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: In section K and O of the RAI User’s Manual, there are items than can be checked “on admission.” Per the manual, this refers to an assessment period of days one through three of the skilled nursing facility Medicare Part A stay, starting with A2400B. Does this include services provided in the hospital prior to admission to the SNF on day one?Question: In section K and O of the RAI User’s Manual, there are items than can be checked “on admission.” Per the manual, this refers to an assessment period of days one through three of …
- Q&A: If the Notice of Medicare Non-Coverage (NOMNC) was not provided timely, is the facility liable for the days daily skilled services were no longer being provided until the last covered day (LCD) issued on the NOMNC?Question: If the Notice of Medicare Non-Coverage (NOMNC) was not provided timely, is the facility liable for the days daily skilled services were no longer being provided until the last covered day (LCD) issued on …
- Q&A: A resident was previously skilled for 100 days under Medicare Part A for a peg tube and subsequently discharged home with no home health services. If this resident remains at home for 60 days or longer, will he earn a new 100-day Medicare benefit period?Question: A resident was previously skilled for 100 days under Medicare Part A for a peg tube and subsequently discharged home with no home health services. If this resident remains at home for 60 days or longer, …
- Q&A: A resident came to our facility for a short stay with a Stage 4 pressure ulcer. The resident has since exhausted his 100 days of Medicare, became a long-term resident, and still has the Stage 4 pressure ulcer. Will this resident trigger the long-stay pressure ulcer measure?Question: A resident came to our facility for a short stay with a Stage 4 pressure ulcer. The resident has since exhausted his 100 days of Medicare, became a long-term resident, and still has the …
- Q&A: When a resident received IV fluids (K0520A) for hydration, but did not have any calories from the fluids, do we code K0710A (Proportion of total calories the resident received through parenteral or tube feeding) as 1. 25% or less?Question: When a resident received IV fluids (K0520A) for hydration, but did not have any calories from the fluids, do we code K0710A (Proportion of total calories the resident received through parenteral or tube feeding) …
- Q&A: A resident was admitted to our facility on Medicare Part A and passed in facility after only a couple of hours. I had scheduled a 5-Day/Admission for the 7th day before she passed. How do I set up MDS assessments?Question: A resident was admitted to our facility on Medicare Part A and passed in facility after only a couple of hours. I had scheduled a 5-Day/Admission for the 7th day before she passed. How …
- Q&A: A resident was recently admitted with multiple fractures related to an ATV accident. Is it appropriate to use Z47.89, Encounter for other orthopedic aftercare, as the principal diagnosis code?Question: A resident was recently admitted with multiple fractures related to an ATV accident. Is it appropriate to use Z47.89, Encounter for other orthopedic aftercare, as the principal diagnosis code? Answer from Carol Maher, …
- Q&A: I am confused with what can be included at O0110A1, chemotherapy while a resident. A resident is currently receiving Ibrance, as part of her cancer treatment. Can I code oral chemotherapy? Question: I am confused with what can be included at O0110A1, chemotherapy while a resident. A resident is currently receiving Ibrance, as part of her cancer treatment. Can I code oral chemotherapy? Answer from Scott …
- Q&A: A resident recently admitted to us with over 20 pressure ulcers and 10 of these are deep tissue pressure injuries. M0300 only allows us to enter a single digit amount 0-9 on the MDS. How do we code when it is 10 or more?Question: A resident recently admitted to us with over 20 pressure ulcers and 10 of these are deep tissue pressure injuries. M0300 only allows us to enter a single digit amount 0-9 on the MDS. …
- Q&A: I completed the pain interview with the resident two days before the ARD and he reported no pain. How do I code this when it conflicts with other medical record documentation?Question: I completed the pain interview with the resident two days before the ARD and he reported no pain. How do I code this when it conflicts with other medical record documentation? Answer from Jeff …
- Q&A: Would it be considered a delusion if a resident who has dementia states that they have a girlfriend in the absence of one, needs to go find their parents/spouse who are deceased, or needs to go find their truck so that they may go home?Question: Would it be considered a delusion if a resident who has dementia states that they have a girlfriend in the absence of one, needs to go find their parents/spouse who are deceased, or needs …
- Q&A: Is total parenteral nutrition (TPN) coded in MDS items O0110H (IV Medication), K0520A (Parenteral/IV Feeding), and K0710 (Percent Intake by Artificial Route)?Question: Is total parenteral nutrition (TPN) coded in MDS items O0110H (IV Medication), K0520A (Parenteral/IV Feeding), and K0710 (Percent Intake by Artificial Route)? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: TPN is an …
