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: What is the definition for intermittent oxygen therapy? Question: What is the definition for intermittent oxygen therapy? Answer from Jeff Taylor: Item O0110C3, Intermittent oxygen therapy, is based on the amount of continuous time administered, not ordered. Greater than 0 but less than …
- Q&A: If a resident is admitted to the hospital “for observation” and returns within 24 hours, is an OBRA Discharge assessment required? Question: If a resident is admitted to the hospital “for observation” and returns within 24 hours, is an OBRA Discharge assessment required? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: I …
- Q&A: What is the section GG performance period for a Medicare 5-Day and what is the performance period for an OBRA Admission assessment?Question: What is the section GG performance period for a Medicare 5-Day and what is the performance period for an OBRA Admission assessment? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: It would …
- Q&A: If a resident discharges from a Medicare Part A stay, but is remaining in the facility, how do we answer A2121, provision of reconciled medication list to subsequent provider? Question: If a resident discharges from a Medicare Part A stay, but is remaining in the facility, how do we answer A2121, provision of reconciled medication list to subsequent provider? Answer from Jeff Taylor: See …
- Q&A: Do we have to mark “no” on indication for use in section N just because the nurse missed updating the order with the indication even though the medical record from the hospital clearly states the indication for use?Question: Do we have to mark “no” on indication for use in section N just because the nurse missed updating the order with the indication even though the medical record from the hospital clearly states …
- Q&A: If a resident discharges home with skilled home health, how do we code the discharge status and do we provide the reconciled medication list to the home health provider or to the resident?Question: If a resident discharges home with skilled home health, how do we code the discharge status and do we provide the reconciled medication list to the home health provider or to the resident? Answer …
- Q&A: A Medicare Part A resident expired three days after admission. He received skilled nursing services only and did not complete any MDS interviews. Is a 5-Day PPS assessment needed?Question: A Medicare Part A resident expired three days after admission. He received skilled nursing services only and did not complete any MDS interviews. Is a 5-Day PPS assessment needed? Answer from Carol Maher, RN-BC, …
- Q&A: Part of the new coding instructions for section O “while a resident,” states to include services performed or received since admission OR in the last 14 days. Does this mean it includes services from before entry into the facility and within the last 14 days?Question: Part of the new coding instructions for section O “while a resident,” states to include services performed or received since admission OR in the last 14 days. Does this mean it includes services from …
- Q&A: Does the physician or physician extender have to acknowledge at risk for malnutrition prior to the assessment reference date (ARD) to code it in section I?Question: Does the physician or physician extender have to acknowledge at risk for malnutrition prior to the assessment reference date (ARD) to code it in section I? Answer from Jeff Taylor: Risk for malnutrition is …
- Q&A: Is there a requirement that we complete a 5-Day assessment for HMOs or Medicare Advantage plans?Question: Is there a requirement that we complete a 5-Day assessment for HMOs or Medicare Advantage plans? Answer from Jeff Taylor: Each payer makes its own rules regarding what’s required for reimbursement. This is essentially …
- Q&A: We identified that we could have completed an Interim Payment Assessment (IPA) on a resident back in July. Is there a timeframe that allows you to go back and open that IPA and complete it? Question: We identified that we could have completed an Interim Payment Assessment (IPA) on a resident back in July. Is there a timeframe that allows you to go back and open that IPA and complete it? …
- Q&A: We completed a combined 5-Day/Admission assessment on day 15 of the stay. After submission, our system shows we are out of compliance for CAAs/MDS based on the signature/completion date. Do we need to bill default for the one day we were out of compliance?Question: We completed a combined 5-Day/Admission assessment on day 15 of the stay. After submission, our system shows we are out of compliance for CAAs/MDS based on the signature/completion date. Do we need to bill …
- Q&A: A resident has a catheter for urinary retention. Would this be coded as neurogenic bladder or obstructive uropathy?Question: A resident has a catheter for urinary retention. Would this be coded as neurogenic bladder or obstructive uropathy? Answer from Jeff Taylor:Neither. Retention is a symptom used when the physician hasn’t determined the cause …
- Q&A: Can I code isolation in section O for Extended Spectrum Beta-Lactamase (ESBL) of urine with contact isolation?Question: Can I code isolation in section O for Extended Spectrum Beta-Lactamase (ESBL) of urine with contact isolation? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: The RAI User’s Manual prohibits coding isolation …
- Q&A: For OBRA assessments starting Oct. 1, 2023, will section O therapies data elements be collected or is this item being removed completely?Question: For OBRA assessments starting Oct. 1, 2023, will section O therapies data elements be collected or is this item being removed completely? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: Therapy minutes/days …
