Medicare Advantage Plan Appeals in Skilled Nursing Facilities Date presented: January 21, 2026 In this webinar, Acentra Health provices a look at a recent focus study on how Medicare Advantage plans use NOMNCs in SNFs. During …
Press release Nationwide study finds lower risk of death and rehospitalization among older adults treated with trazodone after hospital admission. A large U.S. study suggests that older adults hospitalized with delirium may experience better outcomes …
Site description: This site includes accessible, concise, and clinically relevant educational reports and podcasts on Geriatric topics. Geriatric Fast Facts (GFFs) are designed to provide concise, practical, evidence-based summaries of key health care issues important …
The HCP Flu Vaccination Module, which is part of the HCP component in NHSN, is used to input required NHSN data for the SNF QRP. This site provides access to the HCP Vaccination Module: Influenza …
The January 2026 refresh of the SNF QRP is now available on the compare tool on Medicare.gov and Provider Data Catalog (PDC). The January refresh includes: Please visit the compare tool on Medicare.gov and PDC to view the updated quality data. For questions about SNF …
Becoming an expert-level nurse assessment coordinator (NAC) doesn’t happen overnight. It’s the result of years of experience, continuous learning, and navigating complex clinical, regulatory, and reimbursement challenges with confidence. At this stage, expert NACs are …
The updated Five-Star rating preview reports for nursing homes are available in iQIES effective February 2, 2026. Nursing Home Care Compare will update with the January Five-Star data on or around February 5, 2026. Important …
SNF QRP The submission deadline for the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) is approaching. Minimum Data Set (MDS) assessment data and data submitted to the Centers for Medicare & Medicaid Services (CMS) …
This ZIP file contains resources for surveyors conducting initial surveys under the Long-term Care Survey Process (LTCSP). It is a one-stop shop containing a multitude of reference materials that are provided to the surveyors going …
Listen 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). …
Listen 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 …
The January Care Compare refresh, scheduled for Jan. 28, 2026, was delayed. In an email response, the Centers for Medicare & Medicaid Services (CMS) BetterCare stated “[they] identified an issue with one of the data …
In late January, the Centers for Medicare & Medicaid Services (CMS) revised the memo QSO-23-01-NH, changing the selection criteria for the Special Focus Facility (SFF) program from staffing to falls. In the memo, CMS noted: …
The SNF Calendar: Key Dates for 2026 QM, VBP, QRP, and PBJ, provides a quick reference highlighting key 2026 deadlines and milestones for skilled nursing facilities. This tool includes quality measures (QMs), Value-Based Purchasing (VBP) …
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 Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist for AAPACN, discuss some …
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? …
Question: Can I set a 5-Day PPS assessment on a non-billable day such as a skip day? The resident was sent to the hospital, did not return prior to midnight, and was not admitted. Answer …
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 …
Members: $25 | Non-members: $50Continuing Education: 1 CE hourRecording Date: Jan. 29, 2026Duration: 60 minutesSpeaker: Jessie McGill, RN, BSN, RAC-MT, RAC-MTA It’s resolution season, and this year we’re resolving to make the long-stay antipsychotic quality measure (QM) make sense! The 2026 re-specifications …
Listen to this article Your browser does not support the audio element. February’s designation as American Heart Month offers an important opportunity to reflect on the role of cardiovascular health in long-term care (LTC). Cardiac …
A strong infection prevention and control plan should serve as the foundation of the comprehensive care plan for any resident with a multidrug-resistant organism (MDRO), says Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC, …
Question: The Skilled Nursing Facility Quality Reporting Program (SNF QRP) Data Validation Audit notification letter requested Admission and Discharge assessments. What assessments should be submitted? Answer from Jessie McGill RN, BSN, RAC-MTA, RAC-MT: On the …
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, …
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, …
The Advanced Beneficiary Notice of Noncoverage (ABN), form CMS-R-131, is used by nursing facilities when Medicare Part B services are ending and the resident does not agree with the decision. The current form, posted on …
On Jan. 12, 2026, the first wave of Skilled Nursing Facility Quality Reporting Program (SNF QRP) validation audits notifications arrived in the iQIES MDS 3.0 Provider Preview Reports folder for some facilities. While 1,500 randomly …
Impact 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 …
Key report excerpts re: SNFs: Within the Traditional Medicare program, reducing improper payments remains a challenge. The improper payment rate reported in FY 2024, 7.66 percent, has not decreased from the rates reported in FYs …
The PBJ system has been updated to accept optional hire and termination dates up to 12/31/2050. CMS helpdesk is starting to get tickets regarding this update, so we are following up with clarifications. Please ensure that …
CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily. The Nursing Home Compare Web site features a quality rating system that gives each nursing home …
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 …
Question: When a resident changes payers from Medicare Advantage to Traditional Medicare, are the Medicare Advantage days subtracted from the Medicare 100-day benefit period? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: Yes, days …
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 …
Consolidated billing specifies that the SNF is the responsible party for the billing of the entire package of care the resident receives during a covered Part A SNF stay, as well as identifies a limited …
Listen 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 …
Listen to this article Your browser does not support the audio element. Mandates to notify or inform the resident and/or their representative about an array of clinical and service issues are woven throughout the resident …
Care Compare refreshes MDS 3.0 Quality Measure (QM) data quarterly in January, April, July, and October with the most recent four full quarters of data. AAPACN’s Five-Star and Care Compare MDS 3.0 Quality Measure Data Periods tools …
This 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
The 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 …
From AHRQ: A new tabletop game turns infection prevention training into a collaborative, story-driven escape room. When players notice a change in a resident’s skin, they work together to interact with environmental services staff, a …
This job aid outlines the user roles and privileges in iQIES. All users must have a role in iQIES. iQIES User Roles Matrix Job Aid v4.7 (posted 12/22/2025)
Medicare 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: December 1, 2025 Released: January …
ADD – EFFECTIVE 01/01/2026 Major Category I. B. – Cardiac Catheterization Major Category III. A. – Chemotherapy Major Category III. C. -Radioisotopes and their Administration TERMINATE – EFFECTIVE 01/01/2026 Major Category III. A. – Chemotherapy …
These 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
Overview What is the SNF Validation Program? The SNF Validation Program is an audit-driven initiative aimed at evaluating the accuracy of quality measure data elements derived from the Minimum Data Set (MDS), which are used …
Every month, AAPACN experts design tools that help our members perform their jobs with more ease, breaking down processes, synthesizing information, and aiding in ways to track required data. To help nurse assessment coordinators (NACs) …
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 Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist with AAPACN discuss when …
F641, Accuracy of the Minimum Data Set (MDS), remains one of the most frequently cited F-Tags during surveys, for good reason. The MDS is a critical foundation of resident assessment, care planning, reimbursement, and quality …
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 …
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 …
Question: If a resident on Medicare Part A admits and discharges to home on the same day, can we bill Medicare for that day? Answer from Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: …
The Centers for Medicare & Medicaid Services (CMS) initiated data validation audits to evaluate the accuracy of quality measure data elements used in the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) and the Value-Based …
The Centers for Medicare & Medicaid Services (CMS) recently released the Minimum Data Set (MDS) 3.0 Quality Measures (QM) User’s Manual, version (V)18.0, which will go into effect Jan. 1, 2026. This update contains the re-specification of …
When a resident’s Medicare Part A skilled stay ends, two types of resident notification processes may be required under the Beneficiary Notices Initiative: the standard denial process and the expedited appeal process. In the standard …
The Minimum Data Set (MDS) 3.0 Quality Measures (QM) User’s Manual Version (V)18.0 is now available along with associated files. Additionally, the updated .zip file titled MDS 3.0 QM User’s Manual v18.0 Effective 1-1-2026 and …
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 …
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 …
Question: Can we still use dementia as a primary diagnosis for our long-term residents? Our facility was recently told we can no longer use the dementia diagnosis (F03.90) although it maps to medical management? Answer …
AAPACN’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 …
The expected October Care Compare refresh was delayed during the government shutdown, but it was finally refreshed on Nov. 30, 2025. The Centers for Medicare & Medicaid Services (CMS) outlined key updates also included with …
Understanding 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 …
In long-term care, maintaining a resident’s functional independence is both a clinical and regulatory priority. The Minimum Data Set (MDS) 3.0 Quality Measure (QM), “Percent of Residents Whose Need for Help with Activities of Daily …
The 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) …
With so many Quality Measures originating from three different payment initiative programs, it’s a lot to keep track of. AAPACN’s At-a-Glance QM, QRP, and VBP tool organizes all of the measures for you. This tool has been …
AHRQ’s new Toolkit for Improving Skin Care and MDRO Prevention in Long-Term Care strengthens infection prevention in nursing homes, addressing the unique needs of residents and the care environment they live in. The toolkit outlines four evidence-based …
Nearly 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 …
This communication pertains to the Fiscal Year (FY) 2028 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program performance standards for the Number of Hospitalizations per 1,000 Long Stay Resident Days (Long Stay Hospitalization) measure which …
This 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
With the federal government now reopened after the 43-day shutdown, the Centers for Medicare & Medicaid Services (CMS) is expected to move quickly from the contingency plans outlined in the QSO-26-01-ALL REVISED memo and back …
Multidrug-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, …
Question: A resident was skilled under Medicare Part A and exhausted benefits. We completed a Significant Change in Status Assessment to capture the improvement before the end of the stay. Should I have completed an …
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 …
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 …
The 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, …
On November 14, 2025, the Centers for Medicare & Medicaid Services (CMS) released the 2026 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2026 Medicare Part D …
In skilled nursing facilities across the country, quality care is not just a standard—it is a promise to residents and families who place their trust in dedicated caregivers. At Genesis Healthcare, that promise is being …
Long-term care nurses who follow the path of becoming nurse assessment coordinators (NACs) can advance their careers and skill levels through experience and gained knowledge over time. At every stage of professional development, NACs can …
An 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, …
Are you considering advancing your career and looking to gain knowledge to be successful in your next role? Or are you already in the position you love but looking to improve your knowledge for additional …
The Centers for Medicare & Medicaid Services (CMS) is increasing quality of care for Medicare beneficiaries while significantly reducing unnecessary spending and promoting payment accuracy. The calendar year (CY) 2026 Medicare Physician Fee Schedule (PFS) final rule advances primary …
Written 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 …
Question: Can the physician certification be met through a detailed order versus a separate certification form? Answer from Jessie McGill RN, BSN, RAC-MTA, RAC-MT: CMS does not mandate a specific form or format, but …
Question: We have a resident that had a qualifying hospital stay (QHS), then went to a long-term acute care hospital (LTACH) for more than 30 days. Can the resident still utilize their Medicare benefits in …
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, …
The Centers for Medicare & Medicaid Services (CMS) released an updated memo regarding “Contingency Plans – State Survey & Certification Activities in the Event of Federal Government Shutdown,” QSO-26-01-ALL Revised, on Oct. 31, 2025. CMS …
AAPACN 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 …
Do 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 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. …
The 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 …
Question: Is there a specific table that shows which items if dashed will count against us for the Skilled Nursing Facility Quality Reporting Program (SNF QRP)? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: …
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 …
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 …
In 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 …
The ICD-10-CM Coding Convention Terminology Quick Reference Guide provides a concise reference to key ICD-10-CM coding terminology and conventions for long-term care nurse assessment coordinators and coders. This guide simplifies complex terms and coding rules …
