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 …
On June 3, 2021, CMS announced that Medicare Administrative Contractors (MACs) may now begin conducting post-payment medical reviews for dates of service after March 2020. Early in the COVID-19 public health emergency (PHE), CMS held …
Question: If an OBRA or PPS assessment is completed late but the ARD was set timely in the appropriate window, is there a financial penalty or is it just a possible survey tag? Answer from …
Question: A resident on Medicare Part A admitted to the facility from the hospital on 5/26. He was sent to the emergency department (ED) on 5/27 and remained there on observation until 5/29. He readmitted …
The U.S. Department of Health and Human Services, through the Health Resources and Services Administration (HRSA), is releasing revised reporting requirements for recipients of Provider Relief Fund (PRF) payments. This announcement includes expanding the amount …
Understanding the technical and skilled level care requirements for Medicare A is always a challenge. We’ve broken down the process with our Skilled or Not? tool . This tool was originally published in April 2017. It has …
MACs Resume Medical Review on a Post-payment Basis: Beginning August 2020, Medicare Administrative Contractors (MACs) resumed post-payment reviews of items and services with dates of service before March 2020. MACs may now begin conducting post-payment …
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 …
Question: A resident admitted for skilled care under a Medicare Advantage (MA) plan. The plan did not require a 3-day qualifying hospital stay (QHS) and the resident was hospitalized for observation only. The resident has …
The newest Five-Star data is to be released on the Care Compare website on May 26, 2021. AAPACN recommends reviewing this data on the website to ensure it is correct, especially if the Five-Star preview …
List of Blanket Waivers (PDF) UPDATED (5/24/2021). Note from AAPACN staff: CMS unintentionally removed the update that made the SNF/NF section consistent with the May 10 QSO memo expirations (https://www.cms.gov/files/document/qso-21-17-nh.pdf). Please see the May 10 …
These address issues related to SNF consolidated billing, telehealth, and other Medicare coverage and payment issues. Frequently Asked Questions to Assist Medicare Providers (PDF) UPDATED (5/24/21) Medicare Monoclonal Antibody COVID-19 Infusion Program Instruction (PDF) (4/16/21) Frequently …
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 …
Question: A patient admitted under Original Medicare Part A. Within a couple of hours, his family decided to take him home. What assessments are needed? Answer from Carol Maher, RN-BC, CPC, RAC-MT: Since the resident …
Question: A resident returned following a hip fracture from a fall. Would his primary diagnosis be the S-code for the fracture, or the Z-code for aftercare? Answer from Jennifer LaBay RN, RAC-MT, RAC- MTA, CRC: …
Question: Is metabolic acidosis a skilled diagnosis? Answer from Kim Steele, RN, WCC, RAC-CT, RAC-CTA: While a resident can be skilled for this, it is critical that you have the details of why it is …
By CMS Transmittal # R10770OTN Issue Date 2021-05-11 Subject October Quarterly Update to 2021 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement Implementation Date 2021-10-04 CR # 12272 …
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 …
Question: We have a resident that has an order for Seroquel for Alzheimer’s disease with psychotic features as manifested by episodes of hallucination of seeing deceased relatives in their room. Can we use ICD-10 codes …
Question: If a resident is enrolled hospice, can they still receive therapy under Part B? If so, what is the process to do this? Does the hospice agency need to approve it or does the …
Question: Does a wound vac count as a daily treatment to the wound? Answer from Janine Cortesa, RN, BSN: Typically, the wound vac does not require daily changing and is therefore not a daily skilled …
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 …
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 …
A question that comes up often lately for nurse assessment coordinators (NACs) is, “Should I do an IPA?” The assessment is optional, which can also make deciding when to complete one a challenge. Depending on …
Question: Can a Medicare Part A resident be skilled for an unstageable pressure injury? Answer from Janine Cortesa, RN, BSN, RAC-CT: You must always look at what skill services are needed, not the name of the condition. An …
Question: If a resident is considered skilled using the three-day qualifying stay and the waiver ends during their skilled stay, does the skilled stay need to end as well? Answer from Jessie McGill RN, RAC-MT, RAC-MTA: The …
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 …