- Q&A: When is the new Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN) (2024) required to be used? Question: When is the new Skilled Nursing Facility Advanced Beneficiary Notice (SNF ABN) (2024) required to be used? Answer from Jessie McGill, RN, BSN, RAC-MT, RAC-MTA: The updated SNF ABN (2024), CMS form 10055, must …
- Q&A: A resident had a right below-knee amputation (BKA) a month ago and a Significant Change in Status Assessment (SCSA) was completed at that time. The resident is now going back to have a revision done from the BKA to above-knee amputation (AKA). Would the second surgery be considered a significant change also?Question: A resident had a right below-knee amputation (BKA) a month ago and a Significant Change in Status Assessment (SCSA) was completed at that time. The resident is now going back to have a revision …
- Q&A: I transmitted an assessment with an ARD of 10/3/24. Our software scrubber said the assessment had an error because I signed Z0500 on 10/3/24. The assessment was accepted by CMS. Is there a penalty for early completion of the MDS?Question: I transmitted an assessment with an ARD of 10/3/24. Our software scrubber said the assessment had an error because I signed Z0500 on 10/3/24. The assessment was accepted by CMS. Is there a penalty …
- Q&A: Please clarify the law regarding ICD-10 coding of HIV (B20). Is it a HIPAA violation to include this diagnosis under the medical diagnoses section in the medical record? Question: Please clarify the law regarding ICD-10 coding of HIV (B20). Is it a HIPAA violation to include this diagnosis under the medical diagnoses section in the medical record? Answer from Carol Maher, RN, GERO-BC, …
- Q&A: If a long-term resident was transferred to the Emergency Department (ED) and passed away while at the ED, do I complete a Discharge Return Not Anticipated assessment or a Death-in-Facility record?Question: If a long-term resident was transferred to the Emergency Department (ED) and passed away while at the ED, do I complete a Discharge Return Not Anticipated assessment or a Death-in-Facility record? Answer from Scott …
- Q&A: I found that some of our assessments with dashes received both errors -3897 and -3908 for the same assessment. Will both of these errors count against the facility’s SNF QRP annual payment update (APU) compliance since the resident showed up twice on the report?Question: I found that some of our assessments with dashes received both errors -3897 and -3908 for the same assessment. Will both of these errors count against the facility’s SNF QRP annual payment update (APU) …
- Q&A: Can I use ICD-10 diagnoses that are included in physician notes within the last 60 days that are listed as ‘previous medical history’? These diagnoses have no medication orders and are not listed on the plan of care. Question: Can I use ICD-10 diagnoses that are included in physician notes within the last 60 days that are listed as ‘previous medical history’? These diagnoses have no medication orders and are not listed on …
- Q&A: Would bells on a bathroom door be coded as “other alarm” in section P? The bells are placed on the door to alert staff when a resident enters the bathroom alone.Question: Would bells on a bathroom door be coded as “other alarm” in section P? The bells are placed on the door to alert staff when a resident enters the bathroom alone. Answer from Denise …
- Q&A: How often should the trauma-informed care assessments be completed? Question: How often should the trauma-informed care assessments be completed? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: The following language is from F699. I would focus your assessment efforts on meeting …
- Q&A: A resident was transferred to the hospital and admitted twice during the 60-day wellness period. Will the hospital admissions prevent him from achieving a 60-day wellness period?Question: A resident was transferred to the hospital and admitted twice during the 60-day wellness period. Will the hospital admissions prevent him from achieving a 60-day wellness period? Answer from Jeff Taylor: The resident will …
- Q&A: Can a resident be skilled for Medicare Part A for wound vac services and, on few occasions, daily dressing changes? The resident is in a skilled-level environment with 24-hour nursing services.Question: Can a resident be skilled for Medicare Part A for wound vac services and, on few occasions, daily dressing changes? The resident is in a skilled-level environment with 24-hour nursing services. Answer from Scott …
- Q&A: Can the pain interview be completed during the 7-day look-back or does it need to be completed during the 5-day look-back period?Question: Can the pain interview be completed during the 7-day look-back or does it need to be completed during the 5-day look-back period? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: The pain interview …
- Q&A: Can an End of PPS be done since a resident is not leaving the facility but just changing payor sources?Question: Can an End of PPS be done since a resident is not leaving the facility but just changing payor sources? Answer from Jeff Taylor: Yes, it’s required for any discharge from Medicare Part A …
