Articles from AAPACN
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- Mastering the Discharge Function Score for Skilled Nursing Facilities
By Greg Seiple Discharge planning is an essential component of patient care in skilled nursing facilities. But how do healthcare professionals determine when a resident is ready to leave and manage daily activities independently? Enter … - January Thaw: Get Ready for the QM Unfreeze
Although spring may seem like a mirage right now, it’s time for nurse assessment coordinators (NACs) to prepare for a literal thaw in the Five-Star Quality Rating System. As of January 2025, the Care Compare … - GG0130 and GG0170: Using Clinical Judgment to Establish Usual Performance
The ability to exercise clinical judgment to define usual performance in MDS items GG0130 (Self-Care) and GG0170 (Mobility) offers nursing homes unprecedented opportunity to impact quality measures (QMs), says Rosanna Benbow, RN, CCM, ICC, IP, … - SNF ABN Update: What Changed and How to Keep the Process Running Smoothly
Effective Oct. 31, 2024, skilled nursing facilities (SNFs) now are required to use an updated Skilled Nursing Facility Advance Beneficiary Notice of Noncoverage (SNF ABN), also known as form CMS-10055, and the corresponding revised instructions … - Sepsis Primer: What Is It, and How Does It Tie Into Survey and QMs?
Sepsis—a key driver of hospital readmissions—can have negative clinical impacts for residents and negative financial, quality, survey, and even legal impacts for nursing homes. Here is a review of important basics: What is sepsis? The … - Antibiotic Stewardship: Make Sure New IPs Have an Action Plan
Antimicrobial medications are used to treat infections (and sepsis) caused by bacteria, parasites, viruses, and fungi. Antimicrobial resistance (AR)—when germs conquer the drugs that are supposed to kill them and instead keep growing—occurs naturally. However, … - Opioid Overdose: Are Staff Prepared?
Many residents take opioids to relieve pain, and each of these residents is at risk for overmedication, overdose, or even death. According to the University of California, Los Angeles (UCLA), by 2021, 1 in 370 … - Ethics and Ramifications of Backdating the MDS
Backdating, or placing an earlier date than the actual date on a document, is only permissible in limited Minimum Data Set (MDS) scenarios. Has anyone asked the nurse assessment coordinator (NAC) to change the assessment … - Break the Bad Data Cycle: Keys to Boosting Accuracy in GG0130 and GG0170
MDS items GG0130 (Self-Care) and GG0170 (Mobility) are a common source of headaches for both the nurse assessment coordinator (NAC) and the interdisciplinary team (IDT). While there is no one-size-fits-all approach for obtaining accurate documentation … - QM IQ: All the Vaccine Measures
Vaccination measures play a critical role in long-term care, and the Centers for Medicare & Medicaid Services (CMS) closely monitors vaccination data to ensure the safety of residents and staff. Nineteen different measures for vaccination … - Section GG Strategies: Documentation and Collaboration
Section GG has greatly evolved since 2016. It was first introduced as just a few functional items completed only for Medicare Part A residents, but now it requires 26 functional tasks for all long-term care … - Improving Resident Care Through Effective Communication: The MDS 3.0 Scripted Interview
Effective communication with residents in skilled nursing facilities (SNFs) is essential to understand their needs and preferences. In accordance with Appendix D of the Long-Term Care Facility Resident Assessment 3.0 User’s Manual (RAI User’s Manual) … - Stop Assuming and Start Assessing: How to Improve Critical Thinking in Nurses
Identifying and dealing with a suspected change in condition before a clinical crisis occurs is a critical aspect of caring for fragile, elderly nursing home residents. To achieve that goal, nursing staff must think critically … - Early Lessons: How Onboarding and Retention Specialists May Boost Staffing
Over the last decade, a strong orientation and onboarding process has been linked to higher levels of knowledge, critical thinking skills, and job satisfaction among nursing staff—leading to lower staff turnover and improved retention. Conversely, … - Preparing for Respiratory Virus Season
