Nurse assessment coordinators (NACs) and other interdisciplinary team members can breathe a little easier as they look ahead to the Oct. 1, 2024 implementation of the MDS version 1.19.1 item sets. The MDS 3.0 Item …
It’s the “Which came first, the chicken or the egg?” question of the Minimum Data Set (MDS) world: Which do you assess first, B0700 or the MDS scripted interviews? It’s easy to get lost in …
Question: If a resident goes to the ER and gets IV fluids, and the IV is removed prior to returning to a non-overnight visit during the ARD period, is O0110O1, IV Access, checked on the …
Question: For what situation would we use the activity not attempted code “10” in section GG? We have therapy staff coding “10” when they are not able to complete a task during their session. In …
Question: Recently, I found two assessments that had a dementia diagnosis that does not map to a PDPM category, including F01.C2 for vascular dementia. How do I update these codes? Answer from Jeff Taylor:There are …
The strict coding criteria for O0110M1, Isolation or quarantine for active infectious disease, requires precise documentation to support the MDS. AAPACN’s new Documentation Template: Isolation for Active Infectious Disease tool can help nurse assessment coordinators …
The Centers for Medicare & Medicaid Services (CMS) announced corrections to the Patient-Driven Payment Model (PDPM) mapping files for I0020B, the primary diagnosis representing the reason for the skilled nursing home stay, which is also …
The “PDPM Grouper JAR Package V2.2002.zip” is now available. This release was updated to support corrections to the Fiscal Year (FY) 2024 Patient Driven Payment Model (PDPM) International Classification of Diseases (ICD)-10 code mapping for …
From https://www.cms.gov/medicare/payment/prospective-payment-systems/skilled-nursing-facility-snf/list-federal-regulations/cms-1779-f2 Note: Typically, this file is posted at https://www.cms.gov/medicare/payment/prospective-payment-systems/skilled-nursing-facility-snf/patient-driven-model
The Microsoft Access database containing the International Classification of Diseases (ICD)-10 codes allowed for item I0020B has been updated to reflect changes occurring soon with PDPM V2.2002. The new tables added should be treated as …
See the section “Enhance Enrollees’ Rights to Appeal a Medicare Advantage Plan’s Decision to Terminate Coverage for Non-Hospital Provider Services” for details on expedited determination changes for Medicare Advantage residents. Contract Year 2025 Medicare Advantage …
Update: April, 2024 CMS consistently strives to improve the effectiveness and efficiency of our nursing home oversight and compliance programs to protect residents’ health and safety. In 2017, CMS implemented a new nursing home survey …
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 …
A survey finding of noncompliance with the Medicare and Medicaid requirements of participation may soon be a little more difficult for nursing homes to navigate without significant financial burden. In the March 28, 2024 Fiscal …
In the March 28, 2024 Fiscal Year (FY) 2025 Skilled Nursing Facility Prospective Payment System (SNF PPS) proposed rule, the Centers for Medicare & Medicaid Services (CMS) doesn’t propose the dizzying number of changes that …
Almost all nursing homes are currently staffing-challenged, and that has a direct impact on the quality of the documentation available to support MDS coding, points out Brenda Sowash, RN, RAC-CT, director of clinical assessments, standards, …
Nurses use a common problem-solving technique in root-cause analysis called the “Five Whys.” This method asks “why?” as many times as needed to determine the root cause of the problem. Sometimes this process requires more …
Question: For residents who have intrathecal pain pumps, this is coded under IV medications (O0110H1), but how do I code this under IV access (O0110O1)? Answer from Jessie McGill, RN, BSN, RAC-MT, RAC-MTA: In the …
Question: If a resident discharges to the hospital after a fall, and the hospital later notifies us that the resident is being admitted due to a fracture from the fall, do we need to modify …
Question: When making a correction to a completed assessment prior to submission, are we required to enter the date the correction was made in Z0500B? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: …
The Centers for Medicare & Medicaid Services (CMS) issued a final rule that clarified Medicare Advantage (MA) coverage criteria for basic benefits, use of prior authorization, and the annual review of utilization management tools. While …
Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2025 Filed on: 03/28/2024 at 4:15 pm Scheduled Pub. Date: 04/03/2024 …
Transmittal # R12560CP Issue Date 2024-03-28 Subject July 2024 Quarterly Update to Healthcare Common Procedure Coding System (HCPCS) Codes Used for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Enforcement Implementation Date 2024-07-01 CR # 13576 …
