MDS 3.0 and the RAI Process
The MDS 3.0 and the RAI (Resident Assessment Instrument) is a comprehensive nurse assessment and care planning process used by the long-term and post-acute care field as a requirement for reimbursement under Medicare and Medicaid. AAPACN nurse experts help you stay up to date on changes to the MDS with breaking news, articles, and practical tools.
- Falls MDS Coding: Why the DNS Should Get Involved—and How to Do ItIn September 2025, the Office of Inspector General (OIG) rang the alarm bell on MDS coding inaccuracies involving falls with major injury, and the Centers for Medicare & Medicaid Services (CMS) took actions that every …
- Leave of Absence versus Interrupted Stay: The Effect of EHR Census DecisionsListen to this article Your browser does not support the audio element. Skilled nursing facilities (SNFs) frequently manage residents who temporarily leave the building or experience a break in Medicare Part A coverage. On the …
- Q&A: If a resident returns on day 30 after discharge (return anticipated), is it a readmission or new admission?Question: If a resident was discharged return anticipated and comes back on day 30, would this be considered a readmission or a new admission? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: If the …
- Q&A: When resuming Medicare Part A within the 30-day transfer rule, which GG observation period should be used on a Significant Change in Status (SCSA) combined with a 5-Day?Question: When resuming Medicare Part A within the 30-day transfer rule, which GG observation period should be used on a Significant Change in Status (SCSA) combined with a 5-Day? Answer from Jennifer LaBay, RN, RAC-MT, …
- Q&A: Does “at risk for malnutrition” qualify for coding if it is only documented by a dietitian and not by a physician?Question: Does “at risk for malnutrition” qualify for coding if it is only documented by a dietitian and not by a physician? Answer from Jeff Taylor: The steps for assessment and coding instructions for I5600 …
- SNF QRP and SNF VBP MDS Data Validation Program FAQs UpdatedOverview What is the Data Validation Process? The Data Validation Process evaluates the accuracy of quality measure data elements derived from the Minimum Data Set (MDS), which are used in the Skilled Nursing Facility (SNF) …
- Review SNF QRP Performance Data by May 15The SNF Provider Preview Reports have been updated and are now available. These reports contain provider performance scores for quality measures, which will be published on the compare tool on Medicare.gov and the Provider Data Catalog (PDC) during the July 2026 …
- Cross-Setting: Falls with Major Injury (FMI) QM Respecification TrainingThe Centers for Medicare & Medicaid Services (CMS) is offering a Web-Based Training that provides the latest information about the respecification of the Falls with Major Injury (FMI) Quality Measure (QM) for the Post-Acute Care …
- ICD-10-CM Coding Spotlight Series – Part 4: Slips, Trips, and Fragile Bones: Why Not All Fractures Are Created EqualListen to this article Your browser does not support the audio element. As winter gives way to spring, many are relieved to leave behind icy sidewalks and the inevitable steady number of fall-related injuries that …
- Quick Reference Guide: Traumatic versus Pathologic FractureThis quick reference tool helps interdisciplinary team members accurately distinguish between traumatic and pathological fractures for ICD-10-CM and MDS coding. It provides side-by-side guidance on coding rules, 7th character use, section I diagnosis coding (including …
- Q&A: What should be done with an incomplete MDS if a resident passes away?Question: If a resident dies before an assessment is completed, should the MDS be finished or canceled? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC: When a resident dies while in the middle of …
- Q&A: Does one new pressure ulcer require a Significant Change in Status Assessment?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, …
- FY 2027 SNF PPS Proposed Rule: Associated ResourcesFrom 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
- Falls with Major Injury: New CMS Guidance, Coding Clarity, and QAPI Strategies for SNFsIn 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 …
- FY 2027 SNF PPS Proposed RuleProspective 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 …
- Should Z99.2, Dependence on renal dialysis, be coded when dialysis occurs outside the facility?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, …
