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.
- Q&A: Does AAPACN have any webinars on the changes coming this year with the elimination of G to GG for CNA documentation?Question: Does AAPACN have any webinars on the changes coming this year with the elimination of G to GG for CNA documentation? Answered by Jessie McGill, RN, RAC-MT AAPACN offers an on-demand workshop for section GG, …
- Substantive Changes to the Draft MDS Nursing Home Item SetsOn Dec. 23, 2022, the Centers for Medicare & Medicaid Services (CMS) released an updated draft of the MDS Nursing Home Comprehensive (NC) Item Set version 1.18.11. Nursing homes will be required to implement the …
- Q&A: Where can I find information about iQIES?Question: Where can I find information about iQIES? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT: The Centers for Medicare & Medicaid Services (CMS) recently released the new iQIES Reports User Manual. This manual …
- TIP: CMS Releases QSO Memo with Updates to Care Compare and Quality Measure RatingsThe Centers for Medicare & Medicaid Services (CMS) released a memo last week containing updates to Care Compare and Quality Measure ratings. These changes include: CMS will consider a lesser action to the star ratings …
- How the DNS Can Lead Risk Mitigation for Schizophrenia Diagnoses2015—the year that the Centers for Medicare & Medicaid Services (CMS) added antipsychotic medication use quality measures (QMs) to the Five-Star Quality Rating System—marked the beginning of some difficult trends in the potentially inappropriate diagnosis …
- Q&A: If a resident has a chronic urinary tract infection (UTI) and the physician ordered a prophylactic antibiotic, do I code UTI on the MDS as an active diagnosis?Question: If a resident has a chronic urinary tract infection (UTI) and the physician ordered a prophylactic antibiotic, do I code UTI on the MDS as an active diagnosis? Answer from Carol Maher, RN-BC, RAC-MTA, …
- TIP: Audit for Accurate Schizophrenia Diagnosis CodingCMS recently released a memo stating they will begin conducting an off-site audit of MDS coding of residents with a diagnosis of schizophrenia to ensure accuracy, and based upon the results, the quality measure (QM) …
- Prepare for iQIES to Avoid MDS Submission FailuresThe Centers for Medicare & Medicaid Services (CMS) is on target to transition MDS submissions from the current Quality Improvement and Evaluation System (QIES) to the cloud-based Internet Quality Improvement and Evaluation System (iQIES). “While …
- NACs Empowered: Tips to Optimize the Resident Interview for MDS CodingThe nurse assessment coordinator (NAC) is responsible for coordinating the completion of the MDS assessment, a process which depends on the interdisciplinary team (IDT) supplying documentation to support MDS coding. While the IDT’s role in …
- Five-Star Preview Reports Available Jan. 23; Help Line, Jan. 23 – 27The Five Star Preview Reports will be available on January 23, 2023. To access these reports, select the CASPER Reporting link located on the CMS QIES Systems for Providers page. Once in the CASPER Reporting …
- CMS QSO Memo 23-05-NH: Schizophrenia MDS Audits Are ComingUpdates to the Nursing Home Care Compare Website and Five Star Quality Rating System: Adjusting Quality Measure Ratings Based on Erroneous Schizophrenia Coding, and Posting Citations Under Dispute Summary • Adjusting Quality Measure Ratings: CMS …
- SNF QRP: Feb. 15 Is the Next Quarterly Reporting DeadlineLearn more here: https://www.cms.gov/files/document/snf-qrp-data-collection-and-final-submission-deadlines-fy-2024-snf-qrp.pdf
- April 1, 2023 Release of Revised ICD-10-CM Code Files and Coding Guidelines–UpdatedIn an effort to better enable the collection of health-related social needs (HRSNs), defined as individual-level, adverse social conditions that negatively impact a person’s health or healthcare, are significant risk factors associated with worse health …
- SNF Provider Preview Reports – Now AvailableThe Skilled Nursing Facility (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 Care Compare and Provider Data Catalog (PDC) …
- iQIES Resources SiteiQIES is the Internet Quality Improvement and Evaluation System, which is the system that the MDS submissions system is being transferred to. The QIES Technical Support Office maintains a website with iQIES reference materials, including …