Enhanced Barrier Precautions in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms (MDROs) Memo #QSO-24-08-NH Posting Date 2024-03-20 Fiscal Year 2024 Memorandum Summary • CMS is issuing new guidance for State Survey Agencies and long term care …
The care area assessments (CAAs) are a vital part of the Resident Assessment Instrument (RAI) process to develop a plan for individualized resident care. Taking shortcuts with the CAA process can result in generic care …
The nurse assessment coordinator (NAC) who also serves as the primary Medicare nurse doesn’t always complete either the physician certification/recertification process or the beneficiary notification process for Medicare residents, says Scott Heichel, RN, RAC-MT, RAC-CTA, …
In early March, the Centers for Medicare & Medicaid Services (CMS) released the MDS Data Specifications V3.02.0 (DRAFT). These draft files detail the following changes tentatively scheduled for Oct. 1, 2024: CMS also clarified that …
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 strategies for simplifying the care …
Question: A resident discharged from hospice with one company and enrolled with a different hospice provider a week later. Do I need to complete a Significant Change in Status Assessment (SCSA) for both the hospice …
Question: On a discharge assessment, the documentation showed that the resident refused the last three weekly skin assessments and there is no other documentation in the medical record regarding skin condition. How do I code …
Question: We have a resident on a traditional Medicare Part A stay who was discharged back to the hospital on day three. How should I schedule the 5-Day PPS assessment and the Admission assessment, and …
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 March 2024 Quarterly Confidential Feedback Reports for the fiscal year (FY) 2025 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program are now available to download via the Internet Quality Improvement and Evaluation System (iQIES). …
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 row per state or territory plus a row for …
The MDS Data Specifications V3.02.0 (DRAFT) are now available for download under the Downloads section at the bottom of this webpage. The Section GG goal items will be removed, and three new items will be added: O0350 …
Question: How do you set section GG discharge goals for a resident who is also receiving care for end of life? Answer from Jeff Taylor: Goals can include maintenance or even managed decline. This AAPACN …
Question: A resident was on Hospice in community. He revoked hospice and had a qualifying hospital stay. He opted to receive rehab in the skilled nursing facility and then return to home. Medicare guidelines state …
Question: What is the consequence of a late MDS submission? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: There is no impact on Medicare payment if an MDS is submitted late. The facility could …
The Office of Inspector General (OIG), released the third and final report in a three-part series about the effects of the COVID-19 pandemic on nursing homes, Lessons Learned During the Pandemic Can Help Improve Care …
The interrupted-stay policy in the Patient-Driven Payment Model (PDPM) of the Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS) governs when multiple SNF stays are combined into a single interrupted stay (i.e., …
In the ever-evolving realm of healthcare data management, the transition of the Minimum Data Set (MDS) submission process to the Internet Quality Improvement and Evaluation System (iQIES) in April 2023 marked a significant milestone for …
Nurse assessment coordinators (NACs) are responsible for the coordination and completion of the MDS assessments; however, to ensure these assessments are accepted without error into the National Submissions Database, the Final Validation Report must also …
It’s that time of year again! The AAPACN 2024 Conference will be held this year in Hollywood, FL, on April 10 – 13. AAPACN is excited to gather to celebrate outstanding post-acute care professionals, meet …
Issued on 02/26/2024 | Posted on 02/29/2024 | Report number: OEI-02-20-00492 Report Materials Full Report (PDF, 1.5 MB) Why OIG Did This Review Nursing home residents and staff have been especially impacted by the COVID‑19 pandemic. Now, it is critical to learn from …
One of the frustrations nursing home providers have experienced since the transition to the Minimum Data Set (MDS) 3.0 version 1.18.11 that went into effect on Oct. 1, 2023, is being able to effectively monitor …
Pressure-related deep tissue injury (DTI) coded in M0300G (Unstageable Pressure Injuries Related to Deep Tissue Injury) does not play a role in Medicare payment under the Patient-Driven Payment Model (PDPM). While DTI is an unstageable …
Question: An audit found a missed Significant Change in Status Assessment (SCSA) after a hospice election. The resident is still in the facility. Is an SCSA still needed? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, …
Question: If a resident is dependent on staff for functional items in section GG and they also had a decline in their bowel or bladder status, will they trigger for the New or Worsened Bowel …
