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, …
Question: If an OBRA or PPS assessment is completed late but the ARD was set timely in the appropriate window, is there a financial penalty or is it just a possible survey tag? Answer from …
Question: Is a physician order needed for a restorative passive range of motion (PROM) program? Answer from Kim Steele, RN, WCC, RAC-CT, RAC-CTA: No, a physician order is not required for nursing restorative programs, but …
Question: A resident on Medicare Part A admitted to the facility from the hospital on 5/26. He was sent to the emergency department (ED) on 5/27 and remained there on observation until 5/29. He readmitted …
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, …
Question: A resident admitted for skilled care under a Medicare Advantage (MA) plan. The plan did not require a 3-day qualifying hospital stay (QHS) and the resident was hospitalized for observation only. The resident has …
Question: We had a resident come in with a leg fracture four months ago. At that time, he required extensive assist. He worked with therapy and became independent in functional activities by the end of …
Question: What training is required for nurse aides to work with residents in a Restorative Program? I have reviewed Chapter 3, Section O0500 (page O-43) in the RAI User’s Manual but wondered, other than the …
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 …
Question: A patient admitted under Original Medicare Part A. Within a couple of hours, his family decided to take him home. What assessments are needed? Answer from Carol Maher, RN-BC, CPC, RAC-MT: Since the resident …
Question: A resident returned following a hip fracture from a fall. Would his primary diagnosis be the S-code for the fracture, or the Z-code for aftercare? Answer from Jennifer LaBay RN, RAC-MT, RAC- MTA, CRC: …
Question: Is metabolic acidosis a skilled diagnosis? Answer from Kim Steele, RN, WCC, RAC-CT, RAC-CTA: While a resident can be skilled for this, it is critical that you have the details of why it is …
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 …
Question: We have a resident that has an order for Seroquel for Alzheimer’s disease with psychotic features as manifested by episodes of hallucination of seeing deceased relatives in their room. Can we use ICD-10 codes …
Question: If a resident is enrolled hospice, can they still receive therapy under Part B? If so, what is the process to do this? Does the hospice agency need to approve it or does the …
Question: Does a wound vac count as a daily treatment to the wound? Answer from Janine Cortesa, RN, BSN: Typically, the wound vac does not require daily changing and is therefore not a daily skilled …
Question: How do you access 2021 AAPACN Conference sessions you wanted to see but may have missed? Answer: Members who registered for the 2021 AAPACN Conference but were unable to view a session live can …
Question: Can a Medicare Part A resident be skilled for an unstageable pressure injury? Answer from Janine Cortesa, RN, BSN, RAC-CT: You must always look at what skill services are needed, not the name of the condition. An …
Question: If a resident is considered skilled using the three-day qualifying stay and the waiver ends during their skilled stay, does the skilled stay need to end as well? Answer from Jessie McGill RN, RAC-MT, RAC-MTA: The …
Question: In gathering information for a 5-Day MDS, I noted that the patient had a drug-to-drug interaction. This was not identified on the initial medication review. In answering N2001, should I say “No” since this was not …
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 …
Question: What happens to residents who started skilled services using a waiver and then the COVID-19 public health emergency (PHE) and waivers end? Answer: CMS addressed this in the PPS COVID FAQ doc, page …
Question: Do we have to gather three full days of GG data when scheduling an interim payment assessment (IPA)? Answer: You have a 3-day window (ARD and the prior 2 days) to determine the Interim …
Question: If a Medicare Part A resident expires prior to the completion deadline for an assessment, the RAI User’s Manual states that the assessment is not required, but should you still complete the 5-Day assessment …
Question: I have a resident who dropped off the active resident list on the MDS 3.0 Resident Level Quality Measure Report, but is still in our facility and receiving services. He was never physically discharged …
Question: A therapy director is instructing the therapists to add minutes under section O for donning and doffing of PPE. He is using section O of the RAI User’s Manual listed below to justify this …
Question: During an interview with a resident who has cognitive impairment, she claims that she has no pain, but the MAR shows use of PRN pain medication daily. Should I still code “no pain” on …
Question: In our facility, therapists record function scores within the first 3 days after admission. How are other facilities gathering admission function scores for section GG when the observation period is the ARD plus two previous …