- Person-Centered Care Planning – Nursing In-service EducationParticipants will learn to identify requirements of a person-centered care plan, identify ways to develop a relationship with a resident that facilitates care planning, and define person-centered care according to the Centers for Medicare & …
- MDS 3.0 v1.18.11 Draft Item Sets: PPS Discharge (NPE) Item Set Will See Big ChangesOn Dec. 23, 2022, the Centers for Medicare & Medicaid Services (CMS) released the nine revised MDS 3.0 v1.18.11 draft item sets so that nurse assessment coordinators (NACs) and other interdisciplinary team members can begin …
- Medical Review Audits and Regulatory Compliance: It Takes a VillageLong-term care is one of the most regulated settings in this country. The interpretive guidance in Appendix PP of the State Operations Manual, which surveyors apply during an onsite survey, is 856 pages long—and that …
- TIP: ICD-10 Coding Convention “with”When using the Alphabetical Index in the ICD-10-CM Official Guidelines for Coding and Reporting, generally the main terms and subterms are alphabetical. However, when the word “with” is immediately after a main term or subterm, …
- Medical Record Alert SheetWhile completing MDS assessments, nurse assessment coordinators can monitor for regulatory compliance during the chart review. If compliance issues arise, leadership should be notified to correct them. NACs can utilize AAPACN’s Medical Record Alert Sheet …
- New MDS Items Series: Changes to Ethnicity and RaceIn this new podcast series, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of education and certification strategy for AAPACN, and Jessie McGill, RN, RAC-MT, RAC-MTA, AAPACN curriculum development specialist, discuss upcoming changes …
- Q&A: We have a resident on Medicare Part A that had a planned discharge return not anticipated to another facility. The resident came back to our facility after 24 hours. What assessments are required?Question: We have a resident on Medicare Part A that had a planned discharge return not anticipated to another facility. The resident came back to our facility after 24 hours. What assessments are required? Answer …
- Q&A: What is a reasonable amount of time to skill a resident on Medicare Part A for being COVID-19 positive?Question: What is a reasonable amount of time to skill a resident on Medicare Part A for being COVID-19 positive? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: I would refer you …
- Q&A: I have heard different rules on completing OBRA discharge assessments – that an assessment is required if the resident’s head isn’t in the bed at midnight and if the resident is out less than 24 hours, it isn’t necessary. Which is correct?Question: I have heard different rules on completing OBRA discharge assessments. Some say an assessment is required if the resident’s head isn’t in the bed at midnight, others say if the resident is out less …
- TIP: CMS Releases Draft Minimum Data Set 3.0 Item SetsThe Centers for Medicare & Medicaid Services (CMS) released an updated draft of the new MDS 3.0 Item Sets on Dec. 23, 2022. This newest draft includes changes to the following: Because there are multiple …
- Draft MDS 3.0 Item Sets v1.18.11 and Change Document AvailableThe draft Minimum Data Set (MDS) 3.0 Item Sets version (v)1.18.11 are now available in the Downloads section on the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual page. CMS plans to release the final …
- TIP: OBRA Scheduling Tools Updated for 2023AAPACN offers two great tools to assist nurse assessment coordinators (NACs) in scheduling OBRA assessments:• The Static OBRA Scheduling Tool is a 4-page tool that counts out day 92 for every calendar day – know when that …
- Schizophrenia: Keys to Coding I6000 and Supporting This Critical DiagnosisFrom 2015 – 2019, the number of long-stay residents who were coded in MDS item I6000 (Schizophrenia (e.g., Schizoaffective and Schizophreniform Disorders)) jumped by 35 percent, according to the November 2022 report Long-Term Trends of …
- Final Step of MDS Management: The Final Validation ReportWhen an MDS has been signed as complete, grouped into a batch, and submitted to the national repository, the nurse assessment coordinator (NAC) still is not yet done with managing that assessment. The last crucial …