Fall is here, and respiratory virus season is around the corner. Nursing leaders must take proactive steps to protect residents from these viruses, which carry the potential for serious illness and can lead to hospitalization. … - PPS Discharge Assessment: 10 Steps to a More Complete, Accurate MDS
The Medicare Part A PPS Discharge assessment (i.e., the NPE item set) is now a crucial assessment with far-reaching impacts for skilled nursing facilities (SNFs) in the Skilled Nursing Facility Quality Reporting Program (SNF QRP), … - GG Goals: Not Really Gone
Effective Oct. 1, 2024, the Centers for Medicare & Medicaid Services (CMS) removed column 2, discharge goals, from items GG0130 and GG0170 on the Minimum Data Set (MDS). Many nurse assessment coordinators will welcome the … - I0020B: Avoid Common Sources of Confusion When Coding This MDS Item
The ICD-10-CM code captured in MDS item I0020B (ICD-10 Code/Primary Medical Condition Category) is the foundation of case-mix classification for the Physical Therapy (PT), Occupational Therapy (OT), and Speech-Language Pathology (SLP) payment components in the … - Updates to ICD-10-CM Coding Guidelines: Key Revisions and Their Implications
The International Classification of Diseases, Clinical Modification, 10th revision (ICD-10-CM), coding system is an essential tool needed to document and bill accurately for healthcare services in the long-term care (LTC) setting. Annual updates to both … - Nursing Orientation and Onboarding Done Right Can Boost Retention
Working as a nurse in a nursing home can be overwhelming, especially if the director of nursing services (DNS) and executive leadership expect nurses to learn on the job and fail to set up a … - Steps to a Strong Discharge Process
The facility has a high number of discharges to the community every month, and the director of nursing services (DNS) feels the discharge process is a good one, as she has received no complaints from … - F677: How to De-Risk ADL Care for Dependent Residents
Providing residents with the appropriate level of assistance in the activities of daily living (ADLs) is foundational to care in nursing homes, yet the ADLs consistently remain a common citation risk in the survey process. … - Skilled Teaching and Training: Benefit From the Care Team’s Expertise
Like care plan management and evaluation and observation and assessment of a resident’s condition, teaching and training activities are a core nonskilled component of resident care that can rise to the level of a skilled … - Quality Measure IQ: Discharge Function Score Measure
The newest section GG Quality Measure (QM), the Discharge Function Score, has left many nurse assessment coordinators (NACs) with more questions than answers about how it is calculated. This measure estimates the percentage of Medicare … - FY 2025 SNF PPS Final Rule: SNF QRP Adds Third Way to Trigger 2% APU Cut
The Fiscal Year (FY) 2025 Skilled Nursing Facility Prospective Payment System (SNF PPS) Final Rule, released on July 31, 2024, and scheduled for publication on Aug. 6, 2024, largely finalized “as-is” the FY 2025 SNF … - Navigating the Role: Essential Training for New Nurse Assessment Coordinators
Navigating the multifaceted role of the nurse assessment coordinator (NAC) can be daunting, especially for those new to the position. Whether titled NAC, MDS coordinator, Medicare case manager, or another variant, the responsibilities are both … - Staff Work Schedules: It’s Time to Get Flexible—and Realistic—to Improve Retention
Flexible scheduling, which allows staff members to opt for shorter shifts, longer shifts, add-on shifts, and other staffing flexibilities, can be a strong tool for both recruitment and retention in long-term care, says Jasmine Travers, … - Staff Performance: When Expectations Don’t Match Reality
To implement the minimum nurse staffing standards for registered nurses (RNs) and nurse aides (NAs) and the increased on-site RN requirement in the Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment … - Substance Use Disorders: What the DNS Should Know
Over 1 million people aged 65 and over live with substance use disorders (SUD) (Alliance for Aging Research, 2022). As with most trends, what is prevalent in the community will also be prevalent in nursing … - Preferences and Routines: Use Section F to Collaborate on the Care Plan