Question: When a resident is admitted to the nursing facility for hospice services, do we have to use the admitting hospice diagnosis as the primary diagnosis? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, …
The Center of Excellence for Behavior Health in Nursing Facilities (COE-NF) released a two-part podcast series addressing how to manage substance use disorders (SUDs) in skilled nursing facilities. This AAPACN resource is copyright protected. AAPACN …
Updated February 2024 The FY 2024 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Final Rule (88 FR 53200) revised data collection and submission requirements for the SNF Quality Reporting Program (QRP) affecting the Fiscal …
Announcements This is a friendly reminder to log into NHSN and make sure your facility has an active Facility Administrator. Please note that only the Facility Administrator can enroll a facility in a one or …
Long-term care facilities can track weekly vaccination data for residents and healthcare personnel (HCP) through NHSN. February 2024 Updates Resources January 2024 Updates Training Data Collection Forms and Instructions COVID-19 Vaccination Data Collections Forms Note: …
The FY2024 ICD-10-CM codes are to be used from April 1, 2024 through September 30, 2024. Note: This replaces the FY 2024 – October 1, 2023 release. These files listed below represent the ICD-10-CM FY2024 April …
SUMMARY REPORT PUBLISHED: SNF QRP Listening Session: Possible Expansion of MDS Data Submission to All SNF Patients Regardless of Payer CMS has published a summary report on the virtual SNF QRP Listening Session that was …
Medicare covers skilled nursing care and skilled therapy services under skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care to maintain function or to prevent or slow decline, as …
iQIES is the Internet Quality Improvement and Evaluation System, which is the system that the MDS submissions system is being transferred to. The QIES Technical Support Office maintains a website with iQIES reference materials, including …
Question: If a resident on a Medicare Part A stay leaves the facility on a leave of absence (LOA) with the family and is back in the facility after two midnights, are any assessments required? …
Question: Are we required to complete physician certifications and recertifications for Medicare Advantage or just for Original Medicare? Where is the source guidance? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: It is …
Question: I have a question about coding Functional Abilities in section GG for self-care and mobility on admission for a Medicare A resident. When the RAI User’s Manual states this is to reflect the resident’s …
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, curriculum development specialist for AAPACN, discuss the common challenges nurse assessment coordinators …
Care Compare refreshes MDS 3.0 Quality Measure (QM) data quarterly in January, April, July, and October with the most recent four full quarters of data. AAPACN’s 2024 Five-Star and Care Compare MDS 3.0 Quality Measure …
With the influenza season in full swing plus the ongoing peaks and valleys of COVID-19 and respiratory syncytial virus (RSV) outbreaks across the United States, nurse assessment coordinators (NACs) should take steps both to protect …
The year 2024 brings a plethora of updates to the Medicare program, several significantly impacting skilled nursing facilities (SNFs). SNF staff must stay well informed about these updates to ensure proper billing and adequate coverage …
Question: If a resident is discharged to the hospital on day 14, does an Admission MDS need to be completed? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: Per the Federal rules …
Question: When does the Pain Assessment interview need to be conducted? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: The questions must be asked during the 7-day observation period, but the resident must answer …
Question: Is there a standard letter or beneficiary notice that we have to use when a resident exhausts Medicare benefits? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: No, there isn’t a required …
In this podcast, Kim Hicks, vice president of business development for AAPACN, and Jessica Stucin, RN, BSN, LNHA, RAC-CT, RAC-CTA, assistant director of education for MDS Consultants, LLC, an AAPACN Diamond Business Partner, discuss some …
The Centers for Medicare & Medicaid Services (CMS) recently posted the draft Minimum Data Set (MDS) 3.0 Item Sets, version (v)1.19.1 and Item Matrix in the Downloads section on the Minimum Data Set (MDS) 3.0 …
The expedited determination beneficiary notification process covers a lot of ground in skilled nursing facilities (SNFs), affecting residents in the fee-for-service (FFS) Medicare Part A program and Medicare Advantage plans, as well as residents who …
The Centers for Medicare & Medicaid Services (CMS) announced on the Dec. 7 Skilling Nursing Facilities/Long-Term Care Open Door Forum that the drug classification of anticonvulsants will be added to the Minimum Data Set (MDS) …
