June’s Alzheimer’s & Brain Awareness Month serves as a powerful reminder of the growing impact of cognitive disorders in long-term care (LTC) settings, where many residents live with complex dementia-related needs. Interdisciplinary teams care for …
The ability to identify and act upon potential or actual clinically significant medication issues drives the coding of N2001 (Drug Regimen Review) and its companion item N2003 (Medication Follow-Up) on the PPS 5-Day MDS, as …
Question: Can IV chemotherapy be excluded from consolidated billing during a Part A stay? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC: Exclusion for chemotherapy is based on the Healthcare Common Procedure Coding System …
Question: I have always thought that delivery of the SNF ABN (CMS – 10055) notice offers the Medicare recipient the opportunity to pay for the Medicare Part A services being cut. I was told the …
Question: If a resident revokes hospice services, does the ARD need to be scheduled to avoid coding hospice in O0110K? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: The Significant Change in Status Assessment …
The Centers for Medicare & Medicaid Services (CMS) has released a one-page resource to help providers determine when an OBRA Discharge assessment is required under the MDS 3.0 RAI User’s Manual. The fact sheet outlines …
The Dementia Physician Query tool supports accurate clinical documentation by helping providers clarify the type, severity, and associated manifestations of a resident’s dementia diagnosis using information documented in the medical record. The tool also allows …
The October 1, 2026 diagnosis code update files are now available. Use these files for discharges occurring from October 1, 2026 – September 30, 2027 and for patient encounters occurring from October 1, 2026 – …
The Centers for Medicare & Medicaid Services (CMS) is offering a one-page resource that clarifies when an OBRA Discharge assessment is required under the MDS 3.0 RAI User’s Manual (Chapter 2). This resource outlines the primary discharge …
The June 2026 Quarterly Confidential Feedback Reports for the FY 2027 SNF VBP Program are now available for download via the Internet Quality Improvement and Evaluation System (iQIES). These reports provide SNFs their facility-level measure results …
From https://www.cms.gov/medicare/quality/nursing-home-improvement/value-based-purchasing From https://www.cms.gov/medicare/quality/nursing-home-improvement/value-based-purchasing/scoring-methodology-payment-adjustment
The June 2026 Quarterly Confidential Feedback Reports for the FY 2027 SNF VBP Program are now available for download via the Internet Quality Improvement and Evaluation System (iQIES). These reports provide SNFs their facility-level measure results …
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, CRC, curriculum development specialist with AAPACN, discuss getting to …
Listen to this article Your browser does not support the audio element. In the complex world of Minimum Data Set (MDS) assessment scheduling, discharge scenarios can often confuse even experienced interdisciplinary team (IDT) members. When …
Listen to this article Your browser does not support the audio element. Each year, the Centers for Medicare & Medicaid Services (CMS) releases a proposed Skilled Nursing Facility Prospective Payment System (SNF PPS) rule, outlining …
AAPACN’s ADR Help: HIPPS Code Analyzer interactive tool helps identify the documentation elements that may have contributed to the HIPPS code assigned to an assessment selected for Additional Documentation Request (ADR) review. Designed to support …
The Centers for Disease Control & Prevention (CDC) updated its Clinical Guidance for C. diff Infection Prevention in Acute Care Facilities on May 13, 2026. The guidance emphasizes rapid isolation and contact precautions for residents …
Question: Please clarify when resident interviews need to be completed for the MDS? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: All resident interviews, including the Customary Routine/Activities, BIMS, PHQ-2 to 9, …
Question: Do I need to complete discharge assessments for an emergency evacuation? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: You may not be required to complete the discharge MDS in this situation. Here …
Question: What are the correct dates for flu season and pneumonia vaccines for MDS purposes to count if present during that time? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: The influenza vaccine question …
From MLN Connects eNews: CMS will relaunch the Program for Evaluating Payment Patterns Electronic Report (PEPPER) in the coming months for all Medicare facility types, including hospitals, post-acute care providers, and specialty facilities. PEPPER is …
The Centers for Disease Control and Prevention (CDC) has updated the “Staying Up to Date with COVID-19 Vaccines” guidance several times since requiring COVID-19 vaccinations to be coded on the MDS as of October 2024. …
Starting Oct. 1, 2024, additional supporting documentation is required to capture a diagnosis of sepsis at I2100, Septicemia on the MDS. Nurse assessment coordinators can use the AAPACN Sepsis: Nurse Documentation Training Aid to provide …
Listen to this article Your browser does not support the audio element. The OBRA Significant Correction to Prior Assessment (SCPA), which includes the Significant Correction to Prior Quarterly Assessment and the Significant Correction to Prior …
Listen to this article Your browser does not support the audio element. As summer approaches, many people begin thinking about health goals, wellness check-ins, and how to prepare for more outdoor activities in the warmer …