- Q&A: Is an SCSA required if hospice is revoked and resumed quickly?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 …
- Q&A: Is a hairline fracture from a fall considered a major injury?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 …
- MDS 3.0 Quality Measures (QM) User’s Manual v18.0 Effective Jan. 1, 2026 and Associated Files — Plus ErrataThe 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 …
- CMS Nursing Home Data Sets UpdatedMedicare 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 …
- Q&A: If a resident’s last Medicare Part A covered day is the day before the physical discharge from the facility, can the PPS Discharge and OBRA Discharge assessments be combined?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 …
- Q&A: A resident’s wheelchair tipped backward in therapy. The physical therapy assistant was able to catch him, but it resulted in a skin tear to the arm. The resident remained in the wheelchair and did not come to rest on the ground. Should this be coded as a fall?Question: A resident’s wheelchair tipped backward in therapy. The physical therapy assistant was able to catch him, but it resulted in a skin tear to the arm. The resident remained in the wheelchair and did …
- Q&A: A resident on a Medicare Part A stay was sent to the emergency department by ambulance at 6:45 p.m. on Feb. 2 and returned to the facility just after midnight without being admitted to the hospital. Would this situation qualify as an interrupted stay?Question: A resident on a Medicare Part A stay was sent to the emergency department by ambulance at 6:45 p.m. on Feb. 2 and returned to the facility just after midnight without being admitted to …
- OIG: Nursing Homes Inappropriately Diagnosed Residents with Schizophrenia to Mask the Misuse of Antipsychotic DrugsReport Materials Why OIG Did This Review What OIG Found OIG’s comprehensive review of 40 nursing home inspections completed by CMS found instances of nursing homes inappropriately diagnosing residents with schizophrenia. Specifically, our review of …
- CMS iQIES Reports User Manual UpdateThis user manual provides information for CMS, Providers, Vendors, Accrediting Organizations, Contractors, and State Agencies to effectively perform Reports functions and the processes necessary to request, view, download, and save reports in iQIES. From https://qtso.cms.gov/software/iqies/reference-manuals
- From Coding to Compliance: Avoiding Pitfalls in the 2026 MDS Landscape Listen to this article Your browser does not support the audio element. By: Kristine Martinez BSN, RN, RAC-CT, RAC-CTA, QCP, DNS-CT and Lavatus Donaldson LPN, BPS-HIM, RAC-CT, MBA, QCP With the multiple regulatory bodies that …
- iQIES User Roles Matrix Job AidThis job aid outlines the user roles and privileges in iQIES. All users must have a role in iQIES. iQIES User Roles Matrix Job Aid v5.0 (posted 03/03/2026) From https://qtso.cms.gov/software/iqies/reference-manuals
- Q&A: If the registered dietitian documents a resident is at risk for malnutrition within the MDS look-back period, can “risk for malnutrition” be coded on the MDS section I5600?Question: If the registered dietitian documents a resident is at risk for malnutrition within the MDS look-back period, can “risk for malnutrition” be coded on the MDS section I5600? Answer from Jennifer LaBay RN, RAC-MT, …
- Q&A: How do you code discharge status, A2105, when the resident discharged to a hotel?Question: How do you code discharge status, A2105, when the resident discharged to a hotel? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: A discharge to a homeless shelter, jail, or hotel would be …
- Q&A: If a resident has a diagnosis of “schizoaffective disorder, bipolar type,” how is this coded on the MDS?Question: If a resident has a diagnosis of “schizoaffective disorder, bipolar type,” how is this coded on the MDS? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: Schizoaffective disorder would be coded at I6000, …
- AAPACN 2026 Conference Highlight: The MDS in Court – How Does Yours Standup? with Janine LehmanIn this LTC NAC Chat podcast episode, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Janine Lehmen, director of clinical and legal nursing consulting with Proactive LTC Consulting, discuss …
- PDPM Admission Documentation Request ToolConsistency in documentation is vital to code the MDS accurately. Several MDS items use hospital records to support coding, such as diagnoses, recent surgery, IV fluids/feeding, and tube feeding. Use the PDPM Admission Documentation Request …