- Q&A: A resident was placed in strict isolation and a COVID-19 test was completed due to complaints of a sore throat and cough. The test was negative, but the resident remains in isolation in room due to ongoing symptoms. Can isolation be coded on the MDS in this situation?Question: A resident was placed in strict isolation and a COVID-19 test was completed due to complaints of a sore throat and cough. The test was negative, but the resident remains in isolation in room …
- Q&A: If the registered dietitian writes that the resident is at risk for malnutrition, but the physician doesn’t review and sign that he agrees until after the ARD, should risk for malnutrition be coded on the MDS?Question: If the registered dietitian writes that the resident is at risk for malnutrition, but the physician doesn’t review and sign that he agrees until after the ARD, should risk for malnutrition be coded on …
- Q&A: A resident went on leave of absence (LOA) and after being out for two weeks decided he wanted to be discharged and only return to pick up belongings and discharge paperwork. What is the official discharge date?Question: A resident went on leave of absence (LOA) and after being out for two weeks decided he wanted to be discharged and only return to pick up belongings and discharge paperwork. What is the official …
- Q&A: Does an Interim Payment Assessment (IPA) take the place of a Significant Change in Status Assessment (SCSA) for a Medicare Part A resident or should both be completed?Question: Does an Interim Payment Assessment (IPA) take the place of a Significant Change in Status Assessment (SCSA) for a Medicare Part A resident or should both be completed? Answer from Carol Maher, RN-BC, RAC-MTA, …
- Q&A: A resident will continue skilled coverage for direct nursing care for an unstageable wound. What documentation is needed to support coverage for the wound?Question: We have a resident who is on Medicare Part A and therapy is being discontinued. She will continue skilled coverage for direct nursing care for an unstageable wound. There is a daily treatment including dressing change, …
- Q&A: Is it acceptable to use a hospital weight obtained during the look-back of an admission MDS to code K0200?Question: Is it acceptable to use a hospital weight obtained during the look-back of an admission MDS to code K0200? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO Any weight taken in …
- Q&A: Is there a CMS document that states section GG usual performance can be determined after the 3-day window?Question: We received denial during a Medicare Advantage audit stating “clinical documentation does not support the PT, OT, and Nursing function score for all section GG payment items during the 1-3 of the skilled stay. …
- Q&A: Is there a report that can be pulled that shows exactly which assessments are falling out of compliance with the SNF QRP APU reporting threshold so we can review to ensure proper MDS coding? Question: Is there a report that can be pulled that shows exactly which assessments are falling out of compliance with the SNF QRP APU reporting threshold so we can review to ensure proper MDS coding? …
- Q&A: When is the appropriate timeframe to code question B0100 on the MDS?Question: When is the appropriate timeframe to code question B0100 on the MDS? Answer from Jeff Taylor After the ARD. The steps for assessment and coding instructions say to review the record for the observation period …
- Q&A: Would a chest strap be considered a restraint for a resident who makes no free movements, and it does not restrict him from any normal access to his body?Question: A long-term resident has used a seatbelt on his chair for several years. Recently, the occupational therapist fitted him with a chest support strap for postural support instead. I had been coding the seatbelt …
- Q&A: Can we skill a resident for uncomplicated tube-feedings if he is no longer receiving skilled care related to the primary reason for the Medicare stay?Question: Can we skill a resident for uncomplicated tube-feedings if he is no longer receiving skilled care related to the primary reason for the Medicare stay? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, …
- Q&A: What is the evidence that Enhanced Barrier Precautions are effective at preventing MDRO transmission?Question: What is the evidence that Enhanced Barrier Precautions are effective at preventing MDRO transmission? Answer from CDC Long-Term Care Facilities FAQs about enhanced barrier precautions webpage question seven. The evidence that Enhanced Barrier Precautions …
- Q&A: Can we use administrative presumptive of coverage even though direct skilled care will only be provided on the first three days of the stay?Question: We are admitting a resident today after a qualifying hospital stay who will only have a skilled service of IV antibiotics for the first three days of their stay. Could we use administrative presumptive …
- Q&A: For blood transfusions and other services that are not excluded in consolidated billing, is our billing office supposed to submit a bill directly to Medicare for this service? Question: For blood transfusions and other services that are not excluded in consolidated billing, is our billing office supposed to submit a bill directly to Medicare for this service? Answer from Carol Maher, RN-BC, RAC-MTA, …
