Questions & Answers from AAPACN
Browse these industry related questions and answers written by AAPACN’s nurse experts. Find Q&As related to coding, COVID-19 guidance, documentation, and more. These thorough answers and resources are here to help you stay informed on important topics in post-acute care. Want access to all Q&As? Learn more about AAPACN and AAPACN membership.
- Q&A: Do 48-hour care plan meetings need to be completed for readmissions?Question: Do 48-hour care plan meetings need to be completed for readmissions? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC [email protected]: Assuming the resident already had the Admission MDS completed on their original …
- Q&A: Does an inpatient rehab stay count toward a qualifying hospital stay for Medicare coverage?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 …
- Q&A: A Medicare Part A resident was admitted to the hospital and returned to the SNF for a new Medicare stay. Does the diagnosis from the original stay need to be used or can this change?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 …
- Q&A: 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?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 …
- Q&A: What does the end of the physician visit waiver mean for SNFs?Question: What does the end of the physician visit waiver mean for SNFs? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT : With the recent QSO memo, QSO-22-15-NH & NLTC & LSC, released April 7, …
- Q&A: 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)?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, …
- Q&A: A resident admitted to our facility with a diagnosis of MRSA infection of a wound, receiving oral antibiotics, and in a single room—can I code Isolation in section O?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 …
- Q&A: How are therapy services billed when a resident is admitted to the facility for skilled nursing only and hospital documentation recommended outpatient services at home for PT/OT?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 …
- Q&A: Does NHSN have new forms, and if so, what are they?Question: Does NHSN have new forms, and if so, what are they? Answer from Denise Winzeler BSN, RN, LNHA, DNS-MT, QCP-MT: The National Healthcare Safety Network (NHSN) has released new optional forms for tracking and …
- Q&A: 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 this?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 …
- Q&A: The nursing note states a resident has intermittent shortness of breath with coughing. How would this be coded on the MDS?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 …
- Q&A: A resident had a fall with fracture and discharged to the hospital on the eighth day following admission. When should the Admission Assessment be scheduled and completed?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 …
- Q&A: What is the regulation for how often we should be obtaining vital signs for long-term care residents?Question: What is the regulation for how often we should be obtaining vital signs for long-term care residents? Answer from Alexis Roam, MSN, RN-BC, DNS-CT, QCP: There is not a federal regulation that states a …
- Q&A: If a resident on a Medicare Part A stay goes on a leave of absence for two days, is it considered an interrupted stay? 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 …
- Q&A: If a resident is receiving a full liquid diet due to a recent surgical procedure, is it considered a mechanically altered diet?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), …
- Q&A: When a resident is status-post surgery, would that be enough criteria to quality for skilled services?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 …
- Q&A: Can a weighted blanket be considered a restraint?Question: Can a weighted blanket be considered a restraint? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT: Although the use of a weighted blanket can be a great intervention, if the resident can not …
- Q&A: 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? 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 …
- Q&A: 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?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 …
- Q&A: We just found that we missed some discharge assessments from two years ago. Can these assessments still be completed and submitted?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 …
- Q&A: Where can I find resources to help me with tracking and trending vaccination data?Question: Where can I find resources to help me with tracking and trending vaccination data? Answer from AAPACN: The Agency for Healthcare Research and Quality (AHRQ) has new vaccination tracking and reporting tools to assist …
- Q&A: What are the criteria to code Malnutrition?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 …