On March 30, 2021, the Centers for Medicare & Medicaid Services (CMS) provided a 90-minute webinar on best practices to achieve a full annual payment update (APU). This training covered CMS quality goals, Skilled Nursing …
Question: Do we have to gather three full days of GG data when scheduling an interim payment assessment (IPA)? Answer: You have a 3-day window (ARD and the prior 2 days) to determine the Interim …
Question: If a Medicare Part A resident expires prior to the completion deadline for an assessment, the RAI User’s Manual states that the assessment is not required, but should you still complete the 5-Day assessment …
NEW TRAINING AVAILABLE – Resident Mood Interview (PHQ-9) for the Skilled Nursing Facility (SNF) Setting Video Tutorial CMS Resident Mood Interview (PHQ-9) for the SNF Setting Video Tutorial The Centers for Medicare & Medicaid Services …
https://www.cms.gov/how-update-nursing-home-nhskilled-nursing-facility-snf-demographic-data SNF Quality Reporting Program (QRP) quality data on Care Compare are updated on a quarterly basis. The Centers for Medicare & Medicaid Services (CMS) will be transitioning to a new data source for providers’ demographic data for all five …
Transmittal 10678, dated March 16, 2021, is being rescinded and replaced by Transmittal 10693, dated, March 25, 2021 to remove business requirement 12212.2, to modify business requirement 12212.3 to remove the reference to any action …
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 …
REGISTRATION OPEN – SNF QRP: Achieving a Full APU The Centers for Medicare & Medicaid Services (CMS) will host a webinar on Tuesday, March 30, 2021, from 1:00 p.m. to 2:30 p.m. ET to educate …
The Medicare Payment Advisory Commission (MedPAC) releases its March 2021 Report to the Congress: Medicare Payment Policy. The report includes MedPAC’s analyses of payment adequacy in traditional fee-for-service (FFS) Medicare and reviews the status of Medicare Advantage …
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 …
In this document, CMS states, “Historically, each rule or update notice issued under the annual Skilled Nursing Facility (SNF) Prospective Payment System (PPS), rulemaking cycle included a detailed reiteration of the various individual legislative provisions …
Question: We have a resident on Medicare Part A who exhausted her benefits related to daily skilled nursing services of treating a stage 4 pressure ulcer and continues to receive a skilled level of care. …
Question: Can we skill a new resident under Medicare A if they are started on oxygen therapy and we are titrating it? Answer: Yes, during the initial phases of oxygen therapy and the process of …
Updates March 1, 2021 SNF QRP FAQs An update to the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Frequently Asked Questions (FAQs) document is now available. This document has been updated to reflect the …
The Quick Reference Guides provide high-level information on the SNF Quality Reporting Program, including frequently asked questions and helpful links. In February 2021, CMS issued a generic guide that is not based on fiscal year. …
The Centers for Medicare & Medicaid Services (CMS) is offering a 45-minute course that provides an overview of the assessment and coding of the Drug Regimen Review standardized patient assessment data elements (SPADEs). For permission to …
Question: Does a SNF ABN need to routinely be given to all new admissions? My understanding is that we would not issue a SNF ABN if Medicare technical requirements were not met. Example 1, a …
Question: When we are testing all of our residents for COVID-19 due to a staff member or another resident testing positive, what is the ICD-10 code that should be used when placing the order to …
Full text: https://www.congress.gov/bill/116th-congress/house-bill/133/text Sections addressing SNF VBP changes and access to services for hemophilia residents: SEC. 111. IMPROVING MEASUREMENTS UNDER THE SKILLED NURSING FACILITY VALUE-BASED PURCHASING PROGRAM UNDER THE MEDICARE PROGRAM. …
The Improving Post-Acute Care Transformation Act of 2014 (IMPACT Act) requires the Secretary to specify resource use measures, on which post-acute care (PAC) providers, including skilled nursing facilities, are required to submit necessary data specified …
Historically, each rule or update notice issued under the annual Skilled Nursing Facility (SNF) prospective payment system (PPS) rulemaking cycle included a detailed reiteration of the various individual legislative provisions that have affected the SNF …
The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course that provides an overview of the assessment and coding of the Drug Regimen Review standardized patient assessment data elements (SPADEs) found in the …
CMS will be transitioning to a new data source for a provider’s demographic data for all five Post-Acute Care (PAC) provider types (Skilled Nursing Facilities / Nursing Facilities (SNF/NFs), Home Health Agencies (HHAs), Inpatient Rehabilitation …
