Fee-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, …
Nurse assessment coordinators’ (NACs’) actions drive the Medicare reimbursement that a skilled nursing facility (SNF) receives for the care it provides. NACs oversee the process of assessing residents, developing documentation, and submitting the MDS—all of …
Centers for Medicare & Medicaid Services (CMS) recently announced onboarding training for facility security officials for the iQIES. CMS posted the following materials to improve understanding of the onboarding process and a job aid for …
In 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, talk about recent changes …
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 …
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 …
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, …
The nurse assessment coordinator’s (NAC’s) job is mentally taxing. There is so much to keep track of—assessment reference dates, when to complete an interim payment assessment, how the case-mix adjusted components impact the Patient-Driven Payment …
CMS outlines actions for states to improve safety and quality of care for residents The Centers for Medicare & Medicaid Services (CMS) issued an informational bulletin detailing actions that states can take using existing Medicaid …
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 …
The August update of Appendix B to the RAI 3.0 User’s Manual contains changes to the list of State RAI Coordinators, MDS Automation Coordinators, RAI Panel members, and CMS locations and contacts. To ensure accurate formatting, use a …
Message from the Medicare Learning Network: IQVIA is conducting a survey for the HHS Office of the National Coordinator for Health Information Technology to assess skilled nursing facility (SNF) capabilities related to interoperability, electronically exchanging …
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 …
You can read the blanket waivers for COVID-19 in the List of Blanket Waivers (PDF) UPDATED (8/18/2022). Unless otherwise noted, these waivers will terminate at the end of the COVID-19 public health emergency (PHE) From https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page
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 …
While key details are still pending, the Fiscal Year (FY) 2023 Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule makes clear that meeting the reporting requirements of the Skilled Nursing Facility Quality Reporting …
Clinical 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 …
On 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 …
In this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of education and certification strategy for AAPACN, and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist with AAPACN, discuss the …
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 …
Question: Our billing department is being told by a third party that if we code any “unspecified” diagnoses in I8000, Medicare will deny it. Is this accurate? Answered by Jeff Taylor: This is absolutely false. …
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 …
CMS has an online home for the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program that offers multiple resources explaining how the program works. Landing page: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/SNF-VBP/SNF-VBP-Page.html Measure Scoring Methodology & Payment Adjustment Confidential Feedback …
The SNF Provider Threshold Report in the ‘SNF Quality Reporting Program’ report category in the CASPER Reporting application is unavailable. An issue has been identified with the display of HCP COVID-19 Vaccine data submission results. …
PITTSBURGH – Five individuals and two for-profit skilled nursing facilities in Southwestern Pennsylvania have been indicted by federal grand jury in Pittsburgh on charges of conspiracy to defraud the United States and related health care …
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 …
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 (8/16/22 Medicare Monoclonal Antibody COVID-19 Infusion Program Instruction (PDF) (2/16/21) Frequently Asked …
The Fiscal Year (FY) 2023 Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule may not “turn that frown upside down” as the popular saying goes, but it does give SNFs—and in some cases …
Effective July 27, the Centers for Medicare & Medicaid Services (CMS) has overhauled the methodology for the Staffing domain’s star rating calculations in the Five-Star Quality Rating System on Care Compare, says Jessie McGill, RN, …
Completing 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, …
In 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 …
The July 2022 Care Compare refresh reflected a major overhaul of how the Five-Star Staffing stars are calculated. The staffing domain is now based on six staffing measures, three based on hours per resident day …
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 …
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 …
Question: Can a resident be skilled for Medicare Part A and receive hospice care? Answer by Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: In order to cover someone on hospice for Medicare A, the …
ICD-10-CM related mappings for the purposes of resident classification under the Patient-Driven Payment Model (PDPM) for Medicare Part A SNF stays. Updated all three mappings to FY2023 code list. Reflected all changes finalized in the …
The August 2022 Performance Score Reports (PSRs) for the Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program are now available to download via the Quality Improvement and Evaluation System (QIES)/Certification and Survey Provider Enhanced Reports …
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 …
CDC’s NHSN provides healthcare facilities, such as long-term care facilities (LTCFs), with a secure reporting platform for reporting outcomes and process measures in a systematic way. Reported data are immediately available for use in strengthening local …
Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2023; etc. PDF 348 Pages (962 KB)Permalink Press release: CMS Acts to Improve the …