- Q&A: If a resident is discharged before their planned Medicare discharge date, do I open an OBRA Discharge or a Part A PPS Discharge for a new end of Medicare stay?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 …
- Q&A: 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?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, …
- Q&A: When does the early-bird registration end for the AAPACN 2022 Annual Conference?Question: When does the early-bird registration end for the AAPACN 2022 Annual Conference? Answer from AAPACN: Registrants must register before March 21, 2022, to receive the early-bird discount. Standard registration is March 21 – April …
- Q&A: 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 this code?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 …
- Q&A: Can I code triple antibiotic ointment and/or Bacitracin in section N under antibiotics?Question: Can I code triple antibiotic ointment and/or Bacitracin in section N under antibiotics? Answer from Janine Cortesa RN, BSN: Yes. The RAI states on page N-7 “Include any of these medications given to the resident …
- Q&A: Am I allowed to complete a Significant Change in Status Assessment on a resident who continues to receive hospice services but experienced other unexpected changes?Question: A resident was admitted with hospice services. She improved significantly in her physical functioning, but also worsened significantly in her behaviors. She remains under hospice at this time but is due for review in …
- Q&A: Can a resident take home medications upon discharge?Question: Can a resident take home medications upon discharge? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT: Yes, medications can be sent home with a resident upon discharge. Work with your pharmacy provider to …
- Q&A: A resident discharged return anticipated to the hospital, but then admitted to another SNF before returning to our SNF within 30 days. What assessments are required?Question: We had a resident discharge to the hospital and an OBRA Discharge return anticipated (DCRA) assessment was completed. Resident admitted to different SNF from the hospital but returned to our SNF within 30 days …
- Q&A: I completed a Medicare PPS assessment one day after the completion due date. What is the penalty for late MDS assessment completion?Question: I completed a Medicare PPS assessment one day after the completion due date. What is the penalty for late MDS assessment completion? Answer: There is no financial penalty for late completion. You may possibly …
- Q&A: I was recently told that if a resident is cognitively intact, then behaviors would not be coded, is this correct?Question: I was recently told that if a resident is cognitively intact, then behaviors would not be coded, is this correct? Answer: Behavior coding is not affected by the resident’s cognitive level. The RAI User’s …
- Q&A: Where can I find the latest guidance regarding health care personnel returning to work after COVID-19?Question: Where can I find the latest guidance regarding health care personnel returning to work after COVID-19? Answer: The Work Restrictions for HCP Table on the Center for Disease and Prevention’s (CDC) webpage provides information …
- Q&A: If hospital documentation supports a diagnosis of hip fracture as the initial encounter, do I need to query the physician for the subsequent encounter diagnosis to be used in the SNF?Question: If a resident had a hospital stay for hip fracture repair, with no complications documented, and the hospital documentation supports a diagnosis of hip fracture as the initial encounter, do I need to query …
- Q&A: What are some best practices for collecting and documenting section GG?Question: What are some best practices for collecting and documenting section GG? Answer: We trained our floor nurses to complete GG documentation daily on days 1-3, and our therapists also complete a GG assessment during …
- Q&A: A resident was picked back up on Medicare Part A during the 30-day window for a new Medicare Part A stay. Can the drug regimen review from the prior stay be used to code section N?Question: We have a resident who admitted on Medicare Part A and a drug regimen review (DRR) was completed at that time. Skilled services ended a couple weeks later, and she remained in the facility …
- Q&A: Where can I find resources to assist me with increasing COVID-19 vaccine and booster uptake?There are several great resources for facility leaders to utilize. The Society for Post-Acute and Long-term Care Medicine (AMDA) has several great resources in their COVID-19 Vaccine Education Toolkit. These resources are free to everyone, …