The Resident Assessment Instrument (RAI) process begins with the Minimum Data Set (MDS) assessment and ends with the resident-centered comprehensive care plan. In the MDS, section F focuses on the resident’s preferences for customary routines … - Skilled Observation and Assessment Hinges on a Reasonable Probability of Complication
Direct skilled services under Medicare Part A often are easy to identify because these services involve specific, complex caregiver-to-resident actions. Their “inherent complexity” means that they can “be performed safely and/or effectively only by or … - Care Plan Management and Evaluation Can Be a Skilled Service for At-Risk Residents
The development, management, and evaluation of the resident care plan is the OBRA backbone of the Resident Assessment Instrument (RAI) process for all residents regardless of payer source, so it may surprise some nurse assessment … - How to Use the ICD-10-CM Coding Manual
Since the start of the Patient-Driven Payment Model (PDPM) in October 2019, the International Classifications of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) has been thrust into the forefront of daily tasks for the nurse assessment … - Burnout, Compassion Fatigue, and Moral Injury: Keys to Prevention and Mitigation
Protecting and supporting the nursing home workforce is not optional—it is the daily work of managers and leaders, says Patricia McGaffigan, RN, MS, CPPS, senior advisor for safety at the Institute for Healthcare Improvement (IHI), president … - F689 Accident Survey Citations: What’s Behind These Immediate Jeopardies?
F-tag 689 (Free of Accident Hazards/Supervision/Devices) was the No. 1 tag cited at the immediate jeopardy (IJ) level in 2023—and remains at the top halfway into 2024, according to QCOR data accessed on June 30, … - Taking the Mystery out of the Facility Assessment
Everyone loves a good mystery. Many like to watch their favorite mysteries on television or read a good thriller. However, mystery and suspense should not be a part of the facility assessment review. The final … - Individualized Care Plan: Made to Order
Think about individualization like the almost endless variations of coffee drinks available these days. With an extra pump of this or a drizzle of that, we enjoy endless ways to individualize our order. Beyond coffee, … - PPS Discharge Assessment: Why Is It More Important Than Ever?
Nurse assessment coordinators (NACs) will soon begin preparing the interdisciplinary team for the finalized MDS 3.0 version 1.19.1 item set changes, as well as the revised coding instructions in the yet-to-be-finalized Long-Term Care Facility Resident … - A Closer Look at the Medicare Part A Presumption of Coverage
Skilled nursing facility (SNF) staff must understand the intricate guidelines that regulate Medicare Part A coverage for SNF stays. Several technical requirements must be met before a resident qualifies for a Medicare Part A SNF … - Part A Basics: 30-Day Transfers and the Medical Appropriateness Exception
The 30-day transfer rule and its medical appropriateness exception typically don’t come up on a daily basis in skilled nursing facilities (SNFs), yet these requirements—and flexibilities—are a key component of the fee-for-service Medicare Part A … - Dementia Care: Keys to Implementing Technologies Effectively and Responsibly
Using technologies to engage residents with dementia is becoming increasingly common in nursing homes across the country. Local news shows are peppered with segments on facilities using dancing robots, robotic cats, and other technologies that … - Fall Prevention and Management: How the Consultant Pharmacist Can Add Value
F-tag 689 (Free of Accident Hazards/Supervision/Devices) was the top immediate jeopardy (IJ) citation nationwide—and the second most-frequent citation overall—in calendar year (CY) 2023, and that citation pattern is being maintained so far in CY 2024, … - Beyond Physical Function: Psychosocial Needs of Residents Post-Stroke
Stroke is a common issue among residents in long-term care facilities. When caring for this population, staff often focus on physical issues, yet post-stroke residents often have emotional or behavioral changes as well. It is … - Draft RAI User’s Manual v1.19.1 Study Guide: Key Changes to Review
What the MDS will look like effective Oct. 1, 2024, is beginning to take shape for nurse assessment coordinators (NACs) and the rest of the interdisciplinary team (IDT). Following up on the May 17, 2024, … - Late or Missed PPS 5-Day Assessments: Know the Consequences and How to Avoid Them