- Preparing for the Retirement of Section GIn this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of education and certification strategy for AAPACN, and Jessie McGill, RN, RAC-MT, RAC-MTA, a curriculum development specialist with AAPACN, talk about how …
- Preparing for Section G Retirement: Care Plan UpdatesCMS has announced the retirement of section G, activities of daily living with the MDS item set version 1.18.11, which goes into effect Oct. 1, 2023. To prepare for this change, nurse assessment coordinators can …
- MDS 3.0 Final Validation Reports Quick Facts and ResourcesNurse assessment coordinators (NACs) are responsible for the coordination and completion of the MDS assessments, however, to ensure these assessments are accepted without error into the National Submissions Database the Final Validation Report must also …
- Q&A: What assessments are required when a resident ends skilled care under a Managed Care plan and remains in long-term care?Question: What assessments are required when a resident ends skilled care under a Managed Care plan and remains in long-term care? Answer from Janine Cortesa RN, BSN: Typically, there are no MDS assessments to complete …
- Q&A: How is weight loss in the last six months assessed if the resident has only been in the facility for 14 days?Question: How is weight loss in the last six months assessed if the resident has only been in the facility for 14 days? Answer from Jeff Taylor: Looking at the steps for assessment on page …
- Q&A: We missed a first recertification (due by day 14), and we had the physician sign a delayed certification form. When is the next certification due?Question: We missed a first recertification (due by day 14), and we had the physician sign a delayed certification form. When is the next certification due? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, …
- Strengthen Care Plans to Reflect the Residents’ Needsby Michele Mummert, RN, RAC-CT, RAC-CTA, DNS-CT, Director of Research and Development, The Compliance Store Care planning is the foundation of resident care in the long-term care setting. Everything done to care for the resident …
- Action Required: Register ASAP for an iQIES Account for Early 2023 MDS SubmissionsAs previously announced, CMS is preparing to release the Internet-facing, cloud-based system, referred to as the Internet Quality Improvement and Evaluation System (iQIES) for Minimum Data Set (MDS) submission, in early 2023. Although the MDS …
- Back to Basics: Daily and Weekly Tasks of a Nurse Assessment CoordinatorNurse assessment coordinators (NACs) new to the job often receive guidance from a mentor during their first two weeks in the role. That mentor might lead the new NAC step by step through all the …
- Decision Support Software: How to Get the Benefits and Limit the RisksAccuracy, efficiency, consistency—these are all work process gains that nurse assessment coordinators (NACs) can reap from decision support software, such as MDS “scrubbers” and automated care plan interventions, and they can help lead to improved …
- TIP: Quality Improvement Organization Offers Training LibraryFor nursing facilities in 29 states, Kepro serves as the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). Kepro provides education for healthcare providers to help ensure that appeals are performed quickly and that potential errors …
- SAMPLE Task List for the Nurse Assessment Coordinator (NAC)The new nurse assessment coordinator (NAC) may be overwhelmed with the numerous tasks required of the position. To ease some of this burden, AAPACN developed the Sample Task List for the Nurse Assessment Coordinator tool …
- Q&A: Does anyone have a list of criteria that must be met for a patient to be coded for “at risk for malnutrition” at I5600?Question: Does anyone have a list of criteria that must be met for a patient to be coded for “at risk for malnutrition” at I5600? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: …
- Q&A: For planned discharges, if interviews on the OBRA Discharge assessment have not been completed by the time the resident discharges, do all interview questions need to be dashed?Question: For planned discharges, if interviews on the OBRA Discharge assessment have not been completed by the time the resident discharges, do all interview questions need to be dashed? Answer from Scott Heichel RN, RAC-MT, …
