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 …
The June 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 …
You can read the blanket waivers for COVID-19 in the List of Blanket Waivers (PDF) UPDATED (6/16/2022). From https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page
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 …
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 …
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 …
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 …
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 …
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 …
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 …
Five-Star, NHQI, SNF QRP, SNF VBP, and PBJ data Provider Information General information on currently active nursing homes, including number of certified beds, quality measure scores, staffing and other information used in the Five-Star Rating …
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 …
Editor’s note: This is the fifth and final article in a series on the Patient Driven Payment Model (PDPM) categories for the nursing component, covering various missteps to avoid in PDPM calculation, as well as …
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 July 2022 release. The …
Question: We have a resident with indwelling catheter due to urinary retention. The resident also has a history of traumatic intracranial hemorrhage. Am I able to code I1550 (Neurogenic Bladder)? Answer from Jeff Taylor: No, …
Question: We have a resident who admitted to our facility with a diagnosis of MRSA to a wound and is receiving oral antibiotics. The resident is in a single room by himself. Can I code …
Question: We have a patient coming to us that the hospital rehab documented they are not appropriate for skilled rehab and recommended home with PT/OT outpatient. However, the physician documented a skilled nursing need to …
If the BIMS interview is not completed, the PDPM Cognitive Level will be used to determine cognitive impairment under the SLP and Nursing components of PDPM. AAPACN has updated its Resident Cognitive Level Determination Tool to help nurse …
National Nurses Week begins next Friday, May 6. Throughout the week, the American Association of Post-Acute Care Nursing (AAPACN) will celebrate nurses and other healthcare professionals working in long-term and post-acute care (LTPAC). In today’s …
In this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, vice president of education and certification strategy for AAPACN talks with Jessie McGill, RN, RAC-MT, RAC-MTA and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum …
Last week, the AAPACN 2022 Conference was held in Las Vegas, bringing together nursing professionals for exceptional learning opportunities. One outstanding session occurred on Thursday, April 14, when representatives from the Centers for Medicare & …
The Centers for Medicare & Medicaid Services (CMS) have issued several blanket waivers and updates, as well as terminated selected waivers. AAPACN has developed the SNF COVID-The Centers for Medicare & Medicaid Services (CMS) have …
How can nurse assessment coordinators (NACs) lead the interdisciplinary team (IDT) to develop a workable plan to ensure that MDS section GG (Functional Abilities and Goals) is coded accurately per the coding guidelines in the …
AAPACN honors all LTPAC professionals, we continue to celebrate our roots with NAC Day, which is always the Tuesday of Nurses’ Week. In 2022 Nurses’ Week is May 6 – 12 and NAC Day is …
Question: My electronic software pulls in ADL documentation, but when I do a final refresh, the ADLs that pull in are inaccurate. Now I must manually verify every ADL. Is there a way to fix …
Question: The nursing note states a resident has intermittent shortness of breath with coughing. How would this be coded on the MDS? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: I would …
Question: I have a new resident who fell and broke her hip on the eighth day after admission. The Admission MDS was not completed. She has been discharged to the hospital for surgical repair and …
With the release of the Fiscal Year (FY) 2023 Skilled Nursing Facility Prospective Payment System (SNF PPS) proposed rule, the Centers for Medicare & Medicaid Services (CMS) has signaled a significant commitment to pay-for-performance via …
While the COVID-19 public health emergency (PHE) put the brakes on many nursing home initiatives over the past two years, the Centers for Medicare & Medicaid Services (CMS) is ready to get back to business …
Thousands of dedicated women and men working in post-acute and long-term care dream of the chance to learn more, do more, be more. By funding nursing scholarships, the AAPACN Education Foundation helps to make those …
An updated version of the Skilled Nursing Facility (SNF) Provider Threshold Report (PTR) is now available. The PTR is a user-requested, on demand report which enables users to obtain the status of their data submission …
Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Quality Reporting Program and Value-Based Purchasing Program; Long-Term Care Facilities to Establish Mandatory Minimum Staffing Levels https://www.federalregister.gov/public-inspection/2022-07906/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities Press release:HHS Takes Actions to Promote …
The LTCSP Procedure Guide provides instruction on the procedural and software steps necessary for completing the LTCSP. Use the Procedure Guide for all standard surveys of SNFs and NFs, whether freestanding, distinct parts, or dually …
The Centers for Medicare & Medicaid Services (CMS) is taking steps to continue to protect nursing home residents’ health and safety by announcing guidance that restores certain minimum standards for compliance with CMS requirements. Restoring …
The Q4FY21 release of the Skilled Nursing Facility (SNF) Program for Evaluating Payment Patterns Electronic Report (PEPPER) with statistics through September 2021 is now available for download through the PEPPER Resources Portal. To obtain your SNF PEPPER, the Chief Executive Officer, President, Administrator, …
Nursing homes play a unique dual role in the long-term care continuum, serving as a place where people receive needed health care and a place they call home. Ineffective responses to the complex challenges of …
Revised Guidance for the Interim Final Rule -Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination — The guidance in this memorandum does not apply to the following states at this time: Alabama, Alaska, …
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 …
Even with the implementation of other quality programs over the past few years, the Nursing Home Quality Initiative (NHQI) quality measures (QMs) remain the core public-facing quality thermometer of long-term care. Taking the time to …
When it comes to the MDS and hospice, there are several rules the nurse assessment coordinator (NAC) must be aware of, especially with the requirements of the Significant Change in Status Assessment (SCSA). While many …
Nursing home staff will see two major changes to Care Compare with the April 2022 refresh: Public reporting of the SNF Healthcare Associated Infection (HAI) Requiring Hospitalization In the FY 2022 SNF PPS Final Rule, …
Question: We have a resident who is currently on Medicare Part A receiving skilled services for rehabilitation. His family would like to take him out for a leave of absence (LOA) from Thursday morning to …
Question: If a resident is receiving a full liquid diet due to a recent surgical procedure, is it considered a mechanically altered diet? Answer from Debbie Kohn : According to the RAI User’s Manual (p. K-11), …
Question: When a resident is status-post surgery, would that be enough criteria to quality for skilled services? Answer from Jeff Taylor: It really depends on the resident’s condition and what services/cares they need. If the resident …
An updated Quick Reference Guide is now available. The Quick Reference Guide provides high-level information on the SNF Quality Reporting Program, including frequently asked questions and helpful links. V2.0 was posted in early March. It …
CMS has updated the following document: Definition and Uses of HIPPS Codes (Updated 04/01/2022) (PDF) From https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/HIPPSCodes
MDS 3.0 v.1.17.2 has been in place since Oct. 1, 2020, and CMS wants it to run to Oct. 1, 2023, which presumably means for all of FY 2024. That could put the implementation of …
The Medicare Payment Advisory Commission (MedPAC) has released its March 2022 Report to the Congress: Medicare Payment Policy. The report includes MedPAC’s analyses of payment adequacy in traditional fee-for-service (FFS) Medicare and reviews the status of Medicare …
Editor’s note: This is the fourth article in a series on the PDPM categories for the nursing component, covering various missteps to avoid in PDPM calculation, as well as essential coding tips. Part one focused …
A nurse assessment coordinator (NAC) needs an ICD-10-CM diagnosis code for MDS section I (Active Diagnoses) or a Medicare claim. They enter the physician-documented, active diagnosis into a software tool or online lookup tool and …
CMS recently posted a one-page document that provides links to important Payroll-Based Journaling (PBJ) action items, including how to complete registration for staff, corporate, and third-party users, as well as data submission trainings and resources. …
Using social determinants of health (SDOH) when developing a resident’s discharge plan can help identify and address potential risks that could adversely affect the resident’s ability to safely discharge back to the community. AAPACN’s Social …
In this podcast, Amy Stewart, vice president of education and certification strategy for AAPACN, and Carol Maher, director of education for Hansen, Hunter & Co., discuss ICD-10 diagnosis coding for skilled nursing facilities.