Many new nurse assessment coordinators (NACs)—and even some experienced ones—don’t understand what counts as a late MDS assessment, what counts as a missed MDS assessment, or what the financial ramifications are for late vs. missed … - Quality Measure IQ Series: Long-Stay Falls Measures
Someone with an intelligence quotient (IQ) of 130 may be considered above average for intelligence but still not understand the complexities of the MDS 3.0 Quality Measures (QMs). This series of articles on QMs will … - PDPM Clinically Complex Nursing Qualifiers: Coding and Documentation Refresher
The Patient-Driven Payment Model (PDPM) includes four ways for a resident to classify into the Clinically Complex category of the Nursing payment component. If a resident has conditions or is receiving services that qualify for … - Tricky NAC Issues Even Some Experts Miss
Nurse assessment coordinators (NACs) definitely experience variety in their jobs, to state the obvious. Management and completion of the Minimum Data Set/Resident Assessment Instrument (MDS/RAI) process, Medicare management, and ICD-10-CM coding are just a few … - Physician Services: How to Level Up From F-Tag Compliance to Better Quality of Care
In calendar year 2023, F712 (Physician Visits – Frequency/Timeliness/Alternate Nonphysician Practitioners (NPPs)) was the most frequently cited F-tag among the six physician services citations—and only 0.8 percent of nursing homes received that citation, according to … - Improving Resident Outcomes Through Collaboration
Improving resident outcomes is a top priority for nursing home teams. Outcomes, good or bad, not only affect the residents and their families but also influence the facility’s Quality Measures (QMs), Five-Star ratings, and regulatory … - Seven Ways NACs Can Be Proactive With New Medicare Advantage Plan Rules
A skilled nursing facility (SNF) accepts a resident in a Medicare Advantage plan for admission after the plan provides a prior authorization. The resident receives skilled services for the allotted amount of time, and the … - SNF QRP: Where Is It? Where Is It Going?
Skilled nursing facilities (SNFs) today must manage more than 40 Quality Measures (QMs) from several different programs: the Minimum Data Set (MDS) 3.0 QMs, Five-Star Quality Rating System, SNF Value-Based Purchasing (VBP) program, and SNF … - CMS Minimum Staffing Final Rule: Staffing Mandates Only Set the BaselineThe Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting final rule adopts the Centers for Medicare & Medicaid Services’ (CMS) proposed three-pronged, comprehensive staffing approach for Medicare- and Medicaid-certified …
- How to Hire the Best NP—Even if Someone Else Is Doing the Hiring
The director of nursing services (DNS) in a nursing home often is presented with a newly hired nurse practitioner (NP) or other advanced practice registered nurse (APRN) as a fait accompli (i.e., a done deal), … - Working With NPs and Other APRNs: Learn to Maximize the Benefits
Increasingly, nurse practitioners (NPs) and clinical nurse specialists (CNSs), also known as advanced practice registered nurses (APRNs), work either directly for or closely with nursing homes to improve resident care outcomes—as do physician assistants (PAs). … - Mock Drills for Abuse Situations
A resident-to-resident incident occurred on the dementia unit, resulting in an injury to one resident. The altercation surprised the staff, so their response to the situation was not immediate. Additionally, when they intervened, they did … - Navigating B0700 and MDS Interviews
It’s the “Which came first, the chicken or the egg?” question of the Minimum Data Set (MDS) world: Which do you assess first, B0700 or the MDS scripted interviews? It’s easy to get lost in … - FY 2025 SNF PPS Proposed Rule: CMS Seeks More Enforcement Power With CMPs
A survey finding of noncompliance with the Medicare and Medicaid requirements of participation may soon be a little more difficult for nursing homes to navigate without significant financial burden. In the March 28, 2024 Fiscal … - FY 2025 SNF PPS Proposed Rule: Four Key Proposals for NACs to Keep an Eye on
In the March 28, 2024 Fiscal Year (FY) 2025 Skilled Nursing Facility Prospective Payment System (SNF PPS) proposed rule, the Centers for Medicare & Medicaid Services (CMS) doesn’t propose the dizzying number of changes that … - Isolation Coding on the MDS: MAC Target Drives Home Documentation Needs