- Q&A: If a mechanically altered diet is being trialed during a speech therapy visit to facilitate oral intake, could K0510C, mechanically altered diet, be coded on the MDS?Question: We are seeking clarification on MDS item K0510C, mechanically altered diet. If a resident is being trialed on a mechanically altered diet or given thickened liquids provided during a speech therapy visit to facilitate …
- Q&A: A resident developed a new pressure ulcer while on leave of absence with family for Christmas. Is this considered “present on admission” or “in-house acquired”?Question: A resident developed a new pressure ulcer while on leave of absence with family for Christmas. Is this considered “present on admission” or “in-house acquired”? Answer: Since we do not complete an OBRA Discharge …
- Q&A: What is the requirement for physician certifications when a resident transitions from Managed care to Original Medicare Part A?Question: A resident admitted under a managed care plan on December 15, but disenrolled and went to Original Medicare as of January 1. What is the requirement for physician certifications? Answer: Restart Medicare physician certifications …
- Q&A: What are the changes affecting SNFs in the updated blanket waiver that was recently released?The COVID-19 Emergency Blanket Waivers for Health Care Providers that was updated and released on Nov 29, 2021 adds a new waiver that allows more flexibility in the education and training requirements for individuals serving …
- Q&A: Has anyone encountered surveyors requesting consents for assist bars/enabler bars used for functional mobility not posing as a restraint per the interdisciplinary team assessment?Question: Has anyone encountered surveyors requesting consents for assist bars/enabler bars used for functional mobility not posing as a restraint per the interdisciplinary team assessment? Answer by Carol Maher, RN-BC, CPC, RAC-MT : A restraint …
- Q&A: What is the CMS definition of elopement?Question: I am trying to find the CMS definition of elopement. What exactly do they call an elopement? Answer by Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: The State Operations Manual, appendix …
- Q&A: Is there a waiting period to continue therapy services when a resident transitions from Medicare Part A to Medicare Part B therapy services?Question: Is there a waiting period to continue therapy services when a resident transitions from Medicare Part A to Medicare Part B therapy services? Answer by Kim Steele RN, WCC, RAC-CT, RAC-CTA: There is no …
- Q&A: Where can I find the CMS Quality Safety and Oversight (QSO) memos?Question: Where can I find the CMS Quality Safety and Oversight (QSO) memos? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT AAPACN Curriculum Development Specialist: QSO memos issued from CMS can be found on …
- Q&A: Is a Significant Change in Status Assessment required for a new stage 3 pressure ulcer?Question: Is a Significant Change in Status Assessment required for a new stage 3 pressure ulcer? Answer from Janine Cortesa RN, BSN: A stage 3 pressure ulcer may signify the need for a Significant Change …
- Q&A: Where are SNF quality measure data publicly reported?Question: Where are SNF quality measure data publicly reported? Answer from CMS SNF QRP FAQs: The Care Compare website was launched in August 2020. It combines the Centers for Medicare & Medicaid Services (CMS) eight …
- Q&A: When a Medicare Part A resident discharges to another SNF and will continue skilled Medicare there, what assessments are required and what is the date used in A2400C?Question: I have a Medicare Part A resident discharging to another SNF and will continue skilled Medicare there. Would I combine the OBRA Discharge with a PPS Part A Discharge assessment? In A2400, would I …
- Q&A: Where can I find information on the new CMS COVID-19 vaccination requirements?Question: Where can I find information on the new CMS COVID-19 vaccination requirements? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-CT, QCP: CMS has developed a FAQ document regarding the Interim Final Rule that answers …
- Q&A: Can Incentive Spirometer still be counted on the MDS as long as a respiratory nurse or therapist counts the minutes they assess, monitor, and evaluate?Question: Can Incentive Spirometer still be counted on the MDS as long as a respiratory nurse or therapist counts the minutes they assess, monitor, and evaluate? Answer form Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, …
- Q&A: How do you code a resident who is fed by staff for all meals but can chew and swallow independently?Question: We have been discussing how to code a resident who is fed for all meals but can chew and swallow independently. The argument is the RAI User’s Manual indicates that if someone cannot participate …
