CMS provides a current list of F-tags by regulatory grouping used in the Long-term Care Survey Process (LTCSP) CMS updated the tag list on June 19, 2021. List of Revised FTags [Effective 06/19/2021] (PDF) From …
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 into …
Jessie McGill, RN, RAC-MT, RAC-MTA Every spring, the Centers for Medicare & Medicaid Services (CMS) releases the notice of proposed rulemaking (NPRM) for the next fiscal year’s (FY’s) payment policies and rates. This provides an …
The COVID-19 pandemic is quite diminished but still a concern in some nursing homes due in part to SARS-CoV-2 variants, as well as unvaccinated staff. With the public health emergency worsening the already significant staffing …
On June 3, 2021, CMS announced that Medicare Administrative Contractors (MACs) may now begin conducting post-payment medical reviews for dates of service after March 2020. Early in the COVID-19 public health emergency (PHE), CMS held …
Recently, CMS resumed medical reviews for Medicare claims for dates of service after March 2020; however, it may be difficult for facility staff to audit COVID-19-related diagnoses due to how frequently guidance was updated from …
Question: If an OBRA or PPS assessment is completed late but the ARD was set timely in the appropriate window, is there a financial penalty or is it just a possible survey tag? Answer from …
Question: Is a physician order needed for a restorative passive range of motion (PROM) program? Answer from Kim Steele, RN, WCC, RAC-CT, RAC-CTA: No, a physician order is not required for nursing restorative programs, but …
Question: A resident on Medicare Part A admitted to the facility from the hospital on 5/26. He was sent to the emergency department (ED) on 5/27 and remained there on observation until 5/29. He readmitted …
Most recent updates: June 9, 2021 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 …
Understanding the technical and skilled level care requirements for Medicare A is always a challenge. We’ve broken down the process with our Skilled or Not? tool . This tool was originally published in April 2017. It has …
Meet four rising stars in long-term and post-acute care – the AAPACN Education Foundation 2021 Scholarship recipients. The AAPACN Education Foundation positively impacts the lives of 1.4 million people living in nursing homes by providing …
The 2021 National Impact Assessment of CMS Quality Measures Report (2021 Impact Assessment Report) has been posted on the CMS website. CMS assesses the quality and efficiency impact of endorsed measures every three years. The …
MACs Resume Medical Review on a Post-payment Basis: Beginning August 2020, Medicare Administrative Contractors (MACs) resumed post-payment reviews of items and services with dates of service before March 2020. MACs may now begin conducting post-payment …
On June 30, 2021, Jane Belt, MS, RN, RAC-MT, RAC-MTA, curriculum development specialist for AAPACN, will be retiring. While we are sad to see Jane leave AAPACN and she will surely be missed, she won’t …
On June 1, AAPACN sent out the 2021 Work Study survey link—this survey will collect valuable information from both the nurse assessment coordinator (NAC) and director of nursing services (DNS) on wage, job satisfaction, and job …
by Carol Maher, RN-BC, RAC-MTA, RAC-MT, CPC ICD-10-CM coding is not a skill nursing school conveys to students, yet it is one that nurse assessment coordinators (NACs) must acquire to perform their diagnosis coding duties …
The care area assessment (CAA) process sometimes mistakenly gets lumped under the “required but not critical to resident care” label of regulatory paperwork. While working the CAAs is indeed a mandatory step in the Resident …
Question: A resident admitted for skilled care under a Medicare Advantage (MA) plan. The plan did not require a 3-day qualifying hospital stay (QHS) and the resident was hospitalized for observation only. The resident has …
Question: We had a resident come in with a leg fracture four months ago. At that time, he required extensive assist. He worked with therapy and became independent in functional activities by the end of …
Question: What training is required for nurse aides to work with residents in a Restorative Program? I have reviewed Chapter 3, Section O0500 (page O-43) in the RAI User’s Manual but wondered, other than the …
The following data sets were updated May 1 and released May 26 at https://data.cms.gov/provider-data/search?theme=Nursing%20homes%20including%20rehab%20services: FY 2021 SNF VBP Facility-Level Dataset This dataset contains facility-specific performance information for the fiscal year (FY) 2021 Skilled Nursing Facility …
List of Blanket Waivers (PDF) UPDATED (5/24/2021). Note from AAPACN staff: CMS unintentionally removed the update that made the SNF/NF section consistent with the May 10 QSO memo expirations (https://www.cms.gov/files/document/qso-21-17-nh.pdf). Please see the May 10 …
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 (5/24/21) Medicare Monoclonal Antibody COVID-19 Infusion Program Instruction (PDF) (4/16/21) Frequently …
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-19 Related Waivers At-a-Glance tool to help nurse assessment …
The May 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 [i.e., regional office] contacts. To ensure accurate formatting, use …