- Q&A: A resident discharged from therapy services, but nursing is educating her on how to perform self-catheterization, which is new for her. How is this coded on the MDS to support skilled care?Question: We have a resident who discharged from therapy services, but nursing is educating her on how to perform self-catheterization, which is new for her. How is this coded on the MDS to support skilled …
- OBRA Scheduling Tools for Calendar Year 2023AAPACN offers two great tools to assist nurse assessment coordinators (NACs) schedule OBRA assessments. Be prepared for 2023 with these two tools that are free to members: The Static OBRA Scheduling Tool is a 4-page tool that …
- Discharge Planning: NACs Have a Key Role as an Information BrokerEffective discharge planning is critical to smooth transitions of care, which help guard against both hospital readmissions and adverse drug events, according to the Agency for Healthcare Research and Quality (AHRQ). The benefit for residents …
- TIP: CMS Posts iQIES Job AidThe Centers for Medicare & Medicaid Services (CMS) has announced the transition from the current QIES ASAP database to the web-based iQIES in early 2023. All providers must have a security official approved by CMS …
- Q&A: Weight loss was not coded on the prior comprehensive assessment, although it was indicated in the resident’s nutritional assessment. Does this qualify for a significant correction or just a modification?Question: Is a Significant Correction to a Prior Comprehensive (SCPA) required if on the last comprehensive, a Significant Change in Status Assessment (SCSA) in May 2022, the registered dietitian failed to select weight loss on …
- Q&A: We have a resident that is in our facility for skilled services under Medicare Part A. The family took the resident out for a funeral, and she did not return within 24 hours. Is this a Medicare Part A discharge?Question: We have a resident that is in our facility for skilled services under Medicare Part A. The family took the resident out for a funeral, and she did not return within 24 hours. Is …
- Q&A: Would this be considered a fall? A staff member reached out to grab a resident as he was losing his balance, but he was able to catch himself by placing a hand down on the bed.Question: Would this be considered a fall? A staff member reached out to grab a resident as he was losing his balance, but he was able to catch himself by placing a hand down on …
- Understand the MDS Trickle-Down EffectA tall glass of crystal-clear water is very refreshing. But water that is murky, has particles floating around, or a mineral odor isn’t appealing – and may be dangerous. The source of the water is …
- TIP: Get Ready for the iQIES Transition As the Centers for Medicare & Medicaid Services (CMS) move toward the rollout of iQIES for nursing facilities in early 2023, the first step requires each facility to select a security official. The facility selected …
- MDS Trickle-Down EffectMDS data has a substantial impact on many different facility outcomes; however, communicating just how important this data is can be a daunting task. Using a water pipeline analogy, the AAPACN MDS Trickle-Down Effect tool …
- Better Resident Care Starts with the DNS Understanding the NAC RoleIn this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of education and certification strategy for AAPACN, and Jessie McGill, RN, RAC-MT, RAC-MTA, curriculum development specialist with AAPACN, discuss the challenge nurse …
- Q&A: A resident on a skilled Medicare Part A stay passed away on day seven following admission. Does the 5-Day PPS assessment have to be moved to the day prior to the death in facility (DIF), or can a separate DIF tracking record and a separate 5-Day be set on day seven?Question: A resident on a skilled Medicare Part A stay passed away on day seven following admission. Does the 5-Day PPS assessment have to be moved to the day prior to the death in facility …
- Q&A: A long-term care resident discharged to the hospital on Sept. 20, 2022, and admitted to our facility on Oct. 20, 2022. Is she considered a new admission or readmission?Question: A long-term care resident discharged to the hospital on Sept. 20, 2022, and admitted to our facility on Oct. 20, 2022. Is she considered a new admission or readmission? For the count to determine …
- Q&A: If the assessment reference date is Oct. 20, 2022, and the resident received the influenza vaccine on Oct. 18, 2021, how would I code O0250A?Question: If the assessment reference date is Oct. 20, 2022, and the resident received the influenza vaccine on Oct. 18, 2021, how would I code O0250A? Answer by Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, …