February 4, 2021 An update to the PDPM Grouper DLL package was posted. This is NOT a change to the previously posted DLL file itself, just supporting information. The documentation file was updated, as there were …
Question: Our nurses complete a respiratory therapy assessment on all new admissions for the first seven days. The RAI User’s Manual states that only minutes the respiratory therapist or respiratory nurse spend with the resident …
Question: Can I use the ICD-10 Code, Z47.89 Encounter for other orthopedic aftercare, in addition to the fracture code? Does it allow a fracture to map to an Orthopedic Surgery category? Answer: Per the …
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 …
Do you know what MDS items impact reimbursement under the previously used RUG-IV system and now used under PDPM? Do you know which items are used to calculate the SNF QRP threshold? Use this quick …
Question: I need clarification on parenteral or IV fluids. Do they count under Special Care High for while a resident and while not a resident (in hospital)? I have been watching the On Demand PDPM Essentials workshop …
Medicare Part D Payments During Covered Part A SNF Stay Medicare Part A prospective payments to skilled nursing facilities (SNFs) cover most services, including drugs and biologicals furnished by the SNF for use in the …
The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course that provides an overview of the assessment and coding of pressure ulcers/injuries. This 90-minute course is intended for providers in …
From Data Elements to Quality Measures – Cross-Setting QRP Web-Based Training The Centers for Medicare & Medicaid Services (CMS) is offering a web-based training course that provides a high-level overview of how data elements within …
Jan 15, 2021 The Centers for Medicare & Medicaid Services (CMS) issued a final rule that further advances the agency’s efforts to strengthen and modernize the Medicare Advantage and Part D prescription drug programs. The …
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, …
In early January, CMS released an update to the PDPM Grouper and an updated PDPM ICD-10-CM Codes for I0020B file (dated 1-01-2021). This update added new diagnoses since the Oct. 1, 2020, ICD-10-CM update and …
Question: Are there specific guidelines for what would trigger a Significant Change in Status Assessment (SCSA) for a resident? Answer: The RAI User’s Manual has very specific guidelines for when a Significant Change in …
Question: A resident on Medicare Part A admitted in early December with a primary diagnosis of a stroke. After the Admission/5-Day ARD, she became COVID-19 positive and was placed in single room isolation. Should I …
Question: We had a resident on Medicare Part A who discharged to home, return not anticipated, and started home health that same evening. Sadly, he failed less than 24 hours even with supports in place …
The Resident Assessment Validation and Entry System (jRAVEN) was developed by the Centers for Medicare & Medicaid Services (CMS). jRAVEN is a free Java based software application which provides an option for facilities to collect …
The lookup files containing the allowable ICD codes for item I0020B for FY2021 have been updated to contain the following ICD-10 codes , as well as remove M35.8: The new ICD-10 codes may be used for …
FY 2021 PDPM ICD-10 Mappings (ZIP) (effective 1/1/2021) The Mappings file contains: Mapping of the ICD-10-CM Recorded in Item I0020B of the MDS Assessment to PDPM Clinical Categories Mapping of Comorbidities Included in the PDPM SLP …
QSO Memo, Resources, and Press Release re: CMS Online Platform for Submissions of 1135 Waiver Requests and Inquiries 1. QSO memo: New Platform for Submissions of 1135 Waiver Requests and Inquiries – Go Live Memo …
CMS has issued its 2020 measures under consideration (MUC) list. It includes two proposed SNF QRP QMs. The list includes more detailed info about proposed numerators, denominators, and rationales for each measure: MUC20- 0002: Skilled Nursing …
The MDS 3.0 Provider User’s Guide provides information and instructions pertaining to the QIES ASAP MDS 3.0 system to Long Term Care (LTC) facility and Swing Bed (SB) hospital users who are required to submit …
The Validation Utility Tool (VUT) is a software utility that can be used to validate MDS 3.0 submission files in XML format. The tool enforces the edits that are mapped to the MDS 3.0 items …
Are you confused about which beneficiary notices are needed and when? The updated Beneficiary Notice Guidelines tool lists scenarios that you might run into, clarifying exactly what notices are needed to reduce the risk of claim denials …
2021 Part A MAC Annual Update The SNF consolidated billing file reflects new codes that have been developed for 2021. In addition, the file reflects additions to categories of services excluded from consolidated billing. The …
