AAPACN Q&A from Nurse Experts on LTPAC

Questions & Answers from AAPACN

Q&A: If a resident has four bowel movements in the past seven days, but there is also documentation that she was given a laxative PRN x1 for constipation, do I code constipation on the MDS?August 3, 2021
Question: If a resident has four bowel movements in the past seven days, but there is also documentation that she was given a laxative PRN x1 for constipation, do I code constipation on the MDS? …
Q&A: How do you determine “while a resident” or “while not a resident” when a resident goes out to the hospital and returns?August 3, 2021
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?August 3, 2021
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: Is the 3-day hospital waiver still in place?July 26, 2021
Question: Is the 3-day hospital waiver still in place? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-CT, QCP: Yes, the Public Health Emergency (PHE) was just renewed again on July 20, 2021, which continues all …
Q&A: A resident converted from Managed Care to Traditional Medicare. How is a recent fall captured on the current 5-Day PPS assessment?July 20, 2021
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?July 20, 2021
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?July 20, 2021
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?July 13, 2021
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?July 6, 2021
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?July 6, 2021
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?July 6, 2021
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?June 22, 2021
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?June 15, 2021
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?June 15, 2021
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?June 15, 2021
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?June 8, 2021
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?June 1, 2021
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?June 1, 2021
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?June 1, 2021
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?May 24, 2021
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: A patient admitted under Original Medicare Part A. Within a couple of hours, his family decided to take him home. What assessments are needed?May 18, 2021
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 …
Q&A: 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?May 18, 2021
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: …
Q&A: Is metabolic acidosis a skilled diagnosis?May 18, 2021
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?May 11, 2021
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 we use ICD-10 codes for both Alzheimer’s disease and Psychotic disorder in section I?May 3, 2021
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 …
Q&A: If a resident is enrolled in hospice, can they still receive therapy under Part B?May 3, 2021
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 …
Q&A: Does a wound vac count as a daily treatment to the wound?May 3, 2021
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 …
Q&A: How do you access 2021 AAPACN Conference sessions you wanted to see but may have missed?April 27, 2021
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 …
Q&A: Can a Medicare Part A resident be skilled for an unstageable pressure injury?April 21, 2021
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 …
Q&A: 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?April 21, 2021
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 …
Q&A: In gathering information for a 5-Day MDS, I noted that the patient had a drug-to-drug interaction. How is this coded in N2001-N2003, drug regimen review and follow up items?April 21, 2021
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 …
Q&A: Can a CNA cut, trim, or even color a resident’s hair?April 14, 2021
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: What happens to residents who started skilled services using a waiver and then the COVID-19 public health emergency (PHE) and waivers end?April 6, 2021
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 …
Q&A: Do we have to gather three full days of GG data when scheduling an interim payment assessment (IPA)?April 6, 2021
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 …
Q&A: If a Medicare Part A resident expires prior to the completion deadline, do you still complete the 5-Day assessment to get paid by Medicare?April 6, 2021
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 …
Q&A: 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 from our facility. What should I do?March 22, 2021
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 …
Q&A: A therapy director is instructing the therapists to add minutes under section O for donning and doffing of PPE. Is this correct?March 15, 2021
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 …
Q&A: A resident claims that she has no pain during the scripted interview, but the medication administration record (MAR) shows use of PRN pain medication daily. How do I code the MDS?March 15, 2021
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 …
Q&A: How are you gathering admission function scores for section GG when the observation period is the ARD plus two previous days for assessments like the Interim Payment Assessment (IPA)?March 15, 2021
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 …
Q&A: If all that my facility reports to NHSN is COVID data, are we required to complete the annual NHSN survey?March 9, 2021
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 …
Q&A: When a resident on Medicare Part A exhausts benefits, would a PPS Discharge Assessment need to be completed?March 2, 2021
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. …
Q&A: Can we skill a new resident under Medicare A if they are started on oxygen therapy and we are titrating it?March 2, 2021
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 …
Q&A: Per the CDC guidelines, how many Pneumococcal vaccines do our residents need to be considered up to date?March 2, 2021
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: Does a SNF ABN need to routinely be given to all new admissions?February 24, 2021
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 …
Q&A: 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?February 24, 2021
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 …
Q&A: 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 run the swab?February 24, 2021
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 …
Q&A: What interventions have you found to be successful for residents who are not eating or eating poorly after COVID illness?February 23, 2021
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 …
Q&A: What can facility leadership do to best improve Quality Measures?February 9, 2021
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 …
Q&A: My Five-Star rating really changed. Where can I find the details or explanations of the changes?February 2, 2021
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 …
Q&A: Our nurses complete a respiratory therapy assessment on all new admissions for the first seven days. Can we count these minutes on the MDS?February 2, 2021
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 …
Q&A: Can I use the ICD-10 Code, Z47.89 Encounter for other orthopedic aftercare, in addition to the fracture code?February 2, 2021
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 …
Q&A: Do the Focused Infection Control surveys affect my facility’s Five-Star rating?January 26, 2021
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 …
Q&A: Do parenteral or IV fluids count under Special Care High for while a resident and while not a resident?January 26, 2021
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 …
Q&A: In the past 30 days, but prior to admission, a resident had a diagnosis of UTI and was treated with antibiotics. Should I code UTI on the MDS?January 26, 2021
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 …
Q&A: How should we be coding B0200, Hearing, when speaking loudly due to face shields and masks?January 26, 2021