- SNF PPS Web Pricer for FY 2020 – FY 2023 Available (10/22)Update: End users have reported an issue with the Web Pricer applications, which renders it unable to produce estimates applicable to Fiscal Year 2023. CMS is currently working on this matter and will post an …
- Section GG Data Collection Tool for OBRA AssessmentsIs your state collecting PDPM data on OBRA assessments? Use AAPACN’s Section GG: Three-Day Performance Data-Collection Tool for OBRA Assessments to help guide your staff in documenting the resident’s performance during the window for each …
- Drug Regimen Review Quick GuideHelp your clinical team to understand the MDS Drug Regimen Review (DRR) process and to identify clinically significant medication issues that need immediate physician follow-up. Use the Drug Regimen Review Quick Guide tool to shore …
- Tips for Accurate ICD-10-CM Coding of COVID-19 InfectionOn October 13, 2022, the U.S. Department of Health and Human Services (HHS) renewed the COVID-19 public health emergency (PHE) determination for another 90 days. Although COVID-19 has been affecting skilled nursing facilities (SNFs) for …
- Q&A: I have a resident who has been in the hospital for over 30 days. Do I need to do an admission or reentry tracking record on her return?Question: I have a resident who has been out in the hospital over 30 days. Do I need to do an admission entry and OBRA Admission assessment upon her return? Or do I need to …
- Q&A: Does a nebulizer treatment and post-assessment completed by an LPN meet the criteria to code as respiratory therapy in section O? Or does this need to be completed by an RN?Question: Does a nebulizer treatment and post-assessment completed by an LPN meet the criteria to code as respiratory therapy in section O? Or does this need to be completed by an RN? Answered by Frosini …
- SNF QRP Provider Preview Reports – Now Available Ahead of January 2023 Refresh (10/22)The Skilled Nursing Facility (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 Care Compare and Provider Data Catalog (PDC) during the January 2023 refresh. The …
- FY 2023 ICD-10-CM Codes and Official Coding Guidelines Effective Oct. 1, 2022 (10/22)2023 release of ICD-10-CM The FY2023 ICD-10-CM codes are to be used from October 1, 2022 through September 30, 2023. Note: This replaces the FY 2022 – April 1, release. These files listed below represent …
- How to Speak the Same Language for Section K Coding: NACs and SLPsWhen a nurse assessment coordinator (NAC) reviews the speech language pathologist (SLP) evaluation notes and encounters the term globus sensation, he or she may not even consider that the phrase could indicate a potential swallowing …
- Q&A: We have a resident for whom we are completing an Interim Payment Assessment (IPA). Would we also need to complete a Significant Change in Status Assessment (SCSA) at the same time due to these changes?Question: We have a resident for whom we are completing an Interim Payment Assessment (IPA). Would we also need to complete a Significant Change in Status Assessment (SCSA) at the same time due to these …
- Q&A: I am completing a Significant Change in Status Assessment (SCSA) for a resident who revoked hospice services. How should I code J1400 since hospice services were provided during the 14-day look-back period?Question: I am completing a Significant Change in Status Assessment (SCSA) for a resident who revoked hospice services. How should I code J1400 since hospice services were provided during the 14-day look-back period? I am …
- CMS to End RUGs Support for Medicaid Case-Mix on Oct. 1, 2023; Gives States Guidance re: PDPM (9/22)Guidance on Nursing Facility State Plan Payment and Upper Payment Limit Approaches in Medicaid Relying on the Medicare Patient-Driven Payment Model (SMD 22-005) “As stated at the beginning of this letter, CMS will no longer …
- jRAVEN Free MDS Software Updated to v1.8.2 (9/22)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 …
- FY 2025 (Calendar Year 2023) SNF QRP APU Table for the MDS Data Submission ThresholdA table providing the data elements that will be required to meet the Annual Payment Update (APU) minimum data completion threshold for the Fiscal Year (FY) 2025 Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) …