- ICD-10-CM Coding Spotlight Series – Part 2: Navigating Genitourinary Conditions in Long-Term CareListen to this article Your browser does not support the audio element. As National Kidney Month arrives in March, so does an important reminder: our kidneys work quietly every day, filtering waste, balancing fluids, and …
- MDS Accuracy: It’s Time to Get Back to the BasicsListen to this article Your browser does not support the audio element. All signs point to one universal truth for the nurse assessment coordinator (NAC): MDS accuracy is paramount, says Joel VanEaton, BSN, RN, RAC-MTA, …
- Clinical Judgment for the MDS: Code Sections GG and J with ConfidenceListen to this article Your browser does not support the audio element. Nurse assessment coordinators (NACs) are often tasked with navigating the complex process of following the Minimum Data Set (MDS) instructions precisely while still …
- Q&A: Can you please clarify “head injury”—the criteria for coding major injury at J1900C?Question: Can you please clarify “head injury”—the criteria for coding major injury at J1900C? Answer from Jessie McGill RN, BSN, RAC-MTA, RAC-CTA: CMS did not provide a definition of major injury but instead provided a …
- Q&A: When coding height for a resident with bilateral lower leg amputations, do you code the height prior to amputation or after?Question: When coding height for a resident with bilateral lower leg amputations, do you code the height prior to amputation or after? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: You code the height …
- Q&A: If a long-stay resident has a Stage 2 pressure ulcer and it heals, would a Significant Change in Status Assessment (SCSA) be required?Question: If a long-stay resident has a Stage 2 pressure ulcer and it heals, would a Significant Change in Status Assessment (SCSA) be required? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: On page …
- Quality Measure IQ Series: The Re-Specified Long-Stay Antipsychotic MeasureListen to this article Your browser does not support the audio element. For years, nurse assessment coordinators (NACs) managed the long-stay (LS) antipsychotic quality measure largely through section N of the Minimum Data Set (MDS). …
- Crack the Code: P0100, Physical RestraintsListen to this article Your browser does not support the audio element. Few Minimum Data Set (MDS) items carry as much regulatory weight and ethical considerations as physical restraints. The decision to use any device …
- Q&A: Am I able to code “yes” in item J1400, Prognosis, when the documentation supporting “life expectancy less than six months” is signed by nurse practitioners or physician assistants, or is a physician signature required?Question: Am I able to code “yes” in item J1400, Prognosis, when the documentation supporting “life expectancy less than six months” is signed by nurse practitioners or physician assistants, or is a physician signature required? …
- Q&A: What specialized training is needed to capture respiratory therapy provided by nurses? Question: What specialized training is needed to capture respiratory therapy provided by nurses? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC:The Glossary of the RAI User’s Manual (Appendix A-22) states this: Respiratory Therapy …
- Q&A: When a resident is discharged to the hospital and admitted with a diagnosis of UTI. Does the UTI get coded on the discharge return anticipated MDS? Question: When a resident is discharged to the hospital and admitted with a diagnosis of UTI. Does the UTI get coded on the discharge return anticipated MDS? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, …
- Q&A: How do I code the “Will [care area] be addressed in the care plan” question when a resident discharges return not anticipated before the care plan is complete? Question: How do I code the “Will [care area] be addressed in the care plan” question when a resident discharges return not anticipated before the care plan is complete? Answer from Jennifer LaBay RN, …
- CMS: Impact of Combined Assessments on SNF APU for SNF QRPImpact of Combined Assessments on SNF APU: How Medicare 5-Day and PPS Discharge Combined Assessments Affect Your Facility’s APU Calculation The Centers for Medicare & Medicaid Services (CMS) has released a one-page resource for SNF …
