In this podcast, 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 the sequencing of ICD-10-CM diagnosis coding.Additional Resources: …
Question: Do I code J1400, Prognosis, as yes when a resident is under palliative care and not hospice? There is no physician documentation certifying or stating the physician’s belief that the resident’s terminal illness is that their …
Question: What is considered as the most updated COVID-19 vaccine to code on the MDS? Answer from Jessie McGill RN, BSN, RAC-MTA, RAC-CTA: To determine up to date, we must reference the Staying Up to …
Question: For the PHQ-2 to 9 interview, if the resident is at least sometimes understood and the interview is attempted, but the resident did not respond to the first two questions, how is this coded …
The Centers for Medicare & Medicaid Services (CMS) recently released the FY 2026 Skilled Nursing Facility Value-Based Purchasing (VBP) fact sheet. This fact sheet details the program, measures used, case-minimums, the process for making correction, …
In the Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS) and Consolidated Billing Proposed Rule for Fiscal Year (FY) 2026, officially published on April 30, 2025, the Centers for Medicare & Medicaid Services (CMS) …
The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code assignment continues to be a bit of an enigma in the long-term care setting. Members regularly ask questions about ICD-10-CM coding in AAPACN’s online …
In a complex care environment where workforce development and regulatory demands are constantly evolving, National Health Care Associates is setting a new standard. With a sharp focus on equipping staff at every level with the …
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 …
Analysis and Report Resources General Resources COVID-19: Understanding Key Terms and Up to Date Definitions [PDF – 1 MB] – April 2025 From https://www.cdc.gov/nhsn/ltc/covid19/rpv-resources.html
Battelle is accepting nominations for the Endorsement and Maintenance (E&M) and Pre-Rulemaking Measure Review (PRMR) committees until 11:59 PM (ET) on May 15, 2025. Use the Partnership for Quality Measurement (PQM) nomination form to nominate yourself or others …
Minimum Data Set 3.0 Nursing Home and Swing Bed Prospective Payment System (PPS) for the Collection of Data Related to the Patient-Driven Payment Model and the Skilled Nursing Facility Quality Reporting Program (QRP) MODIFIED: o Item …
The following resources are now available: Mental Health Awareness Training Plan Schizophrenia in Nursing Facilities: Validating Diagnosis and Planning for Appropriate Care Schizophrenia Fact Sheet 4 Ways Nursing Homes Can Promote Substance Use Recovery See …
Question: A resident discharged to the hospital with an unstageable pressure ulcer due to eschar (occurred in house). The wound was debrided in the hospital and then the resident returned with it being a Stage …
Question: A resident had a chest tube placed in the hospital and removed prior to re-admission. In the 5-Day look-back period, we have orders for an ointment and dressing to the area daily until resolved. …
Question: Is an OBRA Discharge assessment required when a non-skilled resident has an unplanned transfer to the hospital, was not admitted, but was there for 30 hours? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, …
AAPACN’s GG Trivia Game is a fun education tool to help nurse aides and other direct care staff understand the performance levels and functional tasks for section GG. The nurse assessment coordinator or delegate hosts …
The Centers for Medicare & Medicaid Services (CMS) recently confirmed the revisions to the State Operations Manual (SOM), Appendix PP, which went into effect April 28, 2025. The revisions are redlined here. While many revisions …
The long-stay Quality Measures (QMs), Percent of Residents with a Urinary Tract Infection and Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder, have straightforward methodology but complex underlying implications. Managing …
A well-run care conference or care plan meeting can help the interdisciplinary team (IDT) improve the resident’s quality of care and quality of life by establishing a more resident-centered, individualized, culturally competent, and trauma-informed care …
Note: Unlike the draft, this transmittal includes Only the updated sections of Appendix PP. Please be aware that there are at least some changes from the draft manual. Transmittal # R229SOMA Issue Date 2025-04-25 Subject …
Transmittal # R13170CP Issue Date 2025-04-17 Subject July 2025 Quarterly Update to Healthcare Common Procedure Coding System (HCPCS) Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement Implementation Date 2025-07-07 CR # 14049 …
Each year, AAPACN honors individuals and organizations who embody the vision and values of AAPACN—integrity, innovation, inspiration, and influence. They are leaders who inspire their teams, elevate standards of care, and make a lasting impact …
Members and Non-members: FreeContinuing Education: 1 CE hourDate: May 15, 2025 Time: 2 pm ET, 1 pm CT, Noon MT, 11 am PTDuration: 60 minutesSpeakers: Laura Velasco, MSN, RN, CIC, and Emily Bouzek, MSN, RN, CIC, LTC-CIP Infection preventionists gather a …