Almost all nursing homes are currently staffing-challenged, and that has a direct impact on the quality of the documentation available to support MDS coding, points out Brenda Sowash, RN, RAC-CT, director of clinical assessments, standards, … - Medication Indication of Use: The Big Why
Nurses use a common problem-solving technique in root-cause analysis called the “Five Whys.” This method asks “why?” as many times as needed to determine the root cause of the problem. Sometimes this process requires more … - 4 Key Purposes of the Care Area Assessment Process
The care area assessments (CAAs) are a vital part of the Resident Assessment Instrument (RAI) process to develop a plan for individualized resident care. Taking shortcuts with the CAA process can result in generic care … - Why NACs Need to Actively Manage Physician Certs/Recerts—and What to Look for
The nurse assessment coordinator (NAC) who also serves as the primary Medicare nurse doesn’t always complete either the physician certification/recertification process or the beneficiary notification process for Medicare residents, says Scott Heichel, RN, RAC-MT, RAC-CTA, … - Process Surveillance Plus QAPI Equals Better Infection Prevention Training
Nursing homes are required to establish a surveillance system (i.e., “the routine, ongoing, and systematic collection, analysis, interpretation, and dissemination of surveillance data”) as part of their infection prevention and control program (IPCP) under F-tag … - Common Missteps in Addressing Plan of Correction Criteria and Best Practices for Compliance Sustainability
According to the Nursing Homes webpage of the Centers for Medicare & Medicaid Services (CMS) site, “Skilled nursing facilities (SNFs) and nursing facilities (NFs) are required to be in compliance with the requirements in 42 … - Learn How to Take Staff Survey Preparation From Reactive to Proactive
“Why in the world did my staff member say this?” and “Why did my staff do that?” are two questions that no director of nursing services (DNS) wants to have when reading the Statement of … - Interrupted Stays: Five Takeaways To Remember
The interrupted-stay policy in the Patient-Driven Payment Model (PDPM) of the Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS) governs when multiple SNF stays are combined into a single interrupted stay (i.e., … - iQIES Essentials for the Nurse Assessment Coordinator
In the ever-evolving realm of healthcare data management, the transition of the Minimum Data Set (MDS) submission process to the Internet Quality Improvement and Evaluation System (iQIES) in April 2023 marked a significant milestone for … - New Measures, No Data: When Can Facilities Expect to See New Quality Measure Data?
One of the frustrations nursing home providers have experienced since the transition to the Minimum Data Set (MDS) 3.0 version 1.18.11 that went into effect on Oct. 1, 2023, is being able to effectively monitor … - Deep Tissue Injury: Section M Assessment and Coding Tips
Pressure-related deep tissue injury (DTI) coded in M0300G (Unstageable Pressure Injuries Related to Deep Tissue Injury) does not play a role in Medicare payment under the Patient-Driven Payment Model (PDPM). While DTI is an unstageable … - Keys to Competencies in Infection Prevention and Control
Under F-tag 726 (Competent Nursing Staff) in Appendix PP of the State Operations Manual, nursing staff, including registered nurses (RNs), licensed practical or vocational nurses (LPNs/LVNs), and certified nursing assistants (CNAs), must have “the competencies … - Improve Staffing and Quality Care Through Individualized Culture Change of the Nursing Department
Staff turnover is a nationwide problem for nursing homes and it may be worse than previous reports have suggested, according to a study of newly available Payroll-Based Journal data published in the National Library of … - Infection Prevention and Control: How to Finetune Whole-House Staff Education
In calendar year (CY) 2023, F880 (Infection Prevention and Control) was the third most frequently cited F-tag in nursing homes nationwide, as well as the fifth most common at the immediate jeopardy (IJ) level, according … - Respiratory Outbreak! How to Protect the MDS and Capture Key Assessment Data