Updated guideline offers the latest in evidence-based research to reduce pain, expand function and improve quality of life ROSEMONT, Ill. , Jan. 23, 2024 /PRNewswire/ — The American Academy of Orthopaedic Surgeons (AAOS) issued an update to the Clinical Practice Guideline (CPG) …
Skilled Nursing Facility CERT reports Skilled nursing facilities (SNF) is defined as all services with a provider type of SNF, including SNF inpatient, SNF outpatient, and SNF inpatient Part B. The projected improper payment amount …
In 2023, the AAPACN Leading in Care Blog brought you inspiration, personal member stories, clarification on need-to-know topics such as the iQIES transition, Quality Measures, and MDS updates, as well as details about important events …
The draft Minimum Data Set (MDS) 3.0 Item Sets version (v)1.19.1 and Item Matrix are now available. The MDS Item Sets v1.19.1 will be effective beginning October 01, 2024. From https://www.cms.gov/medicare/quality/nursing-home-improvement/resident-assessment-instrument-manual
Therapy Services: Per-Beneficiary CY 2024 Threshold Amounts The CY 2024 KX modifier threshold amounts are: More Information: Therapy Code List: 2024 Annual Update CMS updated the list of codes (ZIP) that sometimes or always describe therapy services and …
This user guide addresses Minimum Data Set (MDS) error messages and troubleshooting. CMS iQIES MDS Error Message Reference Guide v1.1 (posted 01/08/2024) From https://qtso.cms.gov/providers/nursing-home-mdsswing-bed-providers/reference-manuals
Effective communication is the glue holding the MDS process together, says Stacy Grondel, BSN, RN, RAC-MT, CMAC, QCP. director of reimbursement operations at QRM in Addison, TX. “The nurse assessment coordinator (NAC) who is a …
Question: A resident was admitted to the hospital while on a leave of absence (LOA). He had a qualifying hospital stay and was readmitted to our SNF on Medicare Part A. What date do I …
Question: A resident was admitted skilled, under managed Medicare, on 11/28. He transferred from managed care to traditional Medicare Part A, on 12/29. Are we required to complete another 5-Day for the Medicare stay starting …
Question: We have a resident on traditional Medicare Part A who was issued a NOMNC on 12/22, with a last covered day of 12/24. Can staff interviews for the PPS discharge assessment be performed after …
In this podcast, Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist for AAPACN, and Jessie McGill, RN, BSN, RAC-MT, RAC-MTA, curriculum development specialist for AAPACN, discuss a few outstanding questions that members asked …
In late December, the Centers for Medicare & Medicaid Services (CMS) released an updated MDS 3.0 Quality Measures User’s Manual v16.0. This manual has been updated to remediate a previous error in the Exclusions list …
The PDPM At-a-Glance tool breaks down the complex methodology of each component used in the Patient-Driven Payment Model—physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), non-therapy ancillaries (NTA), and nursing. This tool provides key …
Note: The audio file listed in the title may not be available. Thursday, December 7, 2023: Transcript, Q&A, Agenda and Audio File- Skilled Nursing Facilities/Long Term Care Open Door Forum (ZIP) From https://www.cms.gov/training-education/open-door-forums/about/odf-podcast-and-transcripts
In response to provider questions related to the MDS 3.0 QM User’s Manual posted on September 20, 2023, an updated MDS 3.0 QM User’s Manual v16.0, effective 10-1-2023, is now posted. Additionally, the updated .zip file titled MDS …
ADD Effective 10/1/2023 Major Category I. C. – Magnetic Resonance Imaging (MRI) Major Category II. A. – Dialysis, EPO, Aranesp, Other Related Services for ESRD Major Category III. A. -Chemotherapy Major Category III.D.-Customized Prosthetic Devices …
When the nurse assessment coordinator (NAC) goes on vacation, there’s a lot to keep track of while they are out of office. The MDS Daily Startup for the NAC Backup tool is intended to help …
The nurse assessment coordinator (NAC) role is a complex one that requires managing numerous deadlines, compliance regulations, and the involvement of the interdisciplinary team (IDT) in the Minimum Data Set (MDS) assessment. The job can …
MDS items E0100A (Hallucinations) and E0100B (Delusions) are qualifiers for the Behavioral Symptoms and Cognitive Performance category in the nursing component of the Patient-Driven Payment Model (PDPM). Even more importantly, these conditions that form the …
In this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, Marti Wdowicki, PharmD, director of clinical operations for PharMerica, and Jeff Herr, PharmD, manager of clinical operations in the …
Question: A resident was unable to complete the PHQ-2 interview, therefore my software did not allow us to complete the staff interview. Is this correct? D0100 was coded as “Yes”, interview should be conducted. D0150 …
Question: While most facilities require two-person assist with stand lift transfers, I have found that not all do. The RAI User’s Manual only addresses a stand lift transfer with two helpers as dependent. Is there …