SNF QRP Reporting Information Details: It is also still available via the AAPACN site: https://www.aapacn.org/news/fy-2026-calendar-year-2024-snf-qrp-apu-table-for-the-mds-data-submission-threshold/ —————- For help monitoring compliance with the SNF QRP data submission requirements: Email: [email protected] to receive this information. For questions about SNF quality …
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 the compare tool on Medicare.gov and Provider Data Catalog (PDC) during …
Question: On admission, our infection control nurse asks about the COVID-19 vaccine and documents the resident’s vaccine status and acceptance or refusal of the vaccine. Since we are no longer providing the vaccine in the …
Question: Is a Part A PPS Discharge assessment required if the resident exhausted the 100-day benefit? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: Yes, the Part A PPS Discharge MUST be completed when …
Question: Do the medications gabapentin/Neurontin get coded in section J, Scheduled pain medication regimen, if the doctor noted they are for pain management, and are they also coded as anticonvulsants in section N? Answer from …
The Centers for Medicare & Medicaid Services (CMS) released a draft of the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual (RAI User’s Manual) v1.20.1, which is planned to become effective Oct. 1, 2025. This …
The nurse assessment coordinator (NAC) brings a unique understanding of facility operations and resident needs that can reap critical benefits for the Quality Assurance and Performance Improvement (QAPI) program, says Lauren Stenson, MSN, RN, CNDLTC, …
The Centers for Medicare & Medicaid Services (CMS) recently released a second version of the draft item set files for Oct. 1, 2025, updates, version 1.20.1v2, and the draft Long-Term Care Facility Resident Assessment Instrument …
Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026 Filed on: 04/11/2025 at 4:15 pm Scheduled Pub. Date: 04/30/2025 PDF 105 Pages (365 …
Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (CMS-4208-F) Direct link: https://www.federalregister.gov/public-inspection/2025-06008/medicare-and-medicaid-programs-contract-year-2026-policy-and-technical-changes-to-the-medicare Fact sheet from https://www.cms.gov/newsroom/fact-sheets/contract-year-2026-policy-and-technical-changes-medicare-advantage-program-medicare-prescription-final …
The March 2025 Quarterly Confidential Feedback Reports for the fiscal year (FY) 2026 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program are now available to download via the Internet Quality Improvement and Evaluation System (iQIES). These …
The deadline is quickly approaching for the Centers for Medicare & Medicaid Services (CMS) Skilled Nursing Facility Quality Reporting Program (SNF QRP). Deadlines are detailed on the fiscal year (FY) 2026 SNF QRP deadlines file. …
The expedited determination process (called “fast-track appeals” in regulation) for appeals of service terminations by Medicare Advantage (MA) plans is very similar to—but not exactly the same as—the expedited determination process for service terminations under …
Question: When coding urinary tract infection (UTI) at I2300, the RAI User’s Manual states that if diagnosis of UTI was made prior to resident admission it is not necessary to evaluate for evidence-based criteria and …
Question: We recently had a state case-mix audit, and I had to correct an error that resulted in a new Care Area Assessment (CAA) triggering. My software gave me a warning that a significant correction …
Question: Should MDS Item I0020B always be the diagnosis from the qualifying hospital stay? How do I code this for a resident who has been in long-term care for many years and has no recent …
In long-term care (LTC) facilities, many residents need care for chronic and acute respiratory problems, such as chronic obstructive pulmonary disease (COPD), pneumonia, tracheostomy, and post-COVID complications. LTC nurses need to know how to manage …
The draft Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) User’s Manual version (v)1.20.1 is now available in the Downloads section on the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual page. The MDS 3.0 RAI User’s Manual v1.20.1 will …
Members and Non-members: FreeContinuing Education: 1 CE hourRecording Date: April 14, 2025Duration: 60 minutesSpeakers: Joan Hebden, MS, RN, CIC, FAPIC, FSHEA, and Deb Patterson Burdsall, PhD, RN-BC, CIC, LTC-CIP, FAPIC Long-term care (LTC) staff provide high-contact resident care and therefore …
Most methods for auditing Patient-Driven Payment Model (PDPM) reimbursement focus on impacts to the HIPPS code. However, AAPACN’s PDPM Audit by MDS Section tool uses an approach that can result in identifying missed opportunities for …
Draft MDS 3.0 Item Sets version 1.20.1v2 UPDATED: Draft MDS 3.0 Item Sets version 1.20.1v2 The draft Minimum Data Set (MDS) 3.0 Item Sets version (v)1.20.1v2 and Item Matrix are now available. The MDS Item …
