Establishing strong, open communication in the nursing department has always been a challenge, says Suzy Harvey, RN-BC, RAC-CT, director of clinical specialty services for Foster …
The nurse staffing shortage that simmered in long-term care—and throughout the entire healthcare field—for years finally boiled over in 2020 as a result of the COVID-19 pandemic, with nursing homes nationwide reporting sometimes crisis-level staffing …
MDS section G (Functional Status) is not used in the Patient-Driven Payment Model (PDPM) under the Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS), nor is it used in the Skilled Nursing …
Federal regulations require nursing homes to provide safe, individualized medication administration to residents. However, even before the COVID-19 public health emergency, many consultant pharmacists only went to nursing homes once a month for medication regimen …
By Jessica Kunkler, MA When interviewing for a new position, don’t forget that an interview is a two-sided exchange. “Not only is the facility interviewing you to determine if you’re a good fit for them, but …
Early 2021 could be challenging for the nation’s nursing homes. Recent trends in infection rates combined with the slow rollout of the COVID-19 vaccine have the potential to make the coming months “the deadliest of …
On Dec. 2, 2020, the Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY) 2021 Medicare Physician Fee Schedule (MPFS) Final Rule. However, on Dec. 21, 2020, Congress passed the Consolidated Appropriations …
By Shahin Sanjar, PhD., Sunovion Pharmaceuticals Inc. Inhalation treatment of respiratory conditions such as asthma and COPD is the predominant mode of therapy for the simple and logical reason that applying pharmacological agents to the target …
Nursing home staff members, like everyone in the United States and across the globe, want to go back to “normal.” However, directors of nursing services (DNSs) need to ensure that infection prevention and control remains …
Amid nationwide staffing shortages, veteran nurse assessment coordinators (NACs) often are being pulled to work the floor, and new NACs are coming on board with limited MDS training, notes Maureen McCarthy, RN, BS, RAC-MT, QCP-MT, …
The phone rings early one Saturday morning; it’s the night shift nurse calling to tell you that Mrs. Jones has a large bruise on her chest and staff does not know how it occurred. What …
As of 2017, 66 percent of nursing homes used an electronic health record (EHR) in some capacity, according to the Office of the National Coordinator for Health Information Technology. However, directors of nursing services (DNSs) …
MDS accuracy is no joking matter, but who can resist a good dietary-related pun? I decided I would take a whisk and go for it. While nutrition has always played a key roll in the …
Skilled nursing facilities now have more than a year of experience with the Patient-Driven Payment Model (PDPM), the updated case-mix classification system used in the Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF …
A vaccination for COVID-19 has been at the forefront of everyone’s thoughts since the pandemic started, and one is anticipated to come to fruition in the coming weeks. At the time of this publication, both …
In October 2019, the Centers for Medicare & Medicaid Services (CMS) removed two pain Quality Measures (QMs) from both Nursing Home Compare and the Five-Star Quality Rating System: Percentage of short-stay residents who report moderate …
As the COVID-19 pandemic continues, escalating case numbers, changing visitation requirements, and isolation continue to challenge nursing facilities, staff members, and residents alike. In a recent study, the Centers for Disease Control and Prevention (CDC) …
The Certification and Survey Provider Enhanced Reports (CASPER) Reporting application in the Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) system can give nurse assessment coordinators (NACs) and members of the management …
Writing a plan of correction that will be accepted by the state survey agency is the first half of the battle to deal with any citations that the survey team hands out on the statement …
Once again, the holiday season is upon us. However, due to the pandemic, the way people celebrate will be different this year. Holiday traditions that normally call for large gatherings of people—such as family dinners, …
Constructing person-centered care plans takes time, effort, and person-specific focus on including the resident’s voice and choice. This is especially important when developing care plans from information gathered under section F, Preferences for Customary Routines …