With the influenza season in full swing plus the ongoing peaks and valleys of COVID-19 and respiratory syncytial virus (RSV) outbreaks across the United States, nurse assessment coordinators (NACs) should take steps both to protect … - Navigating the 2024 Landscape: Updates and Changes in Medicare Impacting Skilled Nursing Facilities
The year 2024 brings a plethora of updates to the Medicare program, several significantly impacting skilled nursing facilities (SNFs). SNF staff must stay well informed about these updates to ensure proper billing and adequate coverage … - Reducing Post-Discharge Hospital Readmissions: Set Up the Resident for Success
Like in-house hospital readmissions, post-discharge hospital readmissions can affect provider performance in the Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP), says Carol Hill, MSN, RN, LNHA, RAC-MT, RAC-MTA, DNS-MT, QCP-MT, CPC, president of Hill … - Expedited Determination Notices: Keys to Avoiding Financial Liability, Survey Issues
The expedited determination beneficiary notification process covers a lot of ground in skilled nursing facilities (SNFs), affecting residents in the fee-for-service (FFS) Medicare Part A program and Medicare Advantage plans, as well as residents who … - Anticonvulsants on the MDS: What to Expect in October 2024
The Centers for Medicare & Medicaid Services (CMS) announced on the Dec. 7 Skilling Nursing Facilities/Long-Term Care Open Door Forum that the drug classification of anticonvulsants will be added to the Minimum Data Set (MDS) … - Communication Basics: How Nurse Leaders Can Build a Two-Way Street
A top-down or autocratic management style is becoming increasingly outdated for dealing with today’s healthcare workforce in non-emergent situations. Other leadership styles, such as transformational leadership, often work better to help staff feel valued, supported, … - Communication: The Key to Improved Dialysis Outcomes
Communication is key to providing residents quality care. This is especially true for dialysis patients who are particularly vulnerable: lack of communication can lead to missed dialysis appointments, medication errors, adverse events, and rehospitalization. This … - Speak Up! Improve Communication to Bolster the MDS Process
Effective communication is the glue holding the MDS process together, says Stacy Grondel, BSN, RN, RAC-MT, CMAC, QCP. director of reimbursement operations at QRM in Addison, TX. “The nurse assessment coordinator (NAC) who is a … - In-House Hospital Readmissions: How to Prevent Upward Trends
The average cost of a hospital readmission is 12.4 percent higher than the average cost of the original hospital admission ($16,300 vs. $14,500), according to a 2023 analysis by the Agency for Healthcare Research and … - Mentoring, Coaching, and Counseling, Oh My! How They All Fit Into The Disciplinary Process
As the leader of the nursing department, the director of nursing services (DNS) plays an integral role in the disciplinary process. Managing employee performance can be challenging, but it is necessary. Failure to address employees’ … - Keep Significant Corrections Simple: Tips for NACs
The nurse assessment coordinator (NAC) role is a complex one that requires managing numerous deadlines, compliance regulations, and the involvement of the interdisciplinary team (IDT) in the Minimum Data Set (MDS) assessment. The job can … - Coding Hallucinations and Delusions on the MDS: Keys to Accuracy and Better Care Plans
MDS items E0100A (Hallucinations) and E0100B (Delusions) are qualifiers for the Behavioral Symptoms and Cognitive Performance category in the nursing component of the Patient-Driven Payment Model (PDPM). Even more importantly, these conditions that form the … - Care Planning: A Team Event
A surveyor investigating a resident with multiple falls approaches a nurse and asks why the care plan wasn’t updated with the latest fall prevention interventions. The nurse tells the surveyor that she doesn’t have anything … - Nonpharmacological Pain Management: How Nursing and Therapy Can Collaborate
Historically, pain is underassessed and undertreated in the geriatric population, says Liz Barlow, RN, CRRN, RAC-CT, DNS-CT, QCP, vice president of marketing at Synchrony Health Services in Louisville, KY. “Up to 75 percent of community-dwelling … - Medicare Expedited Determination vs. Financial Liability Notices: What’s the Difference?
