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: Is this an interrupted stay?Question: Is this an interrupted stay? A resident newly admits to the facility on 9/21 on a Medicare Part A stay. On 9/23, the resident was sent to the emergency room and was admitted to …
- Q&A: We have a resident for whom we are completing an Interim Payment Assessment (IPA). Would we also need to complete a Significant Change in Status Assessment (SCSA) at the same time due to these changes?Question: We have a resident for whom we are completing an Interim Payment Assessment (IPA). Would we also need to complete a Significant Change in Status Assessment (SCSA) at the same time due to these …
- Q&A: I am completing a Significant Change in Status Assessment (SCSA) for a resident who revoked hospice services. How should I code J1400 since hospice services were provided during the 14-day look-back period?Question: I am completing a Significant Change in Status Assessment (SCSA) for a resident who revoked hospice services. How should I code J1400 since hospice services were provided during the 14-day look-back period? I am …
- Q&A: Are there regulatory requirements regarding the use of outdoor patios by independent residents that should be included in a facility policy?Question: Are there regulatory requirements regarding the use of outdoor patios by independent residents that should be included in a facility policy? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT: There is no regulation …
- Q&A: If a resident is diagnosed with COVID-19 and an interim payment assessment (IPA) is completed, does the COVID diagnosis need to be coded at I0020b or I8000?Question: If a resident is diagnosed with COVID-19 and an interim payment assessment (IPA) is completed, does the COVID diagnosis need to be coded at I0020b or I8000? Answered by Melissa Brown, OTR/L, RAC-CT, CDP, …
- Q&A: Can I code a urinary tract infection (UTI) for a new admission from the hospital diagnosis if it’s within the 30-day look-back period?Question: Can I code a urinary tract infection (UTI) for a new admission from the hospital diagnosis if it’s within the 30-day look-back period? Answer by Vicki Gress, RN, RAC-CT: Yes, page I-13 of the …
- Q&A: If a resident goes out to the hospital and then is readmitted to the facility, do we have to complete a baseline care plan upon their readmission within 48 hours?Question: If a resident goes out to the hospital and then is readmitted to the facility, do we have to complete a baseline care plan upon their readmission within 48 hours? Answer by Carol Maher, …
- Q&A: Do residents in Wyoming need to have a two-step Mantoux test upon admission and readmission to a facility if it is in a low-risk area or will screening suffice?Question: Do residents in Wyoming need to have a two-step Mantoux test upon admission and readmission to a facility if it is in a low-risk area or will screening suffice? Answer from Alexis Roam, MSN, …
- Q&A: Can I code psychiatrist visits and orders in MDS items O0600 and O0700?Question: I have been coding psychiatrist visits and orders in MDS items O0600 and O0700. My consultant told me I can’t code this. I thought since a psychiatrist is a medical doctor that specializes in …
- Q&A: When coding K0510A, Nutritional Approach While Not a Resident, can I code IV hydration administered during a surgical procedure on the MDS?Question: When coding K0510A, Nutritional Approach While Not a Resident, can I code IV hydration administered during a surgical procedure on the MDS? Answer by Janine Cortesa, RN, BSN: Coding fluids here is only for …
- Q&A: Can Z codes be used as the primary diagnosis?Question: I was told that, as of the April update of this year, we are no longer allowed to use Z codes as the primary diagnosis. Is this true? Answer by Carol Maher, RN-BC, RAC-MTA, …
- Q&A: Where can I find information for use of CBD products in my facility?AAPACN has a podcast on this topic, CBD Oil Treatment and Care Planning for Nursing Home Residents with Rob Leffler. AMDA provides some information publicly on their website. If your medical director is a member of …
- Q&A: A resident expired at the hospital but was not admitted as an inpatient. Do I need to complete an OBRA Discharge assessment or Death in Facility tracking record?Question: We had a resident code in the facility and was emergency transported to the hospital. The resident expired at the hospital but was never officially admitted to the hospital as an inpatient. Do I …
- Q&A: Our billing department is being told by a third party that if we code any “unspecified” diagnoses in I8000, Medicare will deny it. Is this accurate?Question: Our billing department is being told by a third party that if we code any “unspecified” diagnoses in I8000, Medicare will deny it. Is this accurate? Answered by Jeff Taylor: This is absolutely false. …