Five-Star, NHQI, SNF QRP, SNF VBP, and PBJ data COVID-19 Vaccination Rates – State and National Averages State and National averages for facility resident and healthcare personnel COVID-19 vaccination rates. Data are presented as one …
In this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of education and certification strategy for AAPACN, Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist with AAPACN, and Carol Maher, …
Ah, the great mysteries of life. Which came first, the chicken or the egg? Is there intelligent life on other planets? Where do all the missing socks go? And of course, the enduring mystery: what …
Starting out as a new nurse assessment coordinator (NAC) can be overwhelming. There’s so much to keep track of—from ensuring MDS assessments are in place to understanding all the components of the Patient-Driven Payment Model …
The Skilled Nursing Facility (SNF) Provider Preview Reports, which contain the performance scores of the SNF Quality Reporting Program (QRP) measures, were released in late July. These measures will be publicly reported on Care Compare …
Question: I’m new to MDS. Is there anything that needs to be completed on the MDS before the resident leaves for a planned discharge back to the community? Answered by Kim Steele RN, WCC, RAC-CT, RAC-CTA: …
Question: Can a resident be skilled for Medicare Part A if they are receiving an oral antibiotic for an infection, such as pneumonia or cellulitis? Answered by Jeff Taylor: Here’s a link to the Medicare …
Question: How many days after the due date on a physician recertification can the physician sign and still be in compliance? Answered by Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: After the first recertification, …
For Medicare residents, nurse assessment coordinators (NACs) need to determine whether an interrupted stay has occurred and ensure that the correct MDS assessments, both OBRA and PPS, are in place. AAPACN’s Interrupted Stay Tracker tool …
The interrupted stay policy designates that a Medicare stay is considered a continuous stay when it is interrupted by less than three non-covered days. AAPACN’s Interrupted Stay Policy Quick Guide provides the key facts for …
Determining whether an interrupted stay has occurred can be a challenge, especially when so many different factors must be considered. AAPACN’s enhanced Interrupted Stay Flow Chart will help nurse assessment coordinators (NACs) navigate different scenarios to …
AAPACN has adapted the A2400C flow chart from section A of the RAI User’s Manual to show how A2400C impacts how the nurse assessment coordinator (NAC) schedules the PPS Part A Discharge assessment and how …
The PDF file labeled “MDS3.0RAIManualv1.17R.Errata.v2” contains revisions to pages in Chapter 3, Section I, of the MDS 3.0 RAI Manual v1.17.1R that clarifies the need for a detailed evaluation and appropriate diagnostic information to support …
Summary of Recent Changes: Added additional rationale for the use of Enhanced Barrier Precautions (EBP) in nursing homes, including the high prevalence of multidrug-resistant organism (MDRO) colonization among residents in this setting. Expanded residents for …
Renewal of the Determination that a Public Health Emergency Exists Nationwide as the Result of the Continued Consequences of Coronavirus Disease 2019 (COVID-19) Pandemic COVID-19 National July 15, 2022
In many facilities, the wound nurse may not be doing weekly wound rounds because they are getting pulled to the floor, which can create a nerve-wracking situation for nurse assessment coordinators (NACs) trying to code …
Any staff members, including nurses or certified nursing assistants (CNAs), who document for section GG (Functional Abilities and Goals) need to be trained on how to observe the resident in those areas, says Scott Heichel, …
On June 29, 2022, the Centers for Medicare & Medicaid Services (CMS) released significant revisions to the State Operators Manual (SOM), which surveyors will use to identify noncompliance starting on Oct. 24, 2022. While revisions in several …
In this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of education and certification strategy for AAPACN, and Mark Cifarelli, PT, a physical therapist and director of clinical content development for Legacy …
Question: Are physician certifications required for Medicare Advantage patients? Answered by Karen Bernius, PT, RAC-CTA: There are no federal requirements, but you do need to check with the specific HMO/Medicare Advantage plan. We have found …
Question: We have a resident that is receiving hospice services who had a fall resulting in a fracture and the family has decided not to treat. The resident now has a decline in function, increased …
Question: A long-term care resident recently went out to the hospital and returned on a skilled Medicare Part A stay. I have a PPS 5-Day assessment scheduled with an ARD on day 8 of the …
The unified approach to case-mix adjustment includes standardized patient assessment data collected by the four PAC providers. Unified PAC Report to Congress (PDF) | Unified PAC Report to Congress Appendices (ZIP) Section 2(b)(2)(A) of the Improving Post-Acute …
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 …
Errata V3.00.8 for MDS V3.00.1 (FINAL) Data Submission Specifications Posted An updated errata for the MDS V3.00.1 (FINAL) Data Specifications is now available. Two issues have been added. Discharge performance Items in Section GG were …
CMS Proposes Physician Payment Rule to Expand Access to High-Quality Care On July 7, CMS issued the Calendar Year 2023 Physician Fee Schedule (PFS) proposed rule, which would significantly expand access to behavioral health services, …
CMS Issues Significant Updates to Improve the Safety and Quality Care for Long-Term Care Residents and Calls for Reducing Room Crowding June 29, 2022 As part of the Biden-Harris Administration’s initiative to promote the safety and quality …
Long Term Care Regulatory and Interpretive Guidance and Psychosocial Severity Guide Updates – June 2022 (LTCRIGPSG) Access here: https://qsep.cms.gov/pubs/CourseMenu.aspx?cid=0CMSLTCRegIG_PSG OR https://qsep.cms.gov/ProvidersAndOthers/publictraining.aspx Training Description This course consists of a series of presentations by the Division of …