- Why Directors of Nursing Services Must Be Well-Versed in PDPM and How to Ensure Documentation AccuracyListen to this article Your browser does not support the audio element. In today’s skilled nursing facility (SNF) landscape, the director of nursing services (DNS) is critical not only in overseeing resident care but also …
- Q&A: Is a Significant Change in Status Assessment (SCSA) required for a new pressure ulcer?Question: Is a Significant Change in Status Assessment (SCSA) required for a new pressure ulcer? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: A Significant Change in Status Assessment is required if there are …
- Q&A: If a Discharge – return not anticipated was completed for a resident discharge against medical advice (AMA), and he returned less than 30 days later, is a new OBRA Admission assessment required?Question: If a Discharge – return not anticipated was completed for a resident discharge against medical advice (AMA), and he returned less than 30 days later, is a new OBRA Admission assessment required? Answer from …
- Major Changes on Falls with Major Injury QMsListen to this article Your browser does not support the audio element. The Oct. 1, 2025, update to the definitions of “fall” and “major injury” in the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s …
- iQIES MDS Error Message Reference Guide and Message List v1.1This user guide addresses Minimum Data Set (MDS) error messages and troubleshooting. iQIES MDS Error Message Reference Guide v1.1 (posted 12/29/2025) iQIES MDS Error Messages v1.1 (posted 12/29/2025) From https://qtso.cms.gov/providers/nursing-home-mdsswing-bed-providers/reference-manuals
- SNF QRP/SNF VBP: CMS Video Offers MDS Data Validation Process OverviewThe Centers for Medicare & Medicaid Services (CMS) is offering a recorded presentation which describes the new data validation process. This training will support facilities in understanding the purpose and structure of the data validation …
- FY 2026 ICD-10-CM Code Updates Effective April 1, 2026These files include updates for FY 2026. Use these codes for discharges occurring from April 1, 2026 – September 30, 2026, and for patient encounters occurring from April 1, 2026– September 30, 2026. https://www.cms.gov/medicare/coding-billing/icd-10-codes
- Q&A: A resident has a healing pressure ulcer that was described as “100% epithelial, with slow blanching erythema” during the ARD window. Would this still be coded as a pressure ulcer? Question: A resident has a healing pressure ulcer that was described as “100 % epithelial, with slow blanching erythema” during the ARD window. Would this still be coded as a pressure ulcer? Answer from …
- Q&A: If a resident is losing weight and ordered supplements as an intervention, can we code as a therapeutic diet?Question: If a resident is losing weight and ordered supplements as an intervention, can we code as a therapeutic diet? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC:If the supplements were ordered by a …
- Q&A: Can I code a diagnosis of pneumonia when the nurse practitioner initiated antibiotics for a documented reason of pneumonia, but there was not a chest x-ray completed to confirm the diagnosis?Question: Can I code a diagnosis of pneumonia when the nurse practitioner initiated antibiotics for a documented reason of pneumonia, but there was not a chest x-ray completed to confirm the diagnosis? Answer from Carol …
- Q&A: What date would be used in A2400C (Medicare end date) for an unplanned discharge to the hospital when the assessment is a combined a 5-Day, OBRA discharge, and a PPS discharge?Question: What date would be used in A2400C (Medicare end date) for an unplanned discharge to the hospital when the assessment is a combined a 5-Day, OBRA discharge, and a PPS discharge? Answer from Carol …
- Weight Loss/Gain Calculation Worksheets and Documentation Tip Sheets to Support MDS CodingAAPACN’s Weight Loss/Gain Calculation Worksheets and Documentation Tip Sheets to Support MDS Coding helps clinicians accurately calculate and document weight changes to support compliant MDS section K coding. This easy-to-use resource outlines how to identify …
- Crack the Code: E0800, Rejection of CareUnderstanding and accurately coding E0800, Rejection of Care, is essential both to reflect the resident’s behavior patterns and to ensure the care plan captures both the resident’s behaviors and his or her preferences. Misinterpreting rejection …