The Five Star Preview Reports will be available on May 18, 2021. To access these reports, select the CASPER Reporting link located on the CMS QIES Systems for Providers page. Once in the CASPER Reporting …
By Liz Barlow, RN, CRRN, RAC-CT, DNS-CT With the onset of the COVID-19 public health emergency (PHE), skilled nursing facilities (SNFs) have been focused on infection control, staffing, and heightened patient care. But as facilities …
As a group, the bowel MDS items H0400 (Bowel Continence), H0500 (Bowel Toileting Program), and H0600 (Bowel Patterns) impact nursing homes on multiple levels, including the following: The Nursing Home Quality Initiative Quality Measures (NHQI …
Question: A patient admitted under Original Medicare Part A. Within a couple of hours, his family decided to take him home. What assessments are needed? Answer from Carol Maher, RN-BC, CPC, RAC-MT: Since the resident …
Question: A resident returned following a hip fracture from a fall. Would his primary diagnosis be the S-code for the fracture, or the Z-code for aftercare? Answer from Jennifer LaBay RN, RAC-MT, RAC- MTA, CRC: …
Question: Is metabolic acidosis a skilled diagnosis? Answer from Kim Steele, RN, WCC, RAC-CT, RAC-CTA: While a resident can be skilled for this, it is critical that you have the details of why it is …
On May 11, 2021, CMS released an Interim Final Rule with Comment Period (IFC), [CMS-3414-IFC], which includes new requirements for educating residents or resident representatives and staff regarding the benefits and potential side effects associated …
By CMS Transmittal # R10770OTN Issue Date 2021-05-11 Subject October Quarterly Update to 2021 Annual Update of HCPCS Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement Implementation Date 2021-10-04 CR # 12272 …
In celebration of Nurses Week 2021, the American Association of Post-Acute Care Nursing (AAPACN) Leading In Care Blog will recognize an AAPACN 2021 Award winner each week in May. Winners were honored at the AAPACN …
By CMS The Centers for Medicare & Medicaid Services (CMS) is offering web-based training that provides an overview of the general and key clinical considerations important for conducting standardized cognitive and mood assessments. This four-course …
By the OIG Report OEI-07-19-00490 The Office of Inspector General (OIG) found that the Centers for Medicare and Medicaid’s (CMS’s) use of the Minimum Data Set (MDS) as the sole data source to count the …
The past year has brought a multitude of changes for everyone, but especially those in nursing homes. While the public health emergency (PHE) situation continues to evolve, the Centers for Medicare & Medicaid Services (CMS) …
We have all struggled with a stubborn knot or tangle at some point in our lives—whether it’s your kids’ shoelaces, your earbud cord, a garden hose, or even a fishing line. If you are a …
Traditional fee-for-service Medicare Part A is a national program with a core set of program guidance from the Centers for Medicare & Medicaid Services (CMS) in the Internet-Only Manuals and the Long-Term Care Facility Resident …
On April 27, 2021, CMS issued revised guidance for visitation in nursing homes during the COVID-19 public health emergency, which includes the impact of COVID-19 vaccination. For more details, see the revised QSO-20-39-NH. For permission to …
Question: We have a resident that has an order for Seroquel for Alzheimer’s disease with psychotic features as manifested by episodes of hallucination of seeing deceased relatives in their room. Can we use ICD-10 codes …
Question: If a resident is enrolled hospice, can they still receive therapy under Part B? If so, what is the process to do this? Does the hospice agency need to approve it or does the …
Question: Does a wound vac count as a daily treatment to the wound? Answer from Janine Cortesa, RN, BSN: Typically, the wound vac does not require daily changing and is therefore not a daily skilled …
Question: How do you access 2021 AAPACN Conference sessions you wanted to see but may have missed? Answer: Members who registered for the 2021 AAPACN Conference but were unable to view a session live can …
By Liz Barlow, RN, CRRN, RAC-CT, DNS-CT – April 20, 2021 The federal government focuses intently on preventing fraud, waste, and abuse within the Medicare system. As a part of those efforts, the Program for Evaluating Payment …
MDS item O0100 (Special Treatments, Procedures, and Programs) has 12 sections with two columns (24 total subitems) that identify specific services the resident received either while not a resident (column 1) or while a resident (column …
A question that comes up often lately for nurse assessment coordinators (NACs) is, “Should I do an IPA?” The assessment is optional, which can also make deciding when to complete one a challenge. Depending on …
On Thursday April 8, 2021, CMS issued the QSO-21-17-NH announcing the end of the following three blanket waivers: 1. The emergency blanket waivers related to notification of Resident Room or Roommate changes, and Transfer and Discharge notification …
Question: Can a Medicare Part A resident be skilled for an unstageable pressure injury? Answer from Janine Cortesa, RN, BSN, RAC-CT: You must always look at what skill services are needed, not the name of the condition. An …