The Centers for Medicare & Medicaid Services (CMS) previously announced in March that the updated Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, was now available, but extended implementation to no later than May 12, …
The AAPACN ICD-10-CM Coding Decision Tool: Obesity and BMI Reporting helps long-term care staff accurately determine when BMI and obesity-related ICD-10-CM codes can be reported while ensuring compliance with provider documentation requirements. This tool guides …
In this LTC NAC Chat podcast episode, Jennifer LaBay, RN, RAC-MT, RAC-MTA, CRC, curriculum development specialist for AAPACN, and Jessie McGill, RN, BSN, RAC-MT, RAC-MTA, sr. curriculum development specialist for AAPACN, share clarifications from the …
Question: I need clarification regarding the CAA notes: I was understanding that anything that triggers we would address in the care plan. Do we have to address every single CAA note even if it does …
Question: During our annual survey, I was questioned about coding methenamine as an antibiotic on the MDS. I had coded it based on information received from AAPACN and references discussed in this forum. The surveyor …
Question: Is a signed diagnosis list enough to support coding diagnoses in section I, or does the physician need to document the diagnosis as active in their notes? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, …
Listen to this article Your browser does not support the audio element. In the Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS) and Consolidated Billing Proposed Rule for Fiscal Year (FY) 2027, officially published …
Listen to this article Your browser does not support the audio element. In September 2025, the Office of Inspector General (OIG) rang the alarm bell on MDS coding inaccuracies involving falls with major injury, and …
Orientation for a new nurse assessment coordinator (NAC) is a very complex and long process. It is important to establish a realistic schedule that will allow for effective learning but will not be overwhelming. AAPACN’s …
The deadline to submit healthcare personnel (HCP) influenza vaccination data in the Centers for Disease Control & Prevention’s (CDC) National Healthcare Safety Network (NHSN) system is May 18, 2026. This reporting is required for the …
Listen to this article Your browser does not support the audio element. The Skilled Nursing Facility (SNF) Quality Reporting Program (QRP), often regarded as merely an exercise in reporting compliance, also has direct payment implications. …
Listen 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 …
Written by Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, Chief Nursing Officer, AAPACN Lessons from My Backyard: Thrive. Evolve. Lead. As the Chief Nursing Officer at AAPACN, I spend much of my time thinking …
In this LTC NAC Chat podcast episode, Amy Stewart, chief nursing officer for AAPACN, Jessie McGill, senior curriculum development specialist, and Jennifer LaBay, curriculum development specialist for AAPACN, discuss celebrating yourself on NAC Day, raising …
The deadline to submit healthcare personnel (HCP) influenza vaccination data in the Centers for Disease Control & Prevention’s (CDC) National Healthcare Safety Network (NHSN) system is May 18, 2026. This reporting is required for the …
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 …
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, …
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 …
Overview 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) …
Current Submission RequirementsAs of April 1, 2026, fileSpecVersion 4.10.0 is REQUIRED for all Payroll Based Journal (PBJ) file submissions. Old versions (2.00.0, 2.00.3, and 4.00.0) are no longer accepted. Any files submitted using these versions …
The AAPACN Podcasts—LTC DON Chat and LTC NAC Chat—offer tips, strategies, updates, advice, and breaking news on the most important topics in long-term and post-acute care. Regular hosts and AAPACN staff members provide their own …
The 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 …
Listen 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 …
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 …
Listen to this article Your browser does not support the audio element. In the Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS) and Consolidated Billing Proposed Rule for Fiscal Year (FY) 2027, officially published …
The Centers for Medicare & Medicaid Services (CMS) recently released the fiscal year (FY) 2027 SNF PPS Proposed Rule. Stakeholders have until June 1, 2026, to submit comments on the proposals. The following is a …
This 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 …
Question: A resident admitted after hospitalization is completing therapy but developed an unstageable pressure ulcer during the SNF stay. Can Medicare Part A continue for skilled nursing, even though the condition was not part of …
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 …
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, …
From 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
In 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 …
More than 15,000 nursing professionals working in long-term care take AAPACN education online courses each year. One of the common questions AAPACN receives from new students is, “How can I access my Learner Dashboard?” The …
Prospective 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 …