Question: When a resident was sent to the emergency department (ED) and then later admitted to the hospital, can we code any new diagnoses the resident received in the ED on the discharge assessment? For …
Question: Can the three words used in the BIMS interview (sock, blue, and bed) be changed? Can other words be used like shirt, red, and chair? Half of our team say it must be those …
Question: We just found that we missed some discharge assessments from two years ago. Can these assessments still be completed and submitted? Answer from Carol Maher, RN-BC, CPC, RAC-MT: Any missed discharge assessments should be …
Nursing Home Visitation – COVID-19 (REVISED) Memo # QSO-20-39-NH REVISED Posting Date 2021-11-12 REVISED MARCH 10, 2022 Fiscal Year 2021 Memorandum Summary • CMS is committed to continuing to take critical steps to ensure America’s …
Registration and data submission resources. PBJ QTSO Registration and Training 02-24-2022 (PDF) From https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ
AAPACN’s in-person conference is back and is just around the corner! The AAPACN 2022 Conference will be held this year in Las Vegas, NV on April 12 – 14, and will be a chance for …
Social determinants of health (SDOH) are items most long-term care professionals are familiar with, but they may not immediately recognize how the determinants affect their job. According to the Office of Disease Prevention and Health …
Medicare Advantage (MA) plans, the most common type of Medicare managed care organizations, are an attractive option for healthy Medicare beneficiaries in the community because they often provide a range of supplemental benefits that aren’t …
The Advisory Committee on Immunization Practices (ACIP) released an updated immunization schedule for adults aged 19 years or older. Nurse assessment coordinators (NACs) need to utilize this updated schedule when coding O0300 Pneumococcal Vaccine data. …
Question: What are the criteria to code Malnutrition? Answer from Jeff Taylor: For I5600, I would answer yes if a physician/NP/PA wrote “malnutrition,” “at risk for malnutrition,” or some other diagnostic statement (i.e., marasmus or …
Question: If a resident is discharged before their planned Medicare discharge date, do I open an OBRA Discharge return not anticipated (DCRNA) or do I open a Part A PPS Discharge for a new end …
Question: My software does not allow us to code two digits in the venous/arterial ulcer section on the MDS. How do we code if a resident has more than nine ulcers? Answer from Carol Maher, …
FACT SHEET: Protecting Seniors and People with Disabilities by Improving Safety and Quality of Care in the Nation’s Nursing Homes FEBRUARY 28, 2022 All people deserve to be treated with dignity and respect and to have …
The Skilled Nursing Facility (SNF) PPS Web Pricer is now available for Fiscal Years (FYs) 2020 through 2022. The new SNF Web Pricer can be accessed via the following link: https://webpricer.cms.gov/#/pricer/snf. For the best user experience, …
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 …
Editor’s note: This is the third article in a series on the PDPM categories for the nursing component, covering various missteps to avoid in PDPM calculation, as well as essential coding tips. Part one focused …
The nurse assessment coordinator (NAC) is still commonly stereotyped as a paper pusher or desk nurse in some sectors of long-term care, but the Patient-Driven Payment Model (PDPM) in the Skilled Nursing Facility Prospective Payment …
Early-bird registration is open for the 2022 AAPACN Conference in Las Vegas when registration is completed before March 20. Standard registration rates apply between March 21 – April 4, 2022. More information is available regarding …
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 Joel VanEaton, BSN, RN, RAC-CT, RAC-CTA, executive vice president of PAC regulatory affairs and …
Question: Some members of my PDPM team feel that the diagnosis R27.8 “Other lack of coordination” should be used as the primary diagnosis. What kind of documentation would you need to be able to use …