- Q&A: A resident discharged to the hospital, return anticipated, but went to a sister facility from the hospital for a few days because we did not have a bed available. Now that he is returning, is a new OBRA Admission assessment required?Question: We have a resident who discharged to the hospital (completed an OBRA DC Return-Anticipated). When he was ready to be discharged from the hospital, we did not have a bed available, so he discharged …
- Q&A: Where can I find resources to help our facility prevent and manage sepsis?Question: Where can I find resources to help our facility prevent and manage sepsis? Answer: TMF, a Quality Improvement Organization, offers a free toolkit called the Sepsis Post-Acute Care Training Toolkit for Nursing Homes. This …
- Q&A: Can we code modified diet on section K if a resident has crushed medications but eats a regular diet?Question: Can we code modified diet on section K if a resident has crushed medications but eats a regular diet? Answer from Janine Cortesa RN, BSN: No, crushed medications would not be a mechanically altered …
- Q&A: A resident just returned during the interruption window. What OBRA assessments and tracking records do I need?Question: A resident on a Medicare Part A stay went to the hospital on 10/19 and returned on 10/20. He was admitted to the acute. This is my first time with an interrupted stay. Do …
- Q&A: Would you code a positive nasal swab for MRSA as a multidrug-resistant organism (MDRO) in section I?Question: Would you code a positive nasal swab for MRSA as a multidrug-resistant organism (MDRO) in section I? Answer from Heide Keen, RN, BSN, RAC-CT: Most often, we find that MRSA of nares is colonized …
- Q&A: Where can I find information for the 2021-2022 flu season and vaccination requirements?Question: Where can I find information for the 2021-2022 flu season and vaccination requirements? Answer from Denise Winzeler, BSN, RN, DNS-CT, QCP : The CDC has a lot of great information on their webpage regarding …
- Q&A: If therapists or therapy assistants are working as nurse aides, can these hours be included in PBJ?Question: I have a facility that is experiencing a surge of COVID positive patients and staff. Presently, a significant portion of their staff is out due to COVID-19 or isolation related to COVID exposure. Their in-house …
- Q&A: A resident unexpectedly discharged three days before his planned PPS Discharge. What do I need to do?Question: A resident unexpectedly discharged from the facility on 10/9 while on Medicare Part A. He had a planned PPS Part A Discharge scheduled for 10/12. Can I combine the PPS Discharge and OBRA Discharge, …
- Q&A: I found an error on a resident’s MDS that goes back to 2019. How do I correct this?Question: I have just found out a resident had a change of payer from Medicaid to Private Pay back in 2019 and the system still has their Medicaid information. How do I correct this and …
- Q&A: Is nursing required to sign off on therapy orders?Question: Is nursing required to sign off on therapy orders? Answer from Kendra Coco, MPT, NHA, RAC-CT, RAC-CTA: No, it is not required. However, most therapy orders come through the nurse as a telephone order …
- Q&A: If a resident expires during their assessment window, does the MDS assessment still need to be completed?Question: If a resident expires during their assessment window, does that MDS still need to be completed? For example, if a resident’s assessment window is 9/10 – 9/16 with an ARD of 9/16, but then …
- Q&A: Can a resident meet the skilled level of care criteria with only speech therapy?Question: I have always been taught that you cannot skill a resident for only speech therapy. However, now I am being told a resident that is receiving speech therapy 5 days a week should be …
- Q&A: A resident was receiving a skilled level of care on a Medicaid stay prior to a 3-day qualifying hospital stay. Will he be able to qualify for Medicare when he returns to the SNF?Question: A long-term care resident admitted to the hospital and will return after a 3-day qualifying inpatient stay. Prior to discharge, the resident had Medicaid as a primary payer and was receiving skilled therapy five …
- Q&A: Can I notify a resident representative of discharge from skilled services by phone?Question: Can I notify a resident representative of discharge from skilled services by phone? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: According to NOMNC Form Instructions: If the provider is personally unable …
- Q&A: I have a resident taking a medication that is classified as an antineoplastic. Can I code chemotherapy at MDS item O0100A?Question: I have a resident taking a medication that is classified as an antineoplastic. Can I code chemotherapy at MDS item O0100A? Answer from Forrest Deimel, RN: If the antineoplasm medication is used to treat …
- Q&A: I was recently instructed to dash item K0100 if a resident has a PEG tube. Is this correct?Question: I was recently instructed to dash item K0100 if a resident has a PEG tube. Is this correct? Answer from Janine Cortesa RN, BSN: The RAI User’s Manual does not state to dash if …