- Falls With Major Injury (FMI) NHQI Technical Specification ReportThe Centers for Medicare & Medicaid Services (CMS) has released the official Technical Specification Report for the Falls with Major Injury (FMI) measure. This report incorporates feedback received during the cross-setting Technical Expert Panel (TEP) …
- OIG: First SNF PDPM Audit ReportNearly All Skilled Nursing Services Provided by Pinnacle Multicare Nursing and Rehabilitation Center Did Not Meet Medicare Payment Requirements Issued on 11/14/2025 | Posted on 11/18/2025 | Report number: A-02-22-01017 Report Materials Why OIG Did This Audit What OIG Found What …
- iQIES Assessment Management: Assessment Submitter ManualThis document shows how to upload assessments, create and manage assessments, complete change requests, and review Final Validation Reports (FVR) in iQIES. Nov 18, 2025 CMS iQIES Assessment Management for Assessment Submitter v2.2 From https://qtso.cms.gov/software/iqies/reference-manuals
- MDS Item I1700: Navigate the Complexities of Coding MDROsMultidrug-resistant organisms (MDROs) are a red flag for a nursing home’s infection prevention and control program that either contact precautions or enhanced barrier precautions may need to be initiated, points out Carol Maher, RN, GERO-BC, …
- Q&A: If the stay is only 15 days, how do I calculate the 30-day weight loss for section K?Question: If the stay is only 15 days, how do I calculate the 30-day weight loss for section K? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: You use the weight that is closest …
- Q&A: What ARD is used for a Death in Facility record if the resident expires before midnight, but the mortuary did not pick up until after midnight? Question: What ARD is used for a Death in Facility record if the resident expires before midnight, but the mortuary did not pick up until after midnight? Answer from Jeff Taylor: The actual time/date …
- Back to PDPM Basics – Part 5: The NTA ComponentThe Non-Therapy Ancillary (NTA) component of the Patient-Driven Payment Model (PDPM) accounts for the medical complexity and resource-intensive services provided to residents in nursing facilities. This component is calculated using a combination of clinical diagnoses, …
- Crack the Code: B1000, VisionAn assessor does not need perfect eyesight to see that vision plays a significant role in the quality of life of residents in long-term care. Accurately evaluating vision, and how it is coded at B1000, …
- How to Manage Challenging Admission AssessmentsWritten by Brenda Schumacher, Staff Writer, AAPACN When a resident discharges before the Admission assessment is complete, nurse assessment coordinators (NACs) must make decisions that directly affect compliance, survey readiness, and resident care planning. Jessie …
- 2025 Section GG UpdatesIn this LTC NAC Chat podcast episode, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Jessie McGill, RN, BSN, RAC-MT, RAC-MTA, senior curriculum development specialist for AAPACN, discuss recent …
- Q&A: What is the look-back period for K0100? The RAI User’s Manual does not mention the look-back period or if this can include days during the hospital stay?Question: What is the look-back period for K0100? The RAI User’s Manual does not mention the look-back period or if this can include days during the hospital stay? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, …
- OBRA Scheduling Tools for Calendar Year 2026AAPACN offers two great tools to assist nurse assessment coordinators (NACs) in scheduling OBRA assessments. Be prepared for 2026 with these two tools that are free to members: This AAPACN resource is copyright protected. AAPACN …
- MDS Data Collection for the NAC ToolDo you have an organized approach to collect MDS data during the 7- and 14-day look-back periods? AAPACN’s MDS Data Collection for the NAC tool provides an organized approach to gathering supporting data from the …
- MDS Item L0200: Teeth Matter—and Not Just to DentistsMDS section L (Oral/Dental Status) is one of the most frequently undervalued areas of the MDS, says Eleisha Wilkes, RN, GERO-BC, RAC-CT, RAC-CTA, DNS-CT, QCP, a senior consultant with Proactive LTC Consulting in Evansville, IN. …
- Back to PDPM Basics – Part 4: The Nursing Component – Clinically Complex, Behavioral Symptoms and Cognitive Performance, and Reduced Physical FunctionThe nursing component of the Patient-Driven Payment Model (PDPM) may appear straightforward: calculate a section GG Nursing Function Score and assign the resident to one of six nursing categories. But accuracy relies on a detailed …