I. SUMMARY OF CHANGES: This Change Request (CR) updates the list of codes that sometimes or always describe therapy services. The additions, changes, and deletions to the therapy code list reflect those made in the …
In response to the national emergency that was declared concerning the COVID-19 outbreak, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) is implementing 6 new diagnosis codes into 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 …
In the skilled nursing facility (SNF), the nurse assessment coordinator (NAC) may need to be familiar with many different payer types, as well as different audit and appeal processes. The AAPACN SNF Audits and Appeals …
Question: We had planned on an IPA for a resident on 12/3 due to COVID with symptoms. They were already skilled for other things prior. Unfortunately, their condition worsened, and they were sent to the …
Question: Can someone help me understand when to apply the COVID-19 “Encounter for screening and the exposure to” codes? Answer: Here is what the FY2021 ICD-10-CM Guidelines state: e) Exposure to COVID-19 For asymptomatic …
On Dec. 7, 2020, the Health Resources and Services Administration (HRSA) operating under the U.S. Department of Health and Human Services (HHS), is announcing it will distribute $523 million in second round performance payments to …
On 12/7/20, the federal government, through the Health Resources and Services Administration (HRSA) operating under the U.S. Department of Health and Human Services (HHS), announced it will distribute $523 million in second round performance payments …
Question: When a long-term care resident tests positive for COVID-19, can we skill the resident under Medicare Part A for nursing skilled services? Answer: You would need more than a positive diagnosis to warrant skilled …
Question: A resident started a new benefit period using the benefit period waiver. Daily skilled care is now ending. Do I need to issue any of the beneficiary notices to take the resident off Medicare? …
On Nov. 9, 2020, CMS released MLN Matters Number (SE20011 Revised) for Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19). This update provided clarification on pages 14 to 16 on …
Question: A physician documented, “comfort cares with 6 months or less” for a resident a couple of weeks ago. This met the requirements of a Significant Change in Status Assessment (SCSA) and one was completed …
Question: Is the Part A PPS Discharge Assessment (NPE) or Interim Payment Assessment (IPA) required for insurance companies? Answer: The answer to this question would be totally dependent on each insurance company and what they …
Question: I have a resident who was readmitted to our SNF after being hospitalized with a CVA. The resident has deficits to her left side and returned with a PEG tube. She was being treated …
The Centers for Medicare & Medicaid Services (CMS) is granting exceptions under certain Medicare quality reporting and value-based purchasing programs to hospitals, skilled nursing facilities, home health agencies, hospices, inpatient rehabilitation facilities, renal dialysis facilities, …
Transmittal # R10469GI Issue Date 2020-11-20 Subject Update to Medicare Deductible, Coinsurance and Premium Rates for Calendar Year (CY) 2021 Implementation Date 2021-01-04 CR #12024 Publication #100-01 SUMMARY OF CHANGES: This recurring Change Request (CR) …
The Department of Health and Human Services (HHS) published two final rules that aim to reduce regulatory barriers to care coordination and accelerate the transformation of the healthcare system into one that pays for value …
Skilled nursing facility claims saw a $1 billion reduction in estimated improper payments in the last year due to a policy change related to the supporting information for physician certification and recertification for skilled nursing facility …
CMS will retire the original Compare Tools on December 1st. Use Medicare.gov’s Care Compare to find and compare health care providers. In early September, the Centers for Medicare & Medicaid Services (CMS) released Care Compare on Medicare.gov, …
With so many Quality Measures originating from three different payment initiative programs, it’s a lot to keep track of. AANAC’s At A Glance QM, QRP, and VBP tool organizes all of the measures for you. …
With so many Quality Measures originating from three different payment initiative programs, it’s a lot to keep track of. AADNS’s At A Glance QM, QRP, and VBP tool organizes all of the measures for you. …
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 …
The October 2020 refresh of Nursing Home Compare (NHC) included the Skilled Nursing Facility Quality Reporting Program (SNF QRP) data for the following measures: Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury (reported on NHC …