Skilled Nursing Facility Prospective Payment System (SNF PPS) MDS assessments rightfully get a lot of attention during the COVID-19 public health emergency as nurse assessment coordinators (NACs) continue to try to obtain accurate Medicare Part …
A surveyor approaches the DNS and shares that the team is investigating an acquired pressure injury and preliminary findings suggest the facility has not met the requirements for F684, Quality Care. Unless the director of …
In 1995, an artist named William Utermohlen was diagnosed with Alzheimer’s disease. He chronicled his experience living with dementia in self-portraits to express what was happening to him. As the disease progressed, his portraits became …
“Knock, knock?” “Who’s there?” When the nurse assessment coordinator (NAC) walks into the room, the resident rolls his eyes and unenthusiastically says, “Oh, it’s you. Blue. Sock. Bed.” The scripted resident interviews can be redundant …
As the COVID-19 public health emergency unfolded, the Centers for Medicare & Medicaid Services (CMS) issued—and continues to update—the COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers, which explains the blanket waivers that are …
According to the Centers for Disease Control and Prevention (CDC), the elderly are the population most vulnerable to the effects of COVID-19, and the risk of illness severity increases with age. Other conditions—including diabetes mellitus, …
Frailty made news in the U.S. healthcare community during the first phase of the COVID-19 pandemic when the United Kingdom-based National Institute for Health and Care Excellence’s (NICE) COVID-19 Rapid Guideline: Critical Care in Adults …
Three process mistakes often trip up nurse assessment coordinators (NACs) and other coders and reduce ICD-10-CM coding accuracy: Not knowing the coding conventions; Not using the code book or not using it properly; and Not …
Nursing homes work hard to create the most effective Quality Assurance and Performance Improvement (QAPI) programs that help support the provision of quality services for residents, but translating voluminous data into meaningful information can be …
Creating and implementing a policy and procedure to ensure that facility staffing levels are sufficient to meet the needs of residents during an emergency, such as the COVID-19 pandemic, is an essential component of emergency …
While a number of frameworks, guidance documents, and resources are available to help healthcare systems and stakeholders prepare for and respond to the emergence of crisis standards of care, relatively few address the unique circumstances …
Navigating the COVID-19 public health emergency can be difficult for skilled nursing facilities (SNFs). However, no matter what the challenges are—staffing shortages, time-consuming infection prevention and control practices, the need to rearrange schedules and duties …
It started with a rhythm band. At the time, I was the nurse assessment coordinator and the restorative nurse, and I watched as the activity director guided a small group of residents shaking tambourines and …
Surveyors arrive onsite for the annual survey and tour the facility. They overhear a nurse aide refer to a resident as “honey.” In the next room, they see a nurse completing a dressing change with …
The Centers for Medicare & Medicaid Services (CMS) requires that all nursing homes have an emergency preparedness program. With disasters ranging from the COVID-19 pandemic to wildfires and hurricanes seemingly around every corner, taking the …
Mrs. Elderberry is ready to go home. It’s been five long weeks of rehabilitation following a broken hip from that clumsy slip on a rug. Home. She’s wondering if her son actually watered her house …
On Oct. 1, the revised fiscal year (FY) 2021 ICD-10-CM code sets and FY 2021 ICD-10-CM Official Guidelines for Coding and Reporting go into effect. Understanding these annual updates is crucial. ICD-10 coding accuracy has …
So far, 2020 has been a very trying year, to say the least. COVID-19 caught long-term care teams unaware and has not only affected staff physically, but emotionally as well. Illness and loss of life …
Late last year, nursing homes gained additional time to deal with implementing United States Pharmacopeia (USP) general chapter <800>, “Hazardous Drugs—Handling in Healthcare Settings.” While COVID-19 has rightfully taken precedence through much of 2020, directors …
By Jessica Kunkler, MA Managing an organized MDS department is difficult even in the best of times. Under the stresses of a pandemic, it can be much harder, but difficult days make a well-run department all …
MDS item L0200 (Dental) often gets limited attention even though it fuels the Dental Care care area assessment (CAA), one of 20 CAAs that can be triggered in response to MDS coding (i.e., care area …