- Q&A: Does it count against the SNF APU Threshold, if we dashed the BIMS/PHQ-2 to 9 for residents who were only in the facility for two days, had unplanned discharges, and did not return to the facility?Question: Does it count against the SNF APU Threshold, if we dashed the BIMS/PHQ-2 to 9 for residents who were only in the facility for two days, had unplanned discharges, and did not return to …
- Q&A: Are section GG discharge goals providing a false error message that it impacts the provider threshold?Question: I thought starting Oct 2023 discharge goals for section GG were no longer required on the MDS. If discharge goals are not required is this a false error message that it is impacting the …
- Q&A: Is the Part A PPS Discharge (End of PPS) Assessment required for Medicare Advantage or Managed Care residents?Question: Is the Part A PPS Discharge (End of PPS) Assessment required for Medicare Advantage or Managed Care residents? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC It is up to the Managed …
- Q&A: Is a “Level 7-Easy to Chew” diet coded as a mechanically altered diet?Question: Is a “Level 7-Easy to Chew” diet coded as a mechanically altered diet? Could there be ADR concerns? Note: “Level 7-Easy to Chew” is from the International Dysphagia Diet Standardization Initiative (IDDSI), more information …
- Q&A: To code isolation in section O, does the isolation need to be every day during the look-back period?Question: To code isolation in section O, does the isolation need to be every day during the look-back period? Also, if the resident has COPD and shortness of breath is not documented, but it is …
- Q&A: Is a Notice of Medicare Noncoverage (NOMNC) beneficiary notice required when the resident and family request services be ended?Question: A resident is receiving speech-language pathology services under Medicare Part B. The resident and family decided they no longer want to pay the copays and requested services be ended. Is a Notice of Medicare …
- Q&A: If two PHQ mood interviews were completed during the look-back period, which should we use?Question: If two PHQ mood interviews were completed during the look-back period, which should we use? Our social services worker completes the PHQ mood interview, but sometimes one is also completed by the psychologist/ psychiatrist …
- Q&A: If a resident triggered the Quality Measure for long-stay indwelling catheter in Jan. 2024 and then passed away, would his passing remove him from triggering the measure?Question: If a resident triggered the Quality Measure for long-stay indwelling catheter in Jan. 2024 and then passed away, would his passing remove him from triggering the measure? Answer from Jessie McGill, RN, BSN, RAC-MT, …
- Q&A: If a resident is care planned for a certain expected behavior, must we code the behaviors on the MDS?Question: If a resident is care planned for a certain expected behavior, must we code the behaviors on the MDS? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC You must code any behaviors …
- Q&A: Can a weight taken after the ARD be used for the MDS?Question: Can a weight taken after the ARD be used for the MDS? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO No, data collected after the ARD cannot be coded on the …
- Q&A: Can a long-term care resident who exhausted his Medicare benefits three months ago, but continued to receive dialysis three times per week earn a new 100-day benefit period?Question: A long-term care resident who is on dialysis three times per week exhausted his Medicare benefits and has been in the facility with Medicaid as the primary payer for the last three months. He …
- Q&A: Is the facility responsible for the expense of a family requested specialty enteral tube feeding formula for a resident on a Medicare Part A stay?Question: Is the facility responsible for the expense of a family requested specialty enteral tube feeding formula for a resident on a Medicare Part A stay? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, …
- Q&A: If a resident goes to the emergency room 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 MDS? 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 …
- Q&A: For what situation would we use the activity not attempted code “10” in section GG?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 …
- Q&A: I found two assessments with outdated dementia ICD-10 codes that do not map to PDPM. How do I update these codes?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 …
- Q&A: For residents who have intrathecal pain pumps, this is coded under IV medications (O0110H1), but how do I code this under IV access (O0110O1)?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 …
- Q&A: 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 the discharge assessment to capture the fracture in section I and J?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 …
- Q&A: When making a correction to a completed assessment prior to submission, are we required to enter the date the correction was made in Z0500B?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: …