Beneficiary notification requirements under the Medicare program can be confusing for nurse assessment coordinators (NACs) who serve as the lead Medicare nurse and other interdisciplinary team members in skilled nursing facilities (SNFs), says Carol Maher, … - How to Explain the Nurse Assessment Coordinator Role to Others
The role of the nurse assessment coordinator (NAC) can often be an enigma to many nursing home staff. Misunderstandings about the position abound, and NACs may find it frustrating that no one knows what they … - How the DNS Can Lead the Team Before, During, and After an Emergency
Emergencies can occur at any moment. Fires, hurricanes, snowstorms, ice storms, water main breaks, power outages, and outbreaks are just a few of the emergencies nursing homes must prepare for throughout the year. However, in … - QAPI: How to Maximize Performance Improvement as well as Quality Assurance
The continuing expansion of the Skilled Nursing Facility Value-Based Purchasing program (SNF VBP) quality measure (QM) set is part of a multi-pronged approach by the Centers for Medicare & Medicaid Services (CMS) to encourage improvements … - Schizophrenia Audit Takeaways for NACs and the IDT
In the Jan. 18, 2023, Quality, Safety, and Oversight (QSO) memo QSO-23-05-NH, the Centers for Medicare & Medicaid Services (CMS) announced plans to conduct offsite audits to assess whether nursing homes appropriately assess, document, and … - Avoid Frostbite: Understand the Five-Star Freeze
The transition from section G to section GG on Oct. 1, 2023, also had a substantial impact on Quality Measures (QMs) and the Five-Star Quality Rating System. The Centers for Medicare & Medicaid Services (CMS) … - SNF VBP QMs: What Just Happened, What’s Next—and What the DNS Should Monitor
On Oct. 1, 2023, the Centers for Medicare & Medicaid Services (CMS) kicked off a critical step in expanding the Skilled Nursing Facility Value-Based Purchasing program (SNF VBP) quality measure (QM) set. This expansion means … - Improving Collaboration with the Registered Dietitian
To meet residents’ individualized needs, the director of nursing services (DNS) requires the expertise of many healthcare professionals working collaboratively. For expertise on nutrition, the DNS should collaborate with the registered dietician (RD), who is … - Putting the Significant Change in Status Assessment Criteria into Clinical Practice
The Significant Change in Status Assessment (SCSA) has been a federal requirement since the inception of the Resident Assessment Instrument (RAI) process that resulted from the Omnibus Budget Reconciliation Act of 1987. The specifications of … - Stop and Read: Skilled Documentation Audit and Education Lessons for the NAC
Skilled nursing facilities (SNFs) are increasingly subject to skilled medical review audits from both fee-for-service Medicare (e.g., the SNF Five-Claim Probe and Educate initiative) and individual Medicare Advantage plans. Audit success ultimately hinges on documentation … - Lessons From TPE Audits: How the DNS Can Lead Toward Better Skilled Documentation
In May 2023—after the Comprehensive Error Rate Testing (CERT) program determined that skilled nursing facility (SNF) Medicare Part A services have been “a top driver” of the overall Medicare fee-for-service improper payment rate since the … - Part of the Essential DNS Toolbox: Effective Daily Clinical Rounds
The director of nursing services (DNS) has many issues to prioritize each day, such as resident falls, staffing, and grievances. Unfortunately, the DNS may be tempted to relegate clinical rounds to “later,” considering them a … - The Significant Change in Status Assessment: Key Issues Related to v1.18.11 and Beyond
The Significant Change in Status Assessment (SCSA) was not a major focus of the revisions in the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual v1.18.11. However, some of the v1.18.11 MDS coding changes …