- Q&A: Can a nurse licensed in one state complete sections of the MDS for another state?Question: Can a nurse licensed in one state complete sections of the MDS for another state? Answered by Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: Unless there is a compact between states, the nurse …
- Q&A: Can an LPN/LVN be the infection preventionist for a skilled nursing facility?Question: Can an LPN/LVN be the infection preventionist for a skilled nursing facility? Answer from Denise Winzeler BSN, RN, LNHA, DNS-MT, QCP-MT: Yes, an LPN/LVN can be the infection preventionist as long as they have …
- Q&A: The physician documented “right sided weakness due to CVA,” but did not mention “hemiparesis.” Can I not code “hemiparesis” on the MDS?Question: A resident had a cerebrovascular accident (CVA) and a significant change in status assessment is being completed. The physician documented “right sided weakness due to CVA,” but did not mention “hemiparesis.” Can I not …
- Q&A: We discovered coding errors that go back to 2020. What is the requirement to correct these assessments?Question: We discovered coding errors that go back to 2020, when a resident first enrolled in hospice services. The prior staff member did not code hospice on any MDS assessment from that time and the …
- Q&A: Can a resident be skilled for Medicare Part A and receive hospice care?Question: Can a resident be skilled for Medicare Part A and receive hospice care? Answer by Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: In order to cover someone on hospice for Medicare A, the …
- Q&A: Do staff have rights when it comes to residents bullying them? How do you manage a resident bully?Answer from Staci Carstens: If a resident is bullying staff, we try to have that staff person avoid that resident or we do double approach with cares. Also, is there an underlying issue with the …
- Q&A: I’m new to MDS. Is there anything that needs to be completed on the MDS before the resident leaves for a planned discharge back to the community?Question: I’m new to MDS. Is there anything that needs to be completed on the MDS before the resident leaves for a planned discharge back to the community? Answered by Kim Steele RN, WCC, RAC-CT, RAC-CTA: …
- Q&A: Can a resident be skilled for Medicare Part A if they are receiving an oral antibiotic for an infection, such as pneumonia or cellulitis? Question: Can a resident be skilled for Medicare Part A if they are receiving an oral antibiotic for an infection, such as pneumonia or cellulitis? Answered by Jeff Taylor: Here’s a link to the Medicare …
- Q&A: How many days after the due date on a physician recertification can the physician sign and still be in compliance? Question: How many days after the due date on a physician recertification can the physician sign and still be in compliance? Answered by Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: After the first recertification, …
- Q&A: When can the 1135 waiver be used?Question: When can the 1135 waiver be used? Answered by Carol Maher, RN-BC, RAC-MTA, RAC-MT, CPC: Beginning on page 16, the updated CMS waiver FAQ says the following:Long-Term Care Facilities and Skilled Nursing Facilities (SNFs) …
- Q&A: Are physician certifications required for Medicare Advantage patients?Question: Are physician certifications required for Medicare Advantage patients? Answered by Karen Bernius, PT, RAC-CTA: There are no federal requirements, but you do need to check with the specific HMO/Medicare Advantage plan. We have found …
- Q&A: Is a Significant Change in Status Assessment required if a resident on hospice experiences a decline following a fall?Question: We have a resident that is receiving hospice services who had a fall resulting in a fracture and the family has decided not to treat. The resident now has a decline in function, increased …
- Q&A: A long-term care resident returned from the hospital on a Medicare stay. Can I complete his Quarterly MDS while he is on a skilled level of care?Question: A long-term care resident recently went out to the hospital and returned on a skilled Medicare Part A stay. I have a PPS 5-Day assessment scheduled with an ARD on day 8 of the …
- Q&A: Where can I find information regarding staffing on the AAPACN website?Question: Where can I find information regarding staffing on the AAPACN website? Answer from Scott Hammond: Use the word “staffing” in the search feature on the AAPACN website. This provides the user with various articles …
- Q&A: A resident on Medicare Part A for skilled therapy could not participate with therapy for a few consecutive days due to a clinical condition. Can he remain on skilled care during those days?Question: A resident on Medicare Part A for skilled therapy could not participate with therapy for a few consecutive days because his Hemoglobin and Hematocrit were too low and he received blood transfusions. Will the …