Question: If all that my facility reports to NHSN is COVID data, are we required to complete the annual NHSN survey? Answer: The survey is not required for facilities submitting only COVID-19 data. However, the 2020 …
Question: We have a resident on Medicare Part A who exhausted her benefits related to daily skilled nursing services of treating a stage 4 pressure ulcer and continues to receive a skilled level of care. …
Question: Can we skill a new resident under Medicare A if they are started on oxygen therapy and we are titrating it? Answer: Yes, during the initial phases of oxygen therapy and the process of …
Question: Per the CDC guidelines, how many Pneumococcal vaccines do our residents need to be considered up to date? We have some with only one vaccine and some with two. If they only have one …
Question: Does a SNF ABN need to routinely be given to all new admissions? My understanding is that we would not issue a SNF ABN if Medicare technical requirements were not met. Example 1, a …
Question: I was told that if the resident needs two staff members in section G, then in GG they are automatically marked as dependent for that task. Is this correct? Answer: Remember that section G …
Question: When we are testing all of our residents for COVID-19 due to a staff member or another resident testing positive, what is the ICD-10 code that should be used when placing the order to …
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 …
Question: What can facility leadership do to best improve Quality Measures? Answer: It takes time and intentional effort to develop and implement processes that consistently produce quality, which is then reflected in Quality Measure …
Question: My Five-Star rating really changed. Where can I find the details or explanations of the changes? Answer: There have been several changes. Basically, the Five-Star system was refreshed with previous data that had …
Question: Our nurses complete a respiratory therapy assessment on all new admissions for the first seven days. The RAI User’s Manual states that only minutes the respiratory therapist or respiratory nurse spend with the resident …
Question: Can I use the ICD-10 Code, Z47.89 Encounter for other orthopedic aftercare, in addition to the fracture code? Does it allow a fracture to map to an Orthopedic Surgery category? Answer: Per the …
Question: Do the Focused Infection Control (FIC) surveys affect my facility’s Five-Star rating? Answer: Yes, the Focused Infection Control (FIC) surveys do affect a facility’s Five-Star rating. Deficiencies cited on FIC surveys are treated slightly …
Question: I need clarification on parenteral or IV fluids. Do they count under Special Care High for while a resident and while not a resident (in hospital)? I have been watching the On Demand PDPM Essentials workshop …
Question: In the past 30 days, prior to admission, a resident had a diagnosis of UTI and was treated with antibiotics. However, the culture showed no growth. Should I code UTI in the past 30 …
Question: How should we be coding B0200, Hearing? The reason I am asking is because of face shields and masks. When I wear an N95 mask, I have to speak very loudly so the resident …
Question: Where can I find information on how to combat burnout? Answer: AAPACN’s Wellness for LTPAC Professionals webpage has many resources to combat burnout and cultivate resiliency and gives tips for maintaining general wellness for …
Question: Are there specific guidelines for what would trigger a Significant Change in Status Assessment (SCSA) for a resident? Answer: The RAI User’s Manual has very specific guidelines for when a Significant Change in …
Question: A resident on Medicare Part A admitted in early December with a primary diagnosis of a stroke. After the Admission/5-Day ARD, she became COVID-19 positive and was placed in single room isolation. Should I …
Question: We had a resident on Medicare Part A who discharged to home, return not anticipated, and started home health that same evening. Sadly, he failed less than 24 hours even with supports in place …
Question: How do I change an email address in SAMS/NHSN? Answer: Follow the steps on the following PDF to edit an email address. https://www.cdc.gov/nhsn/pdfs/gen-support/edit-email-sams-facility-508.pdf Interested in reading more FAQs? Visit the AADNS Network where …
Question: Our facility has a “COVID-19 unit” that is one large room divided by curtains. There are five sections in the room and each section has two beds. Can we code for isolation when a …
Question: We had planned on an IPA for a resident on 12/3 due to COVID with symptoms. They were already skilled for other things prior. Unfortunately, their condition worsened, and they were sent to the …
Question: Can someone help me understand when to apply the COVID-19 “Encounter for screening and the exposure to” codes? Answer: Here is what the FY2021 ICD-10-CM Guidelines state: e) Exposure to COVID-19 For asymptomatic …