Question: If a resident is considered skilled using the three-day qualifying stay and the waiver ends during their skilled stay, does the skilled stay need to end as well? Answer from Jessie McGill RN, RAC-MT, RAC-MTA: The …
Question: In gathering information for a 5-Day MDS, I noted that the patient had a drug-to-drug interaction. This was not identified on the initial medication review. In answering N2001, should I say “No” since this was not …
On April 8, the Centers for Medicare & Medicaid Services (CMS) released for public inspection the Fiscal Year (FY) 2022 Proposed Rule for the Skilled Nursing Facility Prospective Payment System (SNF PPS) and Consolidated Billing, …
The AAPACN 2021 Conference will be held virtually April 14-15, and 21-22. The conference is an excellent time to refresh, refocus, and renew your enthusiasm and dedication for your nurse assessment coordinator (NAC) role and …
Although the Centers for Medicare & Medicaid Services’ (CMS) beneficiary notices have been part of Medicare regulations for a long time, they can still be cited during any survey. Lengthy discussions in the AANAConnect LTC …
Observation and assessment of a resident’s condition is a skilled service under Medicare Part A that many nurse assessment coordinators (NACs) and Medicare case managers hesitate to use because it’s not a direct skilled nursing …
On March 30, 2021, the Centers for Medicare & Medicaid Services (CMS) provided a 90-minute webinar on best practices to achieve a full annual payment update (APU). This training covered CMS quality goals, Skilled Nursing …
Question: What happens to residents who started skilled services using a waiver and then the COVID-19 public health emergency (PHE) and waivers end? Answer: CMS addressed this in the PPS COVID FAQ doc, page …
Question: Do we have to gather three full days of GG data when scheduling an interim payment assessment (IPA)? Answer: You have a 3-day window (ARD and the prior 2 days) to determine the Interim …
Question: If a Medicare Part A resident expires prior to the completion deadline for an assessment, the RAI User’s Manual states that the assessment is not required, but should you still complete the 5-Day assessment …
Summary of Recent Changes Updates as of March 29, 2021 Two prior guidance documents, “Responding to COVID-19 in Nursing Homes” and “Performing Facility-wide SARS-CoV-2 Testing in Nursing Homes” were merged with this guidance. The criteria …
Two new resources from AHRQ are part of the agency’s ongoing efforts to protect nursing home residents and staff from COVID-19. Both are intended to support the use of observational audits, which help facilities understand …
NEW TRAINING AVAILABLE – Resident Mood Interview (PHQ-9) for the Skilled Nursing Facility (SNF) Setting Video Tutorial CMS Resident Mood Interview (PHQ-9) for the SNF Setting Video Tutorial The Centers for Medicare & Medicaid Services …
Memo # QSO-21-15-ALL Posting Date 2021-03-26 Fiscal Year 2021 Summary Burden Reduction Final Rule Interpretive Guidelines: The Centers for Medicare & Medicaid Services (CMS) is releasing interpretive guidelines and updates to Appendix Z of the …
Attention QIES Users: CMS is in compliance with disposition authority N1-440-09-03 and only retains assessment and supporting data that is less than 10 years old in the QIES National database. Therefore, assessment-based quality measures generated in …
ASPR TRACIE (part of the US Department of Health and Human Services) received a request for information on clinical presentation, disease progression, and related information from clinicians in the field treating COVID-19 patients after the …
The FDA posted a new web page SARS-CoV-2 Viral Mutations: Impact on COVID-19 Tests for clinical laboratory staff and health care providers about the impact of viral mutations on COVID-19 molecular, antigen, and serology tests. This web …
Interim Estimates of Vaccine Effectiveness of BNT162b2 and mRNA-1273 COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential and Frontline Workers — Eight U.S. Locations, December 2020–March 2021 …
https://www.cms.gov/how-update-nursing-home-nhskilled-nursing-facility-snf-demographic-data SNF Quality Reporting Program (QRP) quality data on Care Compare are updated on a quarterly basis. The Centers for Medicare & Medicaid Services (CMS) will be transitioning to a new data source for providers’ demographic data for all five …
Transmittal 10678, dated March 16, 2021, is being rescinded and replaced by Transmittal 10693, dated, March 25, 2021 to remove business requirement 12212.2, to modify business requirement 12212.3 to remove the reference to any action …
Guidance released March 10, 2021 regarding Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination | CDC affects only select elements of the current Nursing Home ICAR tool until an updated version of the …
Note from staff: This lawsuit, brought by the now director of the U.S. Department of Health and Human Services, not only alleges problems with the discharge process, it alleges that SNFs submitted false data to …
The Patient-Driven Payment Model (PDPM) uses 161 MDS items to establish the five case-mix adjusted components. Some of these 161 items will have supporting documentation easily found in the medical record, but other items may …