If you’ve been a nurse assessment coordinator for some time now, you may be asking yourself, “Am I ready to take the RAC-CT certification?” To help answer that question, the experts at the American Association …
The CMS regulatory agenda for spring 2022 is available. Find the full agenda here, but three key upcoming rules are highlighted below: Reporting of Crimes Occurring in Federally Funded Long Term Care Facilities and Enforcement …
Jessie McGill, RN, RAC-MT, RAC-MTA and Alexis Roam, MSN, RN-BC, DNS-CT, QCP The annual rulemaking process enables stakeholders to comment on proposals that will affect skilled nursing facilities (SNFs) throughout the next year. In early …
Unlike the baseline care plan, the comprehensive care plan is largely MDS-based and analysis-driven, points out Mary Madison, RN, RAC-CT, CDP, a long-term care and senior living clinical consultant for Briggs Healthcare in Clive, IA. “It …
The Centers for Medicare & Medicaid Services (CMS) released the updated Version 2.6 Electronic Staffing Data Submission Payroll-Based Journal (PBJ) Long-Term Care Facility Policy Manual in June 2022. The update reinforces CMS’s message to validate …
The Centers for Medicare & Medicaid Services (CMS) proposed a new Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) measure that will potentially be included in FY 2025 program year. The Influenza Vaccination Coverage Among …
Question: A resident on Medicare Part A for skilled therapy could not participate with therapy for a few consecutive days because his Hemoglobin and Hematocrit were too low and he received blood transfusions. Will the …
Question: When a resident who elected hospice switches to a different hospice company, is a Significant Change in Status Assessment required? Answer from Janine Cortesa, RN: RAI User’s Manual, page 2-23: An SCSA is required …
Question: Can someone clarify the guidelines or protocol to use sepsis as the principal diagnosis in MDS? Answer from Jeff Taylor: This is what I follow from the blog post, “Conquer Coding for Sepsis and …
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 …
Complying with Outpatient Rehabilitation Therapy Documentation Requirements Fact Sheet ICN: MLN905365 Product Description: Learn how to correctly bill for outpatient Physical Therapy, Occupational Therapy, and Speech-Language Pathology services to avoid common billing errors when submitting claims to …
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 …
Physician certifications and recertifications are a technical requirement of payment (i.e., a condition of payment) under fee-for-service Medicare Part A. These certifications are needed to verify that a resident requires daily skilled care in a …
Question: Has the 3-day qualifying hospital stay waiver expired? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC: It has not. The 3-day qualifying hospital stay waiver is still ongoing; however, many other temporary waivers …
Question: I have a resident with an increase in confusion and a UA with C&S showing >=100,000 CFU/mL of Klebsiella. He has no other noted symptoms and advanced dementia, so he is unable to describe …
In this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of education and certification strategy for AAPACN, and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist for AAPACN, discuss some …
The coding instructions for MDS section I (Active Diagnoses) in the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual require that every diagnosis coded in this section be documented by a physician or a …
Question: I have two residents in my facility that admitted skilled on Medicare Part A and they have since both tested positive for COVID-19. My administrator would like to claim the isolation days and has …
When considering assessment reference date selection, do not forget that IV fluids given in the hospital within the 7-day look-back period “while not a resident” may impact the Special Care High nursing category. Unlike the …
The CASPER Reporting User’s Guide for MDS Providers provides information and instructions pertaining to the CASPER Reporting application. This system enables users to connect electronically to the National Reporting Database. This guide is intended for …
The last MDS item set update nurse assessment coordinators (NACs) had to prepare for was v1.17.1. When it went into effect Oct. 1, 2019, that version provided the changes needed to implement the Patient-Driven Payment …
The most common mistake that nurse assessment coordinators (NACs) and other MDS assessors make when coding malnutrition, at risk for malnutrition, or morbid obesity on the MDS is being unaware that a dietitian cannot diagnose …
When determining the primary diagnosis for a resident, the coder must consider the guidance set forth in the ICD-10-CM Official Guidelines for Coding and Reporting for each fiscal year. One area that may cause confusion …
In 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 for AAPACN, discuss the recently released …
Question: We have a referral for a resident with Medicare Part A who has been in an inpatient rehab facility (IRF) for six weeks. Is the IRF still considered acute and can qualify for the …
Question: A resident was Medicare Part A with a primary diagnosis of pneumonia. On day 15 of the stay, the resident was admitted to the hospital for five days for atrial fibrillation and hospital acquired …
Question: How many days can a Medicare Part A resident be out on a therapeutic leave and be able to come back to the facility without it being considered an End of Stay? Answered by …
Nurse assessment coordinators (NACs) have a vital role in any long-term and post-acute care facility. These nurses are the backbone of reimbursement, and they take charge of resident assessment and ensuring quality of care for …
Nurse assessment coordinators (NACs) often set assessment reference dates (ARDs), which determine the look-back periods for MDS assessments, using a fairly regimented schedule to establish consistency in the Resident Assessment Instrument (RAI) process. However, an …