Nursing home staff sometimes crush medications that should not be crushed, says Diane Crutchfield, PharmD, BCGP, an independent consultant pharmacist in Knoxville, TN. “Staff crush medications to make them easier—or in some cases even possible—to …
By Jessica Kunkler, MA Having a loved one in a nursing home often inspires intense emotions. For many, regular visits and calls to their loved ones helps alleviate some of those feelings and puts their minds …
The Centers for Medicare and Medicaid Services (CMS) gave states the option to collect Patient-Driven Payment Model (PDPM) billing codes on OBRA assessments when not combined with a Medicare PPS 5-Day assessment, beginning Oct. 1, …
On March 30, the Centers for Medicare & Medicaid Services (CMS) suspended most Medicare fee-for-service (Part A and Part B) medical review audits as a result of the Coronavirus 2019 (COVID-19) public health emergency, including …
Nurses have often heard “if it wasn’t documented, it wasn’t done,” but they still struggle to consistently capture documentation that is timely, accurate, and comprehensive. This struggle sometimes emerges when underlying system failures go unaddressed …
As the COVID-19 pandemic continues to pick up speed in many states without waiting for a fall/winter surge, nursing homes across the country are looking for ways to streamline and improve systems so that they …
On July 31, the Centers for Medicare & Medicaid Services (CMS) released for public inspection the final rule. CMS scaled back or cancelled many planned proposals in the FY 2021 SNF PPS Proposed Rule due …
The FY 2021 SNF PPS Proposed Rule was a shadow of what the Centers for Medicare & Medicaid Services (CMS) had planned due to the ongoing coronavirus 2019 (COVID-19) public health emergency. So it’s no …
“Does this surgery count as a major surgery?” is one of the most frequently asked questions that nurse assessment coordinators (NACs) have about MDS items J2100 (Recent Surgery Requiring Active SNF Care) and J2300 – …
Documentation is a critical part of the nurse assessment coordinator’s (NAC’s) role. It helps provide person-centered care, supports clinical decisions, facilitates communication between the nurse and the interdisciplinary team (IDT), prevents many legal issues, and …
The COVID-19 pandemic is a strange and difficult time for long-term care residents. There is a lot happening in their environment that is unfamiliar, and nurse leaders have the difficult job of ensuring residents’ physical …
Editor’s note: This is the third article in a multipart series about advance care planning and how to operationalize an effective program in nursing homes. Find the first article explaining the basics of what it …
During the first day of the AAPACN Virtual Conference, Gina D’Angelo, BSN, MBA, RN, NHA, CLNC, DNS-CT, RAC-CT, clinical consultant, legal nurse consultant, testifying expert, and president of GD Solutions, LLC, presented “Avoid the Slippery …
Obtaining the most specific medical diagnosis benefits skilled nursing facilities (SNFs) on two fronts: receiving accurate reimbursement under the Patient-Driven Payment Model (PDPM) for Medicare Part A residents and improving the quality of care for …
Skilled nursing facilities (SNFs) are collecting a tremendous amount of data in response to the COVID-19 pandemic. When this data is translated into information, it becomes a powerful tool to evaluate performance, identify potential gaps …
Advance Care Planning: Seven Steps to Maximize Effectiveness Editor’s note: This is the second article in a multipart series about advance care planning and how to operationalize an effective program in nursing homes. Find the …
The Centers for Medicare & Medicaid Services (CMS) makes clear in the title of MDS section GG (Usual Performance and Goals) that the assessment subitems in items GG0130 (Self-Care) and GG0170 (Mobility) are designed to …
With residents sometimes in isolation and wearing masks in various situations due to the COVID-19 pandemic, they are already more vulnerable to dehydration than normal, points out Teresa Remy, DSc, MHA, BSN, LNHA, RN, CDP, …
The Centers for Disease Control and Prevention (CDC) has replaced the Interim Additional Guidance for Infection Prevention and Control for Patients With Suspected or Confirmed COVID-19 in Nursing Homes with a new set of core …
Editor’s note: This is the first article in a multipart series about advance care planning and how to operationalize an effective program in nursing homes. The surveyor guidance under F578 (Request/Refuse/Discontinue Treatment; Formulate Advance …
Rulemaking is the result of an extensive process. First, CMS proposes a change and allows for a comment period. After reviewing the submitted comments, CMS publishes the final rule. As a professional association, the American …