- Q&A: When a resident who elected hospice switches to a different hospice company, is a Significant Change in Status Assessment required?Question: When a resident who elected hospice switches to a different hospice company, is a Significant Change in Status Assessment required? Answer from Janine Cortesa, RN: RAI User’s Manual, page 2-23: An SCSA is required …
- Q&A: Can someone clarify the guidelines or protocol to use sepsis as the principal diagnosis in MDS?Question: Can someone clarify the guidelines or protocol to use sepsis as the principal diagnosis in MDS? Answer from Jeff Taylor: This is what I follow from the blog post, “Conquer Coding for Sepsis and …
- Q&A: What can nursing do to improve residents triggering for low-risk incontinence?Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: Nursing should complete a thorough assessment, including a 3-day diary recording the times the resident has been incontinent, the times the resident was continent, and …
- Q&A: Has the 3-day qualifying hospital stay waiver expired?Question: Has the 3-day qualifying hospital stay waiver expired? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC: It has not. The 3-day qualifying hospital stay waiver is still ongoing; however, many other temporary waivers …
- Q&A: When should a urinary tract infection (UTI) be coded at MDS item I2300?Question: I have a resident with an increase in confusion and a UA with C&S showing >=100,000 CFU/mL of Klebsiella. He has no other noted symptoms and advanced dementia, so he is unable to describe …
- Q&A: Should I complete an interim payment assessment (IPA) for a SNF resident who now tests positive for COVID and is newly receiving isolation for the active infection?Question: I have two residents in my facility that admitted skilled on Medicare Part A and they have since both tested positive for COVID-19. My administrator would like to claim the isolation days and has …
- Q&A: Do 48-hour care plan meetings need to be completed for readmissions?Question: Do 48-hour care plan meetings need to be completed for readmissions? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC [email protected]: Assuming the resident already had the Admission MDS completed on their original …
- Q&A: Does an inpatient rehab stay count toward a qualifying hospital stay for Medicare coverage?Question: We have a referral for a resident with Medicare Part A who has been in an inpatient rehab facility (IRF) for six weeks. Is the IRF still considered acute and can qualify for the …
- Q&A: A Medicare Part A resident was admitted to the hospital and returned to the SNF for a new Medicare stay. Does the diagnosis from the original stay need to be used or can this change?Question: A resident was Medicare Part A with a primary diagnosis of pneumonia. On day 15 of the stay, the resident was admitted to the hospital for five days for atrial fibrillation and hospital acquired …
- Q&A: How many days can a Medicare Part A resident be out on a therapeutic leave and be able to come back to the facility without it being considered an End of Stay?Question: How many days can a Medicare Part A resident be out on a therapeutic leave and be able to come back to the facility without it being considered an End of Stay? Answered by …
- Q&A: What does the end of the physician visit waiver mean for SNFs?Question: What does the end of the physician visit waiver mean for SNFs? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT : With the recent QSO memo, QSO-22-15-NH & NLTC & LSC, released April 7, …
- Q&A: We have a resident with indwelling catheter due to urinary retention. The resident also has a history of traumatic intracranial hemorrhage. Am I able to code I1550 (Neurogenic Bladder)?Question: We have a resident with indwelling catheter due to urinary retention. The resident also has a history of traumatic intracranial hemorrhage. Am I able to code I1550 (Neurogenic Bladder)? Answer from Jeff Taylor: No, …
- Q&A: A resident admitted to our facility with a diagnosis of MRSA infection of a wound, receiving oral antibiotics, and in a single room—can I code Isolation in section O?Question: We have a resident who admitted to our facility with a diagnosis of MRSA to a wound and is receiving oral antibiotics. The resident is in a single room by himself. Can I code …
- Q&A: How are therapy services billed when a resident is admitted to the facility for skilled nursing only and hospital documentation recommended outpatient services at home for PT/OT?Question: We have a patient coming to us that the hospital rehab documented they are not appropriate for skilled rehab and recommended home with PT/OT outpatient. However, the physician documented a skilled nursing need to …