In long-term care, the Minimum Data Set (MDS) ensures appropriate care planning, accurate reimbursement, and quality measurement while maintaining compliance with federal and state regulations. However, MDS coding may pose some ethical challenges. Completing the …
“MDS coding accuracy is important” is not a revolutionary new concept for any nurse assessment coordinator (NAC), says Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC, director of education for Hansen, Hunter & Co. PC …
Question: When coding K0100, Swallowing Disorders, can we capture signs and symptoms if they were identified when the resident was working with speech-language pathology (SLP) and on a trial diet? Answer from Jennifer LaBay RN, …
Question: For the Quality Measure (QM) for Long-stay Antipsychotic medication, if a resident expires in the facility and the appropriate Death in Facility record is completed and submitted, when will the resident stop triggering? Answer …
Question: A resident enrolled in hospice services and expired the next day. Do I still need to complete a Significant Change in Status Assessment (SCSA)? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC The …
The Centers for Medicare & Medicaid Services (CMS) released a revised memo, QSO-25-07-NH, which detailed a launch plan to transition the long-term care survey process to the Internet Quality Improvement and Evaluation System (iQIES) platform. …
The AAPACN 2025 Conference will be hosted in Louisville, Kentucky, on April 22 – 25. Attendees will immerse themselves in information and best practices with peers who share their passion for post-acute care and can …
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
Memo # QSO-25-14-NH Memorandum Summary: Revised Surveyor Guidance: CMS is releasing the following revised guidance for nursing home surveyors: Admission, Transfer & Discharge, Chemical Restraints/Unnecessary Psychotropic Medication, Resident Assessment, Nursing Services, Payroll Based Journal, Quality …
Memo # Admin Info 25-07-NH Summary The iQIES Nursing Home launch is currently scheduled for July 14, 2025. The CMS iQIES team is developing a training and support plan to help all State Agency and CMS …
Data Set Links 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 System. Data are presented as one …
Quality Measure (QM) reporting on pressure ulcers is a significant metric used by the Centers for Medicare & Medicaid Services (CMS) to help ensure that nursing homes provide high-quality care to vulnerable residents. Those residents …
The ongoing staffing shortage amid growing economic turbulence and payment pressures means that every nursing home in the country is currently struggling with reimbursement, says Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, IPCO, QCP, ICC, director …
In this podcast, Jessie McGill, RN, BSN, RAC-MT, RAC-MTA, senior curriculum development specialist for AAPACN, and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist for AAPACN, address some of the questions that were …
A common question regarding MDS 3.0 Quality Measures (QMs) is why a discharged resident continues to trigger after leaving the facility. This is explained in section two of the MDS 3.0 Quality Measures User’s Manual, …
The Centers for Disease Control and Prevention (CDC) has updated the “Staying Up to Date with COVID-19 Vaccines” guidance twice since requiring COVID-19 vaccinations to be coded on the MDS as of October 2024. Facility …
Question: We have a Medicare Part A resident who was only skilled by nursing at the end of the stay. How do we code GG items that only therapy perform, such as car transfers and …
Question: A Medicare Part A resident passed away in the emergency department. I know a Death in Facility record needs to be completed, but do I also need to complete a Medicare Part A PPS …
Question: To code K0300A for a physician-ordered weight loss, does the physician need to write a progress note that weight loss is intended or will an order for a diuretic automatically make the weight loss …
Several sections may be useful, including Recommendations for Skilled Nursing Facilities to Improve Medical Record Documentation https://acentraqio.com/newsletter/crc/February2025postacute
The Section S portion of the forthcoming MDS Data Specifications V3.10.1 (FINAL) is now available for download under the Downloads section at the bottom of this webpage. This MDS version will be implemented in production on October …
Open Assessments MDS The electronic change request form titled “MDS 3.0 Manual Individual Correction/Deletion Request” can only be utilized for deletion requests at this time. Please submit A0410 Corrections using the manual process. We are …
Cupid CrewOn Valentine’s Day this year, AAPACN staff joined Wish of a Lifetime as Cupid Crew volunteers to deliver 300 roses to staff and residents at local post-acute care facilities in Denver, Colorado. In the …
For skilled nursing facilities (SNFs), diagnosis selection and accurate ICD-10-CM coding are essential for both quality resident care and compliance with regulations. For therapists providing skilled rehabilitation services, the ability to choose the correct diagnosis …