- FY 2025 (Calendar 2023) SNF QRP Data Collection and Final Submission Deadlines (9/22)A table providing the data collection time frames and final submission deadlines for the Fiscal Year (FY) 2025 Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) is available. Note that the NHSN measure, Influenza Vaccination …
- FY 2024 (Calendar 2022) SNF QRP Data Collection and Final Submission Deadlines UPDATED (9/22)An updated table providing the data collection time frames and final submission deadlines for the Fiscal Year (FY) 2024 Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) is available. The FY 2024 update adds in …
- FY 2023 SNF QRP FAQs (9/22)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 finalized policies for the SNF QRP in …
- A Conversation on Two Technical Expert Panels and the Future Unified Payment Model with Renee KinderIn this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of education and certification strategy for AAPACN, and Renee Kinder, MS, CCC-SLP, RAC-CT, executive vice president of clinical services with AAPACN Diamond …
- New Draft MDS 3.0 Nursing Home Comprehensive Item Set – How SNFs Should PrepareIn this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of education and certification strategy for AAPACN, and Jessie McGill, RN, RAC-MT, RAC-MTA, curriculum development specialist with AAPACN, discuss CMS’s recent release …
- TIP: CMS Posts Draft MDS Comprehensive (NC) Item Set for Oct. 1, 2023The draft Minimum Data Set (MDS) Nursing Home Comprehensive (NC) Item Set version 1.18.11 is now available. CMS plans to release the final version of the MDS Item Sets later in 2022, which will be effective beginning …
- Section G: Scheduled for Retirement October 2023The Activities of Daily Living (ADLs) in section G of the MDS are interwoven throughout the Care Area Assessments (CAAs), Quality Measures (QMs), and some state Medicaid reimbursement systems—and have been for years. Yet CMS …
- Q&A: If a resident is diagnosed with COVID-19 and an interim payment assessment (IPA) is completed, does the COVID diagnosis need to be coded at I0020b or I8000?Question: If a resident is diagnosed with COVID-19 and an interim payment assessment (IPA) is completed, does the COVID diagnosis need to be coded at I0020b or I8000? Answered by Melissa Brown, OTR/L, RAC-CT, CDP, …
- Q&A: Can I code a urinary tract infection (UTI) for a new admission from the hospital diagnosis if it’s within the 30-day look-back period?Question: Can I code a urinary tract infection (UTI) for a new admission from the hospital diagnosis if it’s within the 30-day look-back period? Answer by Vicki Gress, RN, RAC-CT: Yes, page I-13 of the …
- Q&A: If a resident goes out to the hospital and then is readmitted to the facility, do we have to complete a baseline care plan upon their readmission within 48 hours?Question: If a resident goes out to the hospital and then is readmitted to the facility, do we have to complete a baseline care plan upon their readmission within 48 hours? Answer by Carol Maher, …
- Assessing Dark Skin Tone: Advancing Excellence Resources (9/22)Advancing Excellence Collaborative for Long Term Care (AELTCC) has compiled a set of resources to assist nursing and direct care staff with strategies for identifying potential alteration in skin integrity specifically for individuals with dark …
- MDS Validation Utility Tool (VUT) v3.6.1 – Effective 10/1/2022An updated MDS Validation Utility Tool (VUT) v3.6.1 is now available. This release supports the valid FY2023 ICD codes for I0020B as well as the remapping of GG Discharge items when a dash is used …
- October 2023 MDS Item Set: No Section G and More Three-Day Look-BacksOn Sept. 1, 2022, the Centers for Medicare & Medicaid Services (CMS) released the draft MDS Nursing Home Comprehensive (NC) Item Set version 1.18.11, noting that it plans to post all of the final v1.18.11 …
- Draft MDS Nursing Home Comprehensive (NC) Item set version 1.18.11 (9/22)The draft Minimum Data Set (MDS) Nursing Home Comprehensive (NC) Item set version 1.18.11 is now available in the Downloads section below. CMS plans to release the final version of the MDS Item Sets later …
- FY 2023 – 2024 Parity Recalibrations Demand a Back-to-Basics ApproachFee-for-service Medicare Part A reimbursement is under significant pressure over the next two fiscal years due to a parity adjustment recalibration that will reduce aggregate payments by $780 million just in FY 2023 (Oct. 1, …