- Q&A: Can IV fluids administered in the emergency room (ER) or during surgery be included in Section K, items K0510 or K0710?Question: Can IV fluids administered in the emergency room (ER) or during surgery be included in Section K, items K0510 or K0710? Answer from Carol Maher, RN-BC, CPC, RAC-MT: IV fluids given in the ER …
- Q&A: Is there specific guidance regarding staff working in multiple facilities?Question: Is there specific guidance regarding staff working in multiple facilities? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-CT, QCP: Currently, there are no federal guidelines specific to staff who work in multiple facilities. However, …
- Q&A: What are the requirements for restorative program notes?Question: I was recently told that our restorative nursing programs needed monthly progress notes/assessments, but I have only been completing these quarterly. What are the requirements for restorative notes? Answer from Melissa Brown, OTR/L, RAC-CT, …
- Q&A: Is a physician note of the diagnosis enough to support coding the diagnosis in the medical record?Question: The physician listed avascular necrosis of the hip in a progress note but did not address this diagnosis in a treatment plan. The resident is receiving PRN pain medication for this, which has been …
- Q&A: Is it acceptable to answer the PHQ-9 Mood questions directly in MDS section D if the signatures are prior to the ARD date?Question: Is it acceptable to answer the PHQ-9 Mood questions directly in MDS section D if the signatures are prior to the ARD date (they usually complete the interview before, but code the MDS and …
- Q&A: How can I be part of the Director of Nursing Services – Executive Advisory Panel (DNS-EAP)?Question: How can I be part of the Director of Nursing Services – Executive Advisory Panel (DNS-EAP)? Answer from AAPACN: If you are interested in contributing to AAPACN and serving on the DNS-EAP, please send …
- Q&A: Can daily monitoring of a wound vac fall under indirect skilled nursing services for observation and assessment of resident’s condition?Question: Can daily monitoring of a wound vac fall under indirect skilled nursing services for observation and assessment of resident’s condition? Answer from Darlene S. Almand, RN, LNC, RAC-CT: In over 30 years of utilization …
- Q&A: What is the impact on PDPM if you have to dash all items for section GG on the 5-Day?Question: I understand the impact dashes have on SNF QRP, but what is the impact on PDPM if you have to dash all items for section GG on the 5-Day? Answer from Scott Heichel, RN, …
- Q&A: Is the date at V0200C, completion of the care plan, the same date as the actual care plan meeting with families?Question: Is the date at V0200C, completion of the care plan, the same date as the actual care plan meeting with families? Answer from Carol Maher, RN-BC, CPC, RAC-MT: The signature and date in V0200B …
- Q&A: Are there specific requirements for the use of ice packs?Question: Are there specific requirements for the use of ice packs? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-CT, QCP: Although F697 does name ice packs as a non-pharmacological intervention for pain relief, I do …
- Q&A: How do you determine “while a resident” or “while not a resident” when a resident goes out to the hospital and returns?Question: How do you determine “while a resident” or “while not a resident” when a resident goes out to the hospital and returns? Answer from Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: The …
- Q&A: A resident on Medicare Part A had a fall with a subdural hemorrhage and a pelvic fracture. Which diagnosis should be used as primary?Question: Which ICD-10 should be used for primary for this new Medicare Part A admission? The resident had a fall, hit his head, and impacted the pelvic area. Hospital reports show a small subarachnoid hemorrhage …
- Q&A: A resident converted from Managed Care to Traditional Medicare. How is a recent fall captured on the current 5-Day PPS assessment?Question: A resident admitted on a Managed Care plan in late April and elected Traditional Medicare Part A, effective June 1, 2021. In late May (5/29), he had a fall in the facility. I have …
- Q&A: If I have a combination of Total Dependence (4) occurring more than seven times during the look-back period, with the rest showing the Activity Did Not Occur (8), can I code Total Dependence (4) as the final code on the MDS?Question: The RAI User’s Manual states that, “The Rule of 3 does not apply when coding Independent (0), Total Dependence (4) or Activity Did Not Occur (8), since these levels must be EVERY time the …