Some nurse assessment coordinators (NACs) may believe that having a care conference (aka care plan meeting) with the resident and/or their responsible party or family member is a regulatory requirement. “However, no regulations actually use …
Question: Our facility had an influenza-A outbreak with testing from lab. Can we write an ICD-10 code for this for all impacted residents? Answer from Jeff Taylor: You need a provider (physician or physician extender) …
Question: For GG0130A, Eating, the RAI User’s Manual states this is the ability to bring food/liquids to the mouth once the meal is placed in front of the resident. How do you code if the …
Question: A resident elected hospice with one company on 1/31 and we scheduled a Significant Change in Status Assessment (SCSA) on 2/10. The family decided to change companies and enrolled with a different hospice company …
The Centers for Disease Control and Prevention (CDC) released the April diagnosis code update files on the CDC ICD-10 webpage. For the first time in several years, there are no new ICD-10-CM codes effective April …
The Centers for Medicare & Medicaid Services (CMS) provided guidance on which section GG column will be used for new measures in the MDS 3.0 Quality Measures User’s Manual (v17.0), effective Jan. 1, 2025. The …
Question: A resident fell and was transported to the acute hospital for evaluation. X-rays were completed and the resident was admitted to the hospital for a fracture. Do we code the injury from the fall …
Question: If a resident’s skilled Medicare Part A stay ends and the resident remains in the facility an additional five days before discharging home, do I have to complete two discharge assessments? Answer from Scott …
Question: If walking only occurs in the look-back period with therapy, can we use that to determine the usual performance or would we code not applicable or not attempted due to medical condition or safety …
In this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Jessie McGill, RN, BSN, RAC-MT, RAC-MTA, senior curriculum development specialist with AAPACN, discuss a new method for auditing the …
The MDS is more than a data collection tool, says Sabrena McCarley, MBA-SL, OTR/L, CLIPP, RAC-CT, QCP, FAOTA, RAC-CTA, vice president of clinical reimbursement and regulatory affairs for Transitional Care Management in Lisle, IL. McCarley …
Medications are an essential part of the care and interventions provided to residents in a skilled nursing facility. These medications may be used to manage chronic conditions, slow disease progress, ease symptoms, or even prevent …
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 …
Current emergencies Southern California Wildfires – California (2025) Secretary Becerra used his authority in the Public Health Service Act to declare a public health emergency (PHE) on January 10, 2025, giving us the flexibility to support our …
The MDS 3.0 Quality Measure Assessment Selection Methods tool simplifies the assessment selection logic used for MDS 3.0 Quality Measures (QMs) in nursing facilities. The assessment selection logic is used to identify which assessments are …
The Discharge Function Score is an incredibly complicated quality measure (QM), notes Joel VanEaton, BSN, RN, RAC-MT, RAC-CTA, RAC-CT, executive vice president of post-acute care regulatory affairs and education for Broad River Rehab in Asheville, …
The Centers for Medicare & Medicaid Services (CMS) implemented the Patient-Driven Payment Model (PDPM) in October 2019 for residents receiving Medicare Part A coverage in the skilled nursing facility (SNF). PDPM replaced the previous legacy …
Question: Our facility recently had a bill rejected because the ICD-10 code of M62.81, Muscle weakness (generalized), and R53.1, Weakness, were both coded on the bill. Does anyone know the reason why they both cannot …
Question: I am working in an older facility, and every bed has bilateral quarter-length side rails. The facility leadership states the rails are for mobility, but they cannot be lowered for any residents. Could these …
Question: A resident recently enrolled in hospice, and we scheduled a Significant Change in Status Assessment (SCSA) for 1/14/25. The resident expired on 1/10, before the ARD of the SCSA. Do I need to complete …
The Centers for Medicare & Medicaid Services (CMS) recently released the Fiscal Year (FY) 2025 Mission & Priorities document (MPD). This document includes the expected responsibilities of the State Resident Assessment Instrument (RAI) coordinator: CMS …
CDC announces no new ICD-10-CM codes effective April 1, 2025. The April 1, 2025 diagnosis code update files now available address revisions and typographical errors. Use these files for discharges occurring from April 1, 2025 …
To register at QSEP and take the course, you just need to provide an email address. https://qsep.cms.gov Updated: January 16, 2025 This course consists of four presentations by the Division of Nursing Homes outlining the …
On Oct. 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released the draft MDS version 1.20.1 item sets and item matrix for implementation on Oct. 1, 2025. The change history included with the …