- Q&A: Does NHSN have new forms, and if so, what are they?Question: Does NHSN have new forms, and if so, what are they? Answer from Denise Winzeler BSN, RN, LNHA, DNS-MT, QCP-MT: The National Healthcare Safety Network (NHSN) has released new optional forms for tracking and …
- Q&A: My electronic software pulls in ADL documentation, but when I do a final refresh, the ADLs that pull in are inaccurate. Now I must manually verify every ADL. Is there a way to fix this?Question: My electronic software pulls in ADL documentation, but when I do a final refresh, the ADLs that pull in are inaccurate. Now I must manually verify every ADL. Is there a way to fix …
- Q&A: The nursing note states a resident has intermittent shortness of breath with coughing. How would this be coded on the MDS?Question: The nursing note states a resident has intermittent shortness of breath with coughing. How would this be coded on the MDS? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: I would …
- Q&A: A resident had a fall with fracture and discharged to the hospital on the eighth day following admission. When should the Admission Assessment be scheduled and completed?Question: I have a new resident who fell and broke her hip on the eighth day after admission. The Admission MDS was not completed. She has been discharged to the hospital for surgical repair and …
- Q&A: What is the regulation for how often we should be obtaining vital signs for long-term care residents?Question: What is the regulation for how often we should be obtaining vital signs for long-term care residents? Answer from Alexis Roam, MSN, RN-BC, DNS-CT, QCP: There is not a federal regulation that states a …
- Q&A: If a resident on a Medicare Part A stay goes on a leave of absence for two days, is it considered an interrupted stay? Question: We have a resident who is currently on Medicare Part A receiving skilled services for rehabilitation. His family would like to take him out for a leave of absence (LOA) from Thursday morning to …
- Q&A: If a resident is receiving a full liquid diet due to a recent surgical procedure, is it considered a mechanically altered diet?Question: If a resident is receiving a full liquid diet due to a recent surgical procedure, is it considered a mechanically altered diet? Answer from Debbie Kohn : According to the RAI User’s Manual (p. K-11), …
- Q&A: When a resident is status-post surgery, would that be enough criteria to quality for skilled services?Question: When a resident is status-post surgery, would that be enough criteria to quality for skilled services? Answer from Jeff Taylor: It really depends on the resident’s condition and what services/cares they need. If the resident …
- Q&A: Can a weighted blanket be considered a restraint?Question: Can a weighted blanket be considered a restraint? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT: Although the use of a weighted blanket can be a great intervention, if the resident can not …
- Q&A: When a resident was sent to the emergency department (ED) and then later admitted to the hospital, can we code any new diagnoses the resident received in the ED on the discharge assessment? Question: When a resident was sent to the emergency department (ED) and then later admitted to the hospital, can we code any new diagnoses the resident received in the ED on the discharge assessment? For …
- Q&A: Can the three words used in the BIMS interview (sock, blue, and bed) be changed? Can other words be used like shirt, red, and chair?Question: Can the three words used in the BIMS interview (sock, blue, and bed) be changed? Can other words be used like shirt, red, and chair? Half of our team say it must be those …
- Q&A: We just found that we missed some discharge assessments from two years ago. Can these assessments still be completed and submitted?Question: We just found that we missed some discharge assessments from two years ago. Can these assessments still be completed and submitted? Answer from Carol Maher, RN-BC, CPC, RAC-MT: Any missed discharge assessments should be …
- Q&A: Where can I find resources to help me with tracking and trending vaccination data?Question: Where can I find resources to help me with tracking and trending vaccination data? Answer from AAPACN: The Agency for Healthcare Research and Quality (AHRQ) has new vaccination tracking and reporting tools to assist …
- Q&A: What are the criteria to code Malnutrition?Question: What are the criteria to code Malnutrition? Answer from Jeff Taylor: For I5600, I would answer yes if a physician/NP/PA wrote “malnutrition,” “at risk for malnutrition,” or some other diagnostic statement (i.e., marasmus or …