MDS item M1200 (Skin and Ulcer/Injury Treatments) in section M (Skin Conditions) can impact payment under the Patient-Driven Payment Model (PDPM) in the Medicare Part A skilled nursing facility prospective payment system (SNF PPS), as …
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 …
On March 10, the Centers for Medicare & Medicaid Services (CMS) issued updated guidance for nursing homes to safely expand visitation options. According to the updated guidance, issued in collaboration with the Centers for Disease …
Question: A therapy director is instructing the therapists to add minutes under section O for donning and doffing of PPE. He is using section O of the RAI User’s Manual listed below to justify this …
Question: During an interview with a resident who has cognitive impairment, she claims that she has no pain, but the MAR shows use of PRN pain medication daily. Should I still code “no pain” on …
Question: In our facility, therapists record function scores within the first 3 days after admission. How are other facilities gathering admission function scores for section GG when the observation period is the ARD plus two previous …
REGISTRATION OPEN – SNF QRP: Achieving a Full APU The Centers for Medicare & Medicaid Services (CMS) will host a webinar on Tuesday, March 30, 2021, from 1:00 p.m. to 2:30 p.m. ET to educate …
Note: The Access to Ombudsman information is highlighted in red in the memo, but that is what was revised in July. The new updates focus on the updated Q&As under the section, Individuals Entering and …
The Medicare Payment Advisory Commission (MedPAC) releases its March 2021 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 Advantage …
Updated Mar. 10, 2021 Find the most recent update here: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-after-vaccination.html CDC guidance for SARS-CoV-2 infection may be adapted by state and local health departments to respond to rapidly changing local circumstances. On this page Visitation …
NOTE: CMS revised guidance on March 10, 2021 for nursing home visitation during the COVID-19 Public Health Emergency, which supersedes the visitation guidance in this memo. See CMS memorandum QSO-20-39-NH Revised, Nursing Home Visitation-COVID-19. ————————————————————————————————- …
Mar 10, 2021 Nursing homes have been severely impacted by COVID-19, with outbreaks causing high rates of infection, morbidity, and mortality.[1] The vulnerable nature of the nursing home population, combined with the inherent risks of congregate …
Chronic conditions and comorbidities are common among both long-term residents and short-term patients in skilled nursing facilities (SNFs). However, when the symptoms from these chronic conditions become part of the resident’s normal routine, they may …
MDS items N2001 (Drug Regimen Review), N2003 (Medication Follow-up), and N2005 (Medication Intervention) are the primary drivers of the Skilled Nursing Facility Quality Reporting Program (SNF QRP) Quality Measure (QM), Drug Regimen Review Conducted With …
In this document, CMS states, “Historically, each rule or update notice issued under the annual Skilled Nursing Facility (SNF) Prospective Payment System (PPS), rulemaking cycle included a detailed reiteration of the various individual legislative provisions …
Question: We have a resident on Medicare Part A who exhausted her benefits related to daily skilled nursing services of treating a stage 4 pressure ulcer and continues to receive a skilled level of care. …
Question: Can we skill a new resident under Medicare A if they are started on oxygen therapy and we are titrating it? Answer: Yes, during the initial phases of oxygen therapy and the process of …
Question: Per the CDC guidelines, how many Pneumococcal vaccines do our residents need to be considered up to date? We have some with only one vaccine and some with two. If they only have one …
Updates March 1, 2021 SNF QRP FAQs 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 …
The Quick Reference Guides provide high-level information on the SNF Quality Reporting Program, including frequently asked questions and helpful links. In February 2021, CMS issued a generic guide that is not based on fiscal year. …
One year. When asked how long it takes a new nurse assessment coordinator (NAC) to fully learn the job, I say at least one year. The nuances of the Resident Assessment Instrument (RAI) and Minimum …
The Confusion Assessment Method (CAM) is a standardized cognitive assessment that determines whether a resident has signs and symptoms of delirium. The CAM is located in MDS item C1310 (Signs and Symptoms of Delirium), which …
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 Centers for Medicare & Medicaid Services (CMS) is offering a 45-minute course that provides an overview of the assessment and coding of the Drug Regimen Review standardized patient assessment data elements (SPADEs). For permission to …
Question: Does a SNF ABN need to routinely be given to all new admissions? My understanding is that we would not issue a SNF ABN if Medicare technical requirements were not met. Example 1, a …
Question: I was told that if the resident needs two staff members in section G, then in GG they are automatically marked as dependent for that task. Is this correct? Answer: Remember that section G …