Listen to this article Your browser does not support the audio element. Under the Skilled Nursing Facility Quality Reporting Program (SNF QRP), SNFs must meet an annual 90 percent MDS submission threshold to help avoid …
Listen to this article Your browser does not support the audio element. Seasonal celebrations often remind us how quickly small choices can add up. A little handful of candy or a few fruit jelly slices …
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, …
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 …
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 …
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 Long-Stay Antipsychotic Measure: Data Source and Look-Back Guide can be used by interdisciplinary teams to simplify the complex data sources and timeframes used in this measure. The tool clearly outlines numerator criteria and key …
The Centers for Medicare & Medicaid Services (CMS) released an errata document for the MDS 3.0 QM User’s Manual, changing guidance regarding public reporting of the new long stay (LS) antipsychotic measure. CMS removed the …
The 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 …
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: March 1, 2026 Released: March …
A discharge planning tool to help educate residents and/or representatives about ongoing health and medication needs and follow-up care post-discharge. Nursing Facility Discharge Planning Tool
Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide Prevention Recommendations The International Guideline Fourth edition Updated 25 February 2026 https://static1.squarespace.com/static/6479484083027f25a6246fcb/t/699ba2b43f12157598b99c71/1771807412881/QRG-abridged-25Feb2026.pdf or https://www.internationalguideline.com/the-international-guideline
Listen to this article Your browser does not support the audio element. Once uncommon outside of hospitals and outpatient surgery centers, intravenous (IV) hydration has gone mainstream. Average Americans often seek IV hydration through hydration …
Listen to this article Your browser does not support the audio element. When a long-stay resident loses the ability to walk independently, it is rarely just a functional decline. It is often the early signal …
The Centers for Medicare & Medicaid Services (CMS) has released the updated Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131. The notice had expired in January 2026, but CMS instructed facilities to continue issuing the …
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 …
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 …
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 …
The Centers for Medicare & Medicaid Services (CMS), on behalf of the U.S. Department of Health and Human Services (HHS), is making our shareholders aware of the “Adoption of Standards for Health Care Claims Attachments …
The Office of Management and Budget (OMB) has approved the control number for the Advance Beneficiary Notice of Non-coverage (ABN) (CMS-R-131). CMS is notifying the industry through our website, and the Medicare Learning Network and …
Report 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 …
This 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
Free access 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines This guideline retires and replaces the 2018 Guideline on the …
New ASN Kidney Health Guidance on Conservative Management in People with Kidney Failure and Executive Summary now available. Press release Newswise — Washington, DC (March 18, 2026) —The American Society of Nephrology (ASN) today released its latest Kidney Health …
Overview This job aid provides the steps involved to onboard the Provider Security Official (PSO) Role in iQIES. ● For detailed information on onboarding, refer to iQIES Onboarding Guide. ● For detailed information about user …
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) …
CMS hosted an PBJ Technical informational Call for Software Vendors and Developers on Thursday, February 26, 2026. Please see the attached minutes. Downloads PBJ Tech Call Minutes 02/26/2026 https://qtso.cms.gov/news-and-updates/pbj-technical-information-call-minutes-qas-february-26-2026
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 v5.0 (posted 03/03/2026) From https://qtso.cms.gov/software/iqies/reference-manuals
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, …
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 …
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, …
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 Janine Lehmen, director of clinical and legal nursing consulting with Proactive LTC Consulting, discuss …
Consistency 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 …
Start your AAPACN 2026 Conference experience now—download the free AAPACN Conference app! It’s your one-stop hub for everything you need, from selecting sessions to accessing handouts. Plan ahead by selecting the sessions that matter most …
Listen 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 …
Listen to this article Your browser does not support the audio element. The watchword that increasingly defines federal (and some state) programs that drive nursing home operations and payment is connectedness, says Scott Heichel, RN, …
The January 2026 Care Compare refresh was originally scheduled for Jan. 28, 2026, but was delayed due to an issue with one of the data sets until Feb. 5, 2026. This refresh also brought updated …
Listen 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, …
Listen 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 …
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, sr. curriculum development specialist for AAPACN, continue the question …