- Q&A: If a resident is discharged before their planned Medicare discharge date, do I open an OBRA Discharge or a Part A PPS Discharge for a new end of Medicare stay?Question: If a resident is discharged before their planned Medicare discharge date, do I open an OBRA Discharge return not anticipated (DCRNA) or do I open a Part A PPS Discharge for a new end …
- Q&A: My software does not allow us to code two digits in the venous/arterial ulcer section on the MDS. How do we code if a resident has more than nine ulcers?Question: My software does not allow us to code two digits in the venous/arterial ulcer section on the MDS. How do we code if a resident has more than nine ulcers? Answer from Carol Maher, …
- Q&A: When does the early-bird registration end for the AAPACN 2022 Annual Conference?Question: When does the early-bird registration end for the AAPACN 2022 Annual Conference? Answer from AAPACN: Registrants must register before March 21, 2022, to receive the early-bird discount. Standard registration is March 21 – April …
- Q&A: Some members of my PDPM team feel that the diagnosis R27.8 “Other lack of coordination” should be used as the primary diagnosis. What kind of documentation would you need to be able to use this code?Question: Some members of my PDPM team feel that the diagnosis R27.8 “Other lack of coordination” should be used as the primary diagnosis. What kind of documentation would you need to be able to use …
- Q&A: Can I code triple antibiotic ointment and/or Bacitracin in section N under antibiotics?Question: Can I code triple antibiotic ointment and/or Bacitracin in section N under antibiotics? Answer from Janine Cortesa RN, BSN: Yes. The RAI states on page N-7 “Include any of these medications given to the resident …
- Q&A: Am I allowed to complete a Significant Change in Status Assessment on a resident who continues to receive hospice services but experienced other unexpected changes?Question: A resident was admitted with hospice services. She improved significantly in her physical functioning, but also worsened significantly in her behaviors. She remains under hospice at this time but is due for review in …
- Q&A: Can a resident take home medications upon discharge?Question: Can a resident take home medications upon discharge? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT: Yes, medications can be sent home with a resident upon discharge. Work with your pharmacy provider to …
- Q&A: A resident discharged return anticipated to the hospital, but then admitted to another SNF before returning to our SNF within 30 days. What assessments are required?Question: We had a resident discharge to the hospital and an OBRA Discharge return anticipated (DCRA) assessment was completed. Resident admitted to different SNF from the hospital but returned to our SNF within 30 days …
- Q&A: I completed a Medicare PPS assessment one day after the completion due date. What is the penalty for late MDS assessment completion?Question: I completed a Medicare PPS assessment one day after the completion due date. What is the penalty for late MDS assessment completion? Answer: There is no financial penalty for late completion. You may possibly …
- Q&A: I was recently told that if a resident is cognitively intact, then behaviors would not be coded, is this correct?Question: I was recently told that if a resident is cognitively intact, then behaviors would not be coded, is this correct? Answer: Behavior coding is not affected by the resident’s cognitive level. The RAI User’s …
- Q&A: Where can I find the latest guidance regarding health care personnel returning to work after COVID-19?Question: Where can I find the latest guidance regarding health care personnel returning to work after COVID-19? Answer: The Work Restrictions for HCP Table on the Center for Disease and Prevention’s (CDC) webpage provides information …
- Q&A: If hospital documentation supports a diagnosis of hip fracture as the initial encounter, do I need to query the physician for the subsequent encounter diagnosis to be used in the SNF?Question: If a resident had a hospital stay for hip fracture repair, with no complications documented, and the hospital documentation supports a diagnosis of hip fracture as the initial encounter, do I need to query …
- Q&A: What are some best practices for collecting and documenting section GG?Question: What are some best practices for collecting and documenting section GG? Answer: We trained our floor nurses to complete GG documentation daily on days 1-3, and our therapists also complete a GG assessment during …
- Q&A: A resident was picked back up on Medicare Part A during the 30-day window for a new Medicare Part A stay. Can the drug regimen review from the prior stay be used to code section N?Question: We have a resident who admitted on Medicare Part A and a drug regimen review (DRR) was completed at that time. Skilled services ended a couple weeks later, and she remained in the facility …