- Q&A: Is a Pure Wick catheter coded as an external catheter? Question: Is a Pure Wick catheter coded as an external catheter? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: Yes, this would meet the definition of an external catheter in the …
- Q&A: When assessing a fall with an injury to the head, such as a laceration, bruise, or hematoma, would this automatically be considered a major injury? Question: When assessing a fall with an injury to the head, such as a laceration, bruise, or hematoma, would this automatically be considered a major injury? Answer from Jessie McGill RN, BSN, RAC-MTA, RAC-CTA and …
- Follow Up Q&A for AAPACN Sept. 28, 2025 Webinar – Ready or Not: Oct. 1, 2025 MDS ChangesIn this LTC NAC Chat podcast episode, Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist for AAPACN, and Jessie McGill, RN, BSN, RAC-MT, RAC-MTA, senior curriculum development specialist for AAPACN, answer some follow-up …
- TIP: COVID-19 Recommendations UpdatedThe Centers for Disease Control and Prevention (CDC) recently updated guidance for the COVID-19 vaccine administration and the adult immunization schedule. The CDC’s Adult Immunization Schedule webpage was updated Oct. 7, 2025, which changed the …
- Resident Interview ToolkitThe AAPACN Resident Interview Toolkit helps nursing home staff conduct effective resident interviews as part of the MDS 3.0 assessment process. It provides clear guidance and resources for the entire interdisciplinary team—nurses, dietary managers, social …
- TIP: Updated MDS 3.0 RAI User’s Manual Changes – New Definitions for Fall, Injury, and Major InjuryThe Centers for Medicare & Medicaid Services (CMS) released the final version of the RAI User’s Manual, version 1.20.1, which went into effect Oct. 1, 2025. CMS made several changes, including a new definition for …
- Respiratory Therapy MDS Coding ChecklistRespiratory therapy, coded at O0390D and O0400D, must meet definitions and complex instructions per the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual (RAI User’s Manual). AAPACN’s Respiratory Therapy MDS Coding Checklist tool delineates the requirements …
- Q&A: How do you code walking if the resident only walks with therapy staff?Question: How do you code walking if the resident only walks with therapy staff? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, and Jessie McGill, RN, BSN, RAC-MTA, RAC-CTA: If the resident only walked …
- Q&A: With the new definition of fall with major injury, would a bump on the head or a laceration be a head injury? With the new definition of fall with major injury, would a bump on the head or a laceration be a head injury?Question: With the new definition of fall with major injury, would a bump on the head or a laceration be a head injury? With the new definition of fall with major injury, would a bump …
- Q&A: I am confused by the new section GG guidance for when the activity “is being/will be” routinely performed. What does “will” mean?Question: I am confused by the new section GG guidance for when the activity “is being/will be” routinely performed. What does “will” mean? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, and Jessie McGill, …
- QAPI Focus: Section GGAAPACN’s QAPI Focus: Section GG tool can be used at quality assurance and performance improvement (QAPI) meetings to focus specifically on concerns regarding section GG documentation and coding accuracy. This tool identifies specific section GG …
- TIP: CMS Released Additional Updates to RAI User’s Manual v1.20.1On Sept. 24, 2025, the Centers for Medicare & Medicaid Services (CMS) released an updated RAI User’s Manual version 1.20.1 and updated MDS item sets v1.20.1v4. The last-minute updates aligned the MDS item sets with …
- Should SNFs Collect Removed Section R MDS Data—and Why Do HRSN Even Matter?MDS section R (Health-Related Social Needs) did not go into effect on Oct. 1, 2025. The Centers for Medicare & Medicaid Services (CMS) followed through on its proposal and eliminated—prior to implementation—items R0310 (Living Situation), …
- Section O Overhaul: Changes to Therapy CodingThe Long-Term Care Resident Assessment Instrument (RAI) 3.0 User’s Manual (RAI User’s Manual) version 1.20.1, effective Oct. 1, 2025, will bring major changes to section O of the MDS 3.0. The most significant update introduces …