Question: Where can I go to get information regarding face masks? Answer: The FDA has published Face Masks, Including Surgical Masks, and Respirators for COVID-19, a comprehensive new page on FDA.gov with answers to frequently asked …
Question: How long does a pressure injury stay on Quality Measures (QMs)? It was captured several months ago and is now resolved. When it will come off our QMs? Answer: There are two different …
Question: When a long-term care resident tests positive for COVID-19, can we skill the resident under Medicare Part A for nursing skilled services? Answer: You would need more than a positive diagnosis to warrant skilled …
Question: A resident started a new benefit period using the benefit period waiver. Daily skilled care is now ending. Do I need to issue any of the beneficiary notices to take the resident off Medicare? …
Question: How can I improve influenza vaccinations among my staff? Answer: The Centers for Disease Control and Prevention (CDC) has created a toolkit to help SNFs improve vaccination coverage among healthcare workers (HCP). This toolkit …
Question: A physician documented, “comfort cares with 6 months or less” for a resident a couple of weeks ago. This met the requirements of a Significant Change in Status Assessment (SCSA) and one was completed …
Question: Is the Part A PPS Discharge Assessment (NPE) or Interim Payment Assessment (IPA) required for insurance companies? Answer: The answer to this question would be totally dependent on each insurance company and what they …
Question: I have a resident who was readmitted to our SNF after being hospitalized with a CVA. The resident has deficits to her left side and returned with a PEG tube. She was being treated …
Question: Where can I find ideas to use at my facility to improve staff resiliency? Answer: 2020 has reminded all of us that resiliency, inspiration, and self-care are critical components of making it through …
Question: We have a resident who fell in their room, resulting in a right fractured patella, non-displaced. However, there was delayed healing due to noncompliance (the resident refused to wear a brace and continued to …
Question: A resident had a Fall with Major Injury and was counted on the Significant Change MDS with the Assessment Reference Date (ARD) 5/20/20. The resident then discharged back to the community on 7/8/20. Will …
Question: Can a resident ask for both an expedited appeal and a demand bill? Answer: Absolutely, they are two different processes that address two different issues. The Notice of Medicare Non-Coverage (NOMNC), or expedited appeal, …
Question: What is the required temperature of refrigerators in resident rooms? Answer: This requirement may differ from state to state, so I recommend you check with your local or state health department for your state’s …
Question: In section I, do we need a physician’s diagnosis for “risk of malnutrition,” or can we use the dietitian’s assessment to code in section I? Answer: Yes, you need a physician’s diagnosis. Please see …
Question: We have a resident who is cognitively intact and requires extensive assistance with bed mobility and transfers. He does not get out of bed unless being assisted by staff. He uses two half bed …
Question: A resident on Medicare Part A discharged home on 10/7/20 and unfortunately went back to the hospital 10/8/20. He readmitted back to our facility 10/9/20. Is this an interrupted stay? Should I do a …
Question: What are the new emergency preparedness testing exercise requirements? Answer: CMS regulations for Emergency Preparedness require specific testing exercises be conducted to validate the facility’s emergency program. During or after an actual emergency, the …
Question: Our state is requiring PDPM data on OBRA assessments. Is section GG collected on only Medicaid residents or for all payer types? Answer: For states that opted to collect PDPM data, including section GG, …
Question: Are the Quality Measures (QMs) still frozen? If so, does anyone know how long they will remain frozen? Answer: Yes, the publicly reported QMs for Five-Star are currently frozen and using the 2019 …
Question: I have a resident that benefited from the Qualifying Hospital Stay (QHS) waiver and used up all her 100 days under the QHS waiver initially due to a fibula fracture, and during this period, …
Question: Is there a waiver for the lack of staffing in nursing homes during the pandemic? Answer: Currently, the only federal waiver in place regarding staffing is the Training and Certification of Nursing Aides waiver. Review …
Question: Physical therapy completed an evaluation and determined the Medicare Part A resident did not need PT services. The therapist is stating she had 20 minutes of non-MDS time and 30 minutes of actual individual …
Question: If a resident discharges return anticipated and it is not an interrupted stay, should the therapy end date be dashed, or should the discharge date be entered in O0400? Answer: The therapy end …
Question: If a resident has orders to receive an altered consistency of medications, would this be coded at K0510C, mechanically altered diet? Answer: No. Crushed medications are not part of a diet. A mechanically altered diet …