- Q&A: Where can I find resources to assist me with increasing COVID-19 vaccine and booster uptake?There are several great resources for facility leaders to utilize. The Society for Post-Acute and Long-term Care Medicine (AMDA) has several great resources in their COVID-19 Vaccine Education Toolkit. These resources are free to everyone, …
- Q&A: If a mechanically altered diet is being trialed during a speech therapy visit to facilitate oral intake, could K0510C, mechanically altered diet, be coded on the MDS?Question: We are seeking clarification on MDS item K0510C, mechanically altered diet. If a resident is being trialed on a mechanically altered diet or given thickened liquids provided during a speech therapy visit to facilitate …
- Q&A: A resident developed a new pressure ulcer while on leave of absence with family for Christmas. Is this considered “present on admission” or “in-house acquired”?Question: A resident developed a new pressure ulcer while on leave of absence with family for Christmas. Is this considered “present on admission” or “in-house acquired”? Answer: Since we do not complete an OBRA Discharge …
- Q&A: What is the requirement for physician certifications when a resident transitions from Managed care to Original Medicare Part A?Question: A resident admitted under a managed care plan on December 15, but disenrolled and went to Original Medicare as of January 1. What is the requirement for physician certifications? Answer: Restart Medicare physician certifications …
- Q&A: What are the changes affecting SNFs in the updated blanket waiver that was recently released?The COVID-19 Emergency Blanket Waivers for Health Care Providers that was updated and released on Nov 29, 2021 adds a new waiver that allows more flexibility in the education and training requirements for individuals serving …
- Q&A: Has anyone encountered surveyors requesting consents for assist bars/enabler bars used for functional mobility not posing as a restraint per the interdisciplinary team assessment?Question: Has anyone encountered surveyors requesting consents for assist bars/enabler bars used for functional mobility not posing as a restraint per the interdisciplinary team assessment? Answer by Carol Maher, RN-BC, CPC, RAC-MT : A restraint …
- Q&A: What is the CMS definition of elopement?Question: I am trying to find the CMS definition of elopement. What exactly do they call an elopement? Answer by Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: The State Operations Manual, appendix …
- Q&A: Is there a waiting period to continue therapy services when a resident transitions from Medicare Part A to Medicare Part B therapy services?Question: Is there a waiting period to continue therapy services when a resident transitions from Medicare Part A to Medicare Part B therapy services? Answer by Kim Steele RN, WCC, RAC-CT, RAC-CTA: There is no …
- Q&A: Where can I find the CMS Quality Safety and Oversight (QSO) memos?Question: Where can I find the CMS Quality Safety and Oversight (QSO) memos? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT AAPACN Curriculum Development Specialist: QSO memos issued from CMS can be found on …
- Q&A: Is a Significant Change in Status Assessment required for a new stage 3 pressure ulcer?Question: Is a Significant Change in Status Assessment required for a new stage 3 pressure ulcer? Answer from Janine Cortesa RN, BSN: A stage 3 pressure ulcer may signify the need for a Significant Change …
- Q&A: Where are SNF quality measure data publicly reported?Question: Where are SNF quality measure data publicly reported? Answer from CMS SNF QRP FAQs: The Care Compare website was launched in August 2020. It combines the Centers for Medicare & Medicaid Services (CMS) eight …
- Q&A: When a Medicare Part A resident discharges to another SNF and will continue skilled Medicare there, what assessments are required and what is the date used in A2400C?Question: I have a Medicare Part A resident discharging to another SNF and will continue skilled Medicare there. Would I combine the OBRA Discharge with a PPS Part A Discharge assessment? In A2400, would I …
- Q&A: Where can I find information on the new CMS COVID-19 vaccination requirements?Question: Where can I find information on the new CMS COVID-19 vaccination requirements? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-CT, QCP: CMS has developed a FAQ document regarding the Interim Final Rule that answers …