- PDPM Grouper JAR Package V2.4000This release was updated to support FY2026 ICD-10 codes which are used with MDS assessments with a target date on or after October 1, 2025. As part of this release, 487 clinical category mappings were added, …
- AAPACN Resources to Help Prepare for Oct. 1, 2025, MDS ChangesAAPACN Resources to Help Prepare for Oct. 1, 2025, MDS Changes The Long Term-Care Facility Resident Assessment Instrument (RAI) 3.0 User’s Manual version 1.20.1 from the Centers for Medicare & Medicaid Services (CMS) goes into …
- Oct. 2025 RAI User’s Manual – Unexpected Updates In this LTC NAC Chat podcast episode, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Jessie McGill, RN, BSN, RAC-MT, RAC-MTA, senior curriculum development specialist for AAPACN, discuss some …
- SNF QRP Measure Calculations and Reporting User’s Manual V7.0, Change Table, Risk Adjustment and Imputation Appendix Files, and HCC ICD-10 CrosswalksThe Skilled Nursing Facility Quality Reporting Program (SNF QRP) Measure Calculations and Reporting User’s Manual v7.0 and accompanying files are now available. These materials serve as an update to the specifications used to calculate quality measures that …
- OIG: Nursing Homes Failed To Report 43 Percent of Falls With Major Injury and Hospitalization Among Their Medicare-Enrolled ResidentsIssued on 09/15/2025 | Posted on 09/18/2025 | Report number: OEI-05-24-00180 Report Materials Why OIG Did This Review What OIG Found Nursing homes failed to report 43 percent of falls with major injury and hospitalization among Medicare-enrolled residents, as required, in …
- Q&A: We had a resident on a Medicare Part A stay admit and discharge back to the hospital that same evening after a few hours. We could not assess much information during that brief amount of time. What are all the required MDS assessments that need to be completed on this resident? I know an entry tracker and an OBRA discharge, but do we need to also complete a 5-Day PPS?Question: We had a resident on a Medicare Part A stay admit and discharge back to the hospital that same evening after a few hours. We could not assess much information during that brief amount …
- Q&A: The new definition of a fall includes an overwhelming external force, but the definition of fracture related to a fall states, “Do not include fractures caused by trauma related to car crashes or pedestrian versus car accidents or impact of another person or object against the resident.” Does this instruction contradict the new definition of a fall?Question: The new definition of a fall includes an overwhelming external force, but the definition of fracture related to a fall states, “Do not include fractures caused by trauma related to car crashes or pedestrian versus …
- MDS Item J2100 Feeds Into PDPM: Learn What’s at Stake and How to Boost AccuracyMDS 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 …
- Q&A: Can Isolation be coded for methicillin-resistant staphylococcus aureus (MRSA) on a wound?Question: Can Isolation be coded for methicillin-resistant staphylococcus aureus (MRSA) on a wound? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: No, the RAI User’s Manual specifically states that isolation cannot be coded for …
- FY 2028 (CY 2026 Data) SNF QRP Reporting Requirements and Data Submission DeadlinesSNF QRP Data Collection and Final Submission Deadlines The SNF QRP Data Collection and Final Submission Deadlines have been updated to provide the data collection time frames and final submission deadlines for the FY 2028 …
- FY 2027 (CY 2025 Data) Revised SNF QRP MDS Reporting Requirements and Data Submission DeadlinesSNF QRP Data Elements Used for Reporting Assessment-Based QMs and Standardized Patient Assessment Data Elements Affecting FY 2027 APU Determination and Data Collection and Final Submission Deadlines for FY 2027 posted The Skilled Nursing Facility …
- FY 2026 ICD-10 PDPM Mappings FileThis file can be used by NACs to determine how ICD-10-CM codes entered on the MDS “map” to PDPM payment components. https://www.cms.gov/medicare/payment/prospective-payment-systems/skilled-nursing-facility-snf/patient-driven-model
- Q&A: If an open area is found on day four after admission, is that still present on admission (7-day look-back period)? The definition of “present on admission” is “as close to admission as possible.”Question: If an open area is found on day four after admission, is that still present on admission (7-day look-back period)? The definition of “present on admission” is “as close to admission as possible.” Answer from …