- Q&A: Is a standalone PPS Discharge Assessment required for residents with a Medicare Advantage (MA) plan?Question: Is a standalone PPS Discharge Assessment required for residents with a Medicare Advantage (MA) plan? Answer from Carol Maher, RN-BC, CPC, RAC-MT: The Part A PPS Discharge MDSs are not required by CMS for …
- Q&A: How long do I have to report results of an investigation to the state?Answer from Denise Winzeler, BSN, RN, LNHA, DNS-CT, QCP:F609 and F610 state that the final results of the investigation must be reported within five working days. This means five business days, not calendar days. However, the …
- Q&A: If a patient uses a wheelchair in the facility but does not have plans to use it after discharge, should wheelchair items be coded on the 5-Day PPS assessment?Question: We are seeing some discrepancies in coding wheelchair items under section GG. If a patient uses a wheelchair the entire time they are in the facility, but recover such that they no longer need …
- Q&A: If a resident has a triple antibiotic order to apply on a laceration, is it coded as an antibiotic in section N?Question: If a resident has a triple antibiotic order to apply on a laceration, is it coded as an antibiotic in section N? Answer from Jeff Taylor, RAC-CT: Yes. RAI User’s Manual, chapter 3, page …
- Q&A: Is it correct to complete a 5-Day PPS assessment, not submitted, with an ARD on the day of discharge and a separate OBRA Discharge return anticipated assessment also with the ARD on the day of discharge?Question: A resident has an HMO for a skilled stay. She discharged to the hospital return-anticipated on day 5 of the stay. Is it correct to complete a 5-Day PPS assessment, not submitted, with an …
- Q&A: What assessments should my facility be completing for residents who are readmitted?Question: What assessments should my facility be completing for residents who are readmitted? Answer from Michelle Stuercke, DNP, MSN, MPH, LNHA: It often happens that residents have a change in their fall risk, skin risk, …
- Q&A: 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?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 …
- Q&A: Is a physician order needed for a restorative passive range of motion (PROM) program?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 …
- Q&A: A resident on Medicare Part A had an observation hospital for two days, returned for a few hours, and then was sent back to the emergency room until after midnight. Is this an interrupted stay?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 …
- Q&A: Do adverse reactions to the COVID-19 vaccine need to be recorded on the OSHA log?Question: Do adverse reactions to the COVID-19 vaccine need to be recorded on the OSHA log? Answer from OSHA QuickTakes, June 1 : OSHA does not wish to discourage staff members from receiving COVID-19 vaccinations, …
- Q&A: Can a resident disenroll in a Medicare Advantage (MA) plan and revert back to Original Medicare when the 3-day qualifying hospital stay was waived for the MA plan?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 …
- Q&A: Do I need to complete a Significant Change in Status Assessment (SCSA) for a resident who had expected improvements in in all ADLs, but discharge is now delayed?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 …
- Q&A: What training is required for nurse aides to work with residents in a Restorative Program?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 …
- Q&A: What will happen to the online AADNS communities, discussion groups, and libraries?Question: What will happen to the online AADNS communities, discussion groups, and libraries? Answer from AAPACN: The AADNS Network has become a new member community named the Management/Leadership General Discussion community on AAPACN.org. The discussion …
- Q&A: Is metabolic acidosis a skilled diagnosis?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 …
- Q&A: Will I still be able to access AADNS courses that I am currently taking on the new AAPACN website?Question: Will I still be able to access AADNS courses that I am currently taking on the new AAPACN website? Answer from AAPACN: Yes. You still have access to any courses that have not expired …
- Q&A: Can a CNA cut, trim, or even color a resident’s hair?Author: Denise Winzeler, BSN, RN, LNHA, DNS-CT, QCP Question: Can a CNA cut, trim, or even color a resident’s hair? This question has come up as we are into the pandemic and our beautician has …
- Q&A: Per the CDC guidelines, how many Pneumococcal vaccines do our residents need to be considered up to date?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 …
- Q&A: What interventions have you found to be successful for residents who are not eating or eating poorly after COVID illness?Question: What interventions have you found to be successful for residents who are not eating or eating poorly after COVID illness? Answer: Is poor intake related to impaired smell or taste? If so, this …