- Q&A: Can Incentive Spirometer still be counted on the MDS as long as a respiratory nurse or therapist counts the minutes they assess, monitor, and evaluate?Question: Can Incentive Spirometer still be counted on the MDS as long as a respiratory nurse or therapist counts the minutes they assess, monitor, and evaluate? Answer form Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, …
- Q&A: How do you code a resident who is fed by staff for all meals but can chew and swallow independently?Question: We have been discussing how to code a resident who is fed for all meals but can chew and swallow independently. The argument is the RAI User’s Manual indicates that if someone cannot participate …
- Q&A: A resident discharged to the hospital, return anticipated, but went to a sister facility from the hospital for a few days because we did not have a bed available. Now that he is returning, is a new OBRA Admission assessment required?Question: We have a resident who discharged to the hospital (completed an OBRA DC Return-Anticipated). When he was ready to be discharged from the hospital, we did not have a bed available, so he discharged …
- Q&A: Where can I find resources to help our facility prevent and manage sepsis?Question: Where can I find resources to help our facility prevent and manage sepsis? Answer: TMF, a Quality Improvement Organization, offers a free toolkit called the Sepsis Post-Acute Care Training Toolkit for Nursing Homes. This …
- Q&A: Can we code modified diet on section K if a resident has crushed medications but eats a regular diet?Question: Can we code modified diet on section K if a resident has crushed medications but eats a regular diet? Answer from Janine Cortesa RN, BSN: No, crushed medications would not be a mechanically altered …
- Q&A: A resident just returned during the interruption window. What OBRA assessments and tracking records do I need?Question: A resident on a Medicare Part A stay went to the hospital on 10/19 and returned on 10/20. He was admitted to the acute. This is my first time with an interrupted stay. Do …
- Q&A: Would you code a positive nasal swab for MRSA as a multidrug-resistant organism (MDRO) in section I?Question: Would you code a positive nasal swab for MRSA as a multidrug-resistant organism (MDRO) in section I? Answer from Heide Keen, RN, BSN, RAC-CT: Most often, we find that MRSA of nares is colonized …
- Q&A: Where can I find information for the 2021-2022 flu season and vaccination requirements?Question: Where can I find information for the 2021-2022 flu season and vaccination requirements? Answer from Denise Winzeler, BSN, RN, DNS-CT, QCP : The CDC has a lot of great information on their webpage regarding …
- Q&A: If therapists or therapy assistants are working as nurse aides, can these hours be included in PBJ?Question: I have a facility that is experiencing a surge of COVID positive patients and staff. Presently, a significant portion of their staff is out due to COVID-19 or isolation related to COVID exposure. Their in-house …
- Q&A: A resident unexpectedly discharged three days before his planned PPS Discharge. What do I need to do?Question: A resident unexpectedly discharged from the facility on 10/9 while on Medicare Part A. He had a planned PPS Part A Discharge scheduled for 10/12. Can I combine the PPS Discharge and OBRA Discharge, …
- Q&A: I found an error on a resident’s MDS that goes back to 2019. How do I correct this?Question: I have just found out a resident had a change of payer from Medicaid to Private Pay back in 2019 and the system still has their Medicaid information. How do I correct this and …
- Q&A: Is nursing required to sign off on therapy orders?Question: Is nursing required to sign off on therapy orders? Answer from Kendra Coco, MPT, NHA, RAC-CT, RAC-CTA: No, it is not required. However, most therapy orders come through the nurse as a telephone order …
- Q&A: If a resident expires during their assessment window, does the MDS assessment still need to be completed?Question: If a resident expires during their assessment window, does that MDS still need to be completed? For example, if a resident’s assessment window is 9/10 – 9/16 with an ARD of 9/16, but then …
- Q&A: Can a resident meet the skilled level of care criteria with only speech therapy?Question: I have always been taught that you cannot skill a resident for only speech therapy. However, now I am being told a resident that is receiving speech therapy 5 days a week should be …
- Q&A: A resident was receiving a skilled level of care on a Medicaid stay prior to a 3-day qualifying hospital stay. Will he be able to qualify for Medicare when he returns to the SNF?Question: A long-term care resident admitted to the hospital and will return after a 3-day qualifying inpatient stay. Prior to discharge, the resident had Medicaid as a primary payer and was receiving skilled therapy five …
- Q&A: 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, …