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 …
Q&A: Where can I find information on how to combat burnout?January 13, 2021
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 …
Q&A: Are there specific guidelines for what would trigger a Significant Change in Status Assessment (SCSA) for a resident?January 12, 2021
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 …
Q&A: A resident on Medicare Part A admitted with a stroke and later became COVID-19 positive. How and when do I set an IPA ARD?January 12, 2021
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 …
Q&A: A resident on Medicare Part A discharged home, return not anticipated, and returned within 24 hours. Is this an interrupted stay?January 12, 2021
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 …
Q&A: How do I change an email address in SAMS/NHSN?December 15, 2020
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 …
Q&A: Our facility has a “COVID-19 unit” that is one large room divided by curtains. Can isolation be coded for these residents?December 15, 2020
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 …
Q&A: Although an IPA is a standalone assessment (cannot be combined with PPS or OBRA), can we still combine it with a discharge assessment when it is an unplanned discharge?December 15, 2020
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 …
Q&A: Can someone help me understand when to apply the COVID-19 “Encounter for screening and the exposure to” codes?December 15, 2020
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 …
Q&A: Where can I go to get information regarding face masks?December 8, 2020
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 …
Q&A: 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?December 1, 2020
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 …
Q&A: When a long-term care resident tests positive for COVID-19, can we skill the resident under Medicare Part A for nursing skilled services?December 1, 2020
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 …
Q&A: 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?December 1, 2020
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? …
Q&A: How can I improve influenza vaccinations among my staff?November 17, 2020
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 …
Q&A: We recently completed a Significant Change in Status Assessment (SCSA) for a resident with a prognosis of less than six months. Is another SCSA required with a hospice election today?November 17, 2020
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 …
Q&A: Is the Part A PPS Discharge Assessment (NPE) or Interim Payment Assessment (IPA) required for insurance companies?November 17, 2020
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 …
Q&A: All therapy is ending for a Medicare Part A resident. What assessments are needed to continue to skill for direct nursing services?November 17, 2020
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 …
Q&A: Where can I find ideas to use at my facility to improve staff resiliency?November 3, 2020
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 …
Q&A: A resident had a fall with a fracture and delayed healing. Can I code aftercare in I8000?November 2, 2020
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 …
Q&A: Will a Fall with Major Injury remain on the Quality Measures (QMS) for 275 days even though the resident has been discharged?November 2, 2020
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 …
Q&A: Can a resident ask for both an expedited appeal and a demand bill?November 2, 2020
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, …
Q&A: What is the required temperature of refrigerators in resident rooms?October 27, 2020
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 …
Q&A: 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?October 20, 2020
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 …
Q&A: A resident uses two half-siderails when in bed but is not able to remove the siderails once they are up. Should the siderails be coded as a restraint in section P?October 19, 2020
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 …
Q&A: A resident on Medicare Part A discharged home on Oct. 7 and readmitted back to our facility on Oct. 9. Is this an interrupted stay? Should I do a 5-Day or an IPA?October 19, 2020
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 …
Q&A: What are the new emergency preparedness testing exercise requirements?October 13, 2020
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 …
Q&A: Our state is requiring PDPM data on OBRA assessments. Is section GG collected on only Medicaid residents or for all payer types?October 6, 2020
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, …
Q&A: Are the Quality Measures (QMs) still frozen? If so, does anyone know how long they will remain frozen?October 6, 2020
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 …
Q&A: A resident already had their Medicare benefit extended related to COVID-19. Can this same beneficiary receive another 100 days using the waivers?October 6, 2020
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, …
Q&A: Is there a waiver for the lack of staffing in nursing homes during the pandemic?September 22, 2020
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 …
Q&A: Therapy completed an evaluation and determined PT services were not needed, but reported individual treatment minutes—can this be coded on the MDS?September 15, 2020
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 …
Q&A: 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?September 15, 2020
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 …
Q&A: If a resident has orders to receive an altered consistency of medications, would this be coded at K0510C, mechanically altered diet?September 15, 2020
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 …
Q&A: What factors does nursing leadership in your facility review upon receiving an admission referral?September 8, 2020
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 …
Q&A: Under PDPM, do I complete the PPS Discharge Assessment (NPE) when therapy ends or wait until the Medicare stay ends?September 1, 2020
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 …
Q&A: How do I determine if this is an interrupted stay and what discharge assessments are needed?September 1, 2020
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 …
Q&A: Our facility was not notified timely of a change from managed care to Medicare Part A. Can we bill Medicare Part A for any of the days?September 1, 2020
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 …
Q&A: Could you please share some really good interview questions for an ADON position?August 25, 2020
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 …
Q&A: How do Part B minutes get captured on the MDS?August 19, 2020
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 …
Q&A: 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)?August 19, 2020
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 …
Q&A: Do interrupted stays apply to Medicare Advantage Plans?August 19, 2020
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 …
Q&A: 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?August 10, 2020
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: …
Q&A: Does anyone know about the 23 Modules of COVID-19 training that the CDC is going to require?August 4, 2020
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 …
Q&A: I had two residents trigger for dehydration on the CMS 802 Matrix. How is this triggered?August 4, 2020
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 …
Q&A: I have a few questions regarding the 3-midnight qualifying hospital stay. My first question is – do I need documentation for why the resident was not sent to the acute hospital?August 4, 2020
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 …
Q&A: What do providers do when they have a CLIA waiver number and yet come up on the list that indicates to CMS that the provider does not have a CLIA number?July 28, 2020
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 …