- Q&A: Can I code psychiatrist visits and orders in MDS items O0600 and O0700?Question: I have been coding psychiatrist visits and orders in MDS items O0600 and O0700. My consultant told me I can’t code this. I thought since a psychiatrist is a medical doctor that specializes in …
- Q&A: When coding K0510A, Nutritional Approach While Not a Resident, can I code IV hydration administered during a surgical procedure on the MDS?Question: When coding K0510A, Nutritional Approach While Not a Resident, can I code IV hydration administered during a surgical procedure on the MDS? Answer by Janine Cortesa, RN, BSN: Coding fluids here is only for …
- Q&A: Can Z codes be used as the primary diagnosis?Question: I was told that, as of the April update of this year, we are no longer allowed to use Z codes as the primary diagnosis. Is this true? Answer by Carol Maher, RN-BC, RAC-MTA, …
- FY 2023 ICD-10 codes for MDS V3.00.1 (FINAL) Data Submission Specs (8/22)An updated PDPM ICD Codes database for the MDS V3.00.1 (FINAL) Data Specifications is now available for download. The database contains two new tables. The table pdpm_icd_codes_FY2023 contains the allowed FY2023 codes for I0020B, while table …
- CMS: Part A Three-Day Hospital Stay Waiver Will Definitely End at COVID-19 PHE End (8/22)CMS has issued a new fact sheet with information about which COVID-19 Public Health Emergency (PHE) waivers and flexibilities have already been terminated, have been made permanent, or will end at the end of the …
- Onboarding Schedule for MDS Transition to iQIES: Provider Security Officials Schedule (8/22)CMS is excited to announce that we are preparing to release the Internet Quality Improvement Evaluation System (iQIES) for Minimum Data Set (MDS) submission in early 2023. Although the MDS submission functionality will not be …
- Don’t Shortcut the CAAsClinical education teaches nurses a process of problem identification. Encompassing assessment, nursing diagnosis, planning, implementation, and evaluation, it is often just called the nursing process. Many nurse assessment coordinators (NACs) may also recognize that the …
- TIP: CMS Announces Rollout for iQIES for Nursing FacilitiesOn the Aug. 4, 2022, Skilled Nursing Facility Open Door Forum, officials from the Centers for Medicare & Medicaid Services (CMS) announced the beginning of a training rollout for the Internet Quality Improvement and Evaluation …
- Q&A: A resident expired at the hospital but was not admitted as an inpatient. Do I need to complete an OBRA Discharge assessment or Death in Facility tracking record?Question: We had a resident code in the facility and was emergency transported to the hospital. The resident expired at the hospital but was never officially admitted to the hospital as an inpatient. Do I …
- Q&A: Can a nurse licensed in one state complete sections of the MDS for another state?Question: Can a nurse licensed in one state complete sections of the MDS for another state? Answered by Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: Unless there is a compact between states, the nurse …
- Tips to Achieve Supporting Documentation: Get the Information NACs Need to Code the MDSCompleting the MDS assessment requires documentation in the medical record to support nearly every item’s coding. When supporting documentation is in place, the MDS assessment process can be smooth and efficient. If it is not, …
- TIP: CMS Clarifies Schizophrenia Diagnosis Coding on the MDSIn mid-July, CMS posted the MDS 3.0 RAI User’s Manual (v1.17.1R) Errata (v2) which provided clarification on the Patient-Driven Payment Model (PDPM) mapping for skin problems to the feet for the nontherapy ancillary component and …
- Q&A: The physician documented “right sided weakness due to CVA,” but did not mention “hemiparesis.” Can I not code “hemiparesis” on the MDS?Question: A resident had a cerebrovascular accident (CVA) and a significant change in status assessment is being completed. The physician documented “right sided weakness due to CVA,” but did not mention “hemiparesis.” Can I not …
- Q&A: We discovered coding errors that go back to 2020. What is the requirement to correct these assessments?Question: We discovered coding errors that go back to 2020, when a resident first enrolled in hospice services. The prior staff member did not code hospice on any MDS assessment from that time and the …