- Q&A: 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 discharge and again for the new hospice enrollment?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 …
- Q&A: 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 M0100, M0210, and M0300? 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 …
- Q&A: 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 would this change if he returns within the 3-day interruption window?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 …
- Q&A: How do you set section GG discharge goals for a resident who is also receiving care for end of life? 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 …
- Q&A: A resident enrolled in hospice revoked services for a skilled Medicare Part A stay during the month. What is required for beneficiary notices and assessments if the resident transitions to a Medicare Advantage plan at the beginning of the next month?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 …
- Q&A: What is the consequence of a late MDS submission?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 …
- Q&A: 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?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, …
- Q&A: 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 and Bladder measure?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 …
- Q&A: 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?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, …
- Q&A: 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: 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? …
- Q&A: Are we required to complete physician certifications and recertifications for Medicare Advantage or just for Original Medicare? Where is the source guidance?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 …
- Q&A: For the “Admission Performance” in section GG, if therapy is started on day two and the resident’s performance improved on day two, do we still have to code their baseline usual functions from day one data?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 …
- Q&A: If a resident is discharged to the hospital on day 14, does an Admission MDS need to be completed?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 …
- Q&A: When does the Pain Assessment interview need to be conducted? 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 …
- Q&A: Is there a standard letter or beneficiary notice that we have to use when a resident exhausts Medicare benefits?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 …
- Q&A: Please clarify when a device would or would not be considered a restraint?Question: Can a winged versus a concave mattress be considered a restraint if it fits the definition? Can a tilt and space wheelchair be considered a restraint? It is being explained to me that it …
- Q&A: We have a resident that is in our facility for skilled services under Medicare Part A. The family took the resident out for a funeral, and she did not return within 24 hours. Is this a Medicare Part A discharge?Question: We have a resident that is in our facility for skilled services under Medicare Part A. The family took the resident out for a funeral, and she did not return within 24 hours. Is …
- 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: 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: Is overseeing the Therapy department within the scope of the DNS position?Question: I am a relatively new DNS and my job description includes overseeing the Therapy Department. Is this within my scope? Answer: In most SNFs, the therapy department usually has its own director/manager, with ultimate oversight …
- Q&A: Does anyone have an ‘International Dysphagia Diet Standardization Initiative’ policy?Question: Does anyone have an ‘International Dysphagia Diet Standardization Initiative’ policy? Answer: The IDDSI framework has many resources and guidance on how to implement the framework. https://iddsi.org/framework/ Consider convening a meeting with the dietitian, ST, …
- Q&A: How do I code the primary diagnosis on the UB-04 for a Medicare Part A resident?Question: When I received training for ICD-10 coding as it relates to billing, I was taught that the primary diagnosis code for long term SNF residents on a UB-04 claim would be their primary diagnosis …
- Q&A: Are we responsible for dental appointments (toothache) on our Medicare Part A residents or does the dentist bill the family?Question: Are we responsible for dental appointments (toothache) on our Medicare Part A residents or does the dentist bill the family? Answer: Dental coverage is not part of the Medicare Part A program, so the …
- Q&A: How should diagnoses be listed on the UB-04 claim?Question: I understand that the diagnosis in I0020B should be listed as the principal diagnosis on the UB-04 claim; however, should the remaining diagnoses be listed in order according to the main reasons the resident …
- Q&A: When residents pass away at the facility and do not have a funeral home listed, how long (hours) are we able to keep the body?Question: This situation seems to be happening at my facility more and more. When residents pass away at the facility and do not have a funeral home listed, how long (hours) are we able to …