Question: What factors does nursing leadership in your facility review upon receiving an admission referral? Answer: There are a number of things that a DON must look at when reviewing a referral. Understanding what your …
Question: Therapy is ending for a Medicare Part A resident, but the resident will continue on Medicare for daily skilled nursing care. Under PDPM, do I complete the PPS Discharge Assessment (NPE) when therapy ends …
Question: I need help on a possible interrupted stay. A Medicare resident discharged on 8/22 and returned today on 8/25. How do I determine if this is an interrupted stay and what discharge assessments are …
Question: A resident admitted with a managed care plan in April and the required assessments were completed. However, we were just notified that the resident switched over to traditional Medicare Part A almost three months …
Question: Could you please share some really good interview questions for an ADON position? Looking for questions that would show their commitment and knowledge to LTC. Answer: I like to use a combination of …
Question: How do Part B minutes get captured on the MDS? Answer: Part B minutes should be captured on the MDS when you are completing OBRA assessments. Based on the assessment reference date (ARD), therapy …
Question: If an alert and oriented resident wheels himself in and out of his room, to the dining room, and out onto the patio, is that wandering (E0900)? Answer: The RAI User’s Manual provides guidance …
Question: Do interrupted stays apply to Medicare Advantage Plans? Answer: Each Medicare Advantage plan can make their own rules for payment. Many follow the PPS schedule that includes interrupted stays. Others may not. The only …
Question: I am currently a Unit Manager and my next goal is to be a DON. How do I prepare as this is a big step? Answer: Response from Juzell Pettis, DNS-CT, DNS-MT, DWC, WCC: …
Question: Does anyone know about the 23 Modules of COVID-19 training that the CDC is going to require? Answer: As of July 24, the programs have not yet been released, they are still “rolling …
Question: I had two residents trigger for dehydration on the CMS 802 Matrix. I read the explanation that this was because the resident takes in 1500 ml or less fluids per day. Does this come …
Question: I have a few questions regarding the waiver for skilling residents without a 3- midnight hospital stay. I interpreted the waiver as ‘if we would not have sent the resident out to the hospital …
Question: Providers need a CLIA number so they can receive a point of care test kit from CMS. What do providers do when they have a CLIA waiver number and yet come up on the …
Question: Beneficiary notices were provided for a Medicare Part A resident with thea last covered day on 7/6. The resident restarted therapy on 7/9 at a skilled level under Medicare Part A. I believe this …
Question: A resident was recently discharged from Medicare Part A services after meeting her goals. We are going to restart therapy following a decline within the 30-day window. Is a 5-Day or an Interim Payment …
Question: We had a Medicare Part A resident discharge the day after she was admitted. The discharge was unplanned and the interviews for the BIMS and PHQ-9 were not completed. How do I code these …
Question: What does the respiratory protection program for nursing homes include? Answer: Response from Juzell Pettis, DNS-MT, DWC, WCC: Here is some help we sent out in Wisconsin to sort through the confusion – I …
Question: CMS announced the membership of the Independent Coronavirus Commission on Safety and Quality in Nursing Homes, which includes an AADNS member! Answer: Our own member Dallas Taylor, BSN, RN, Director of Nursing for Eliza …
Question: Is there an update for when annual surveys will be restarted? Answer: There was a recent QSOG posting: June 1, 2020 Ref: QSO-20-31-All COVID-19 Survey Activities, CARES Act Funding, Enhanced Enforcement for Infection Control deficiencies, …
Question: Can repositioning be coded as a non-pharmaceutical pain relief measure in section J of the MDS? Answer: Based on coding guidance from the RAI User’s Manual, page J-2, I would include repositioning as an …
Question: I have a resident who recently admitted for rehabilitation following a fall without a fracture at home and one-day observation stay at the hospital. There is no positive COVID-19 in the hospital or in …
Question: How does your facility handle employees that refuse to have a COVID-19 test? Answer: This is what we are doing: If employees refuse to be tested for any reason, they are having to quarantine at …
Question: Can the nursing assessment performed upon admission into a SNF be used to support skilled service under Medicare Part A if the skilled service is “Observation and Assessment”? Answer: The resident’s medical record …
Question: I have a patient who admitted with a stage 3 pressure ulcer. The wound physician stated it will take at least 4-6 weeks to heal. I know that stage 3 is a skillable service, …