- Q&A: Can the MDS 3.0 scripted interviews be coded directly on the MDS or is additional separate documentation required? Question: Can the MDS 3.0 scripted interviews be coded directly on the MDS or is additional separate documentation required? Answer from Kim Steele RN, WCC, RAC-CT, RAC-CTA: You are not required to document the answers …
- Q&A: A resident exhausted benefits in March 2023 with a new G-tube and 100% tube feeding. She was recently admitted to the hospital for three days and had the G-tube removed and was eating by mouth. Can this resident be skilled for Medicare Part A? Question: A resident exhausted benefits in March 2023 with a new G-tube and 100% tube feeding. She was recently admitted to the hospital for three days and had the G-tube removed and was eating by …
- Q&A: How do you code GG0130E, Shower/bathe self, when the resident did not have a bath scheduled during the three-day assessment period? Question: How do you code GG0130E, Shower/bathe self, when the resident did not have a bath scheduled during the three-day assessment period? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: If there was …
- Q&A: If a resident admits to the facility with a second or third degree burn and it was documented as healed during the look-back period, would it be coded on the MDS at M1040F? Question: If a resident admits to the facility with a second or third degree burn and it was documented as healed during the look-back period, would it be coded on the MDS at M1040F? Answer …
- Q&A: We have a resident on a Medicare Advantage (MA) plan, who went out for a one-day leave of absence. Since this is covered by the MA plan, do we need to complete a discharge assessment, reentry, and set a new 5-Day assessment? Question: We have a resident on a Medicare Advantage (MA) plan, who went out for a one-day leave of absence (LOA). I understand that the discharge assessment and reentry would not be required for Medicare …
- Q&A: When will the new changes affect the MDS assessment? Is this according to the assessment reference date (ARD) or the admission date?Question: When will the new changes affect the MDS assessment? Is this according to the assessment reference date (ARD) or the admission date? For example, if the resident admitted on Sept. 28, 2023, and has …
- Q&A: Are there specific requirements for CNA documentation?Question: Are there specific requirements for CNA documentation? Answer from Alexis Roam, MSN, RN-BC, CPHQ, DNS-MT, QCP-MT: Although Appendix PP of the State Operations Manual (SOM) includes numerous references to documentation, it does not specify what …
- Q&A: This October, are the ethnicity and race items required to be asked on all assessments or can this information be carried over across each MDS assessment?Question: Has there been any additional guidance provided as to whether the questions A1005 Ethnicity and A1010 Race are required to be asked on all assessments or if this information can be carried over across …
- Q&A: What assessments are required when a resident goes out on a leave of absence (LOA)? Question: What assessments are required when a resident goes out on a leave of absence (LOA)? Answer by Jeff Taylor: No discharge is required for a leave of absence as defined in chapter 2 of …
- Q&A: If a resident admits with a UTI diagnosis from the hospital, do we need to code it on the MDS even if McGeer criteria is not met?Question: If a resident admits with a UTI diagnosis from the hospital, do we need to code it on the MDS even if McGeer criteria is not met? Answer by Carol Maher, RN-BC, RAC-MTA, RAC-MT, …
- Q&A: We just noted that we missed a Quarterly assessment a few months ago on a resident who has now been discharged. How do we correct this?Question: We just noted that we missed a Quarterly assessment a few months ago on a resident who has now been discharged. How do we correct this? Answered from Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, …
- Q&A: How do I determine if a resident needs a new qualifying hospital stay to use remaining Medicare benefits?Question: A resident was in our skilled nursing facility (SNF) stay with a qualifying hospital stay over a month ago. She was skilled in our facility until a week ago when she discharged home. She …
- Q&A: I submitted an Admission/5-Day assessment and recently learned that the 5-Day is not needed because Managed Care is the payer, not Medicare. How do I correct this?Question: I have a resident who we thought was Medicare Part A and completed and submitted an Admission/5-Day assessment. I am now being told that the resident was Managed Care and I need to inactivate …
- Q&A: Where can I find the list of Special Focus Facilities and candidates?Question: Where can I find the list of Special Focus Facilities and candidates? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT: CMS releases their Special Focus Facility (SFF) Program list monthly. This list includes …
- Q&A: What can a facility implement to aid with staffing challenges?Question: What can a facility implement to aid with staffing challenges? Answer from Alexis Roam MSN, RN-BC, CPHQ, DNS-MT, QCP-MT: A few things that might help address risk of noncompliance and also attract and retain …
- Q&A: We have a resident who was admitted with a Peg tube about a year ago. He was hospitalized and had it replaced. The resident returned to us under Medicare. Does anyone know if you would consider this a new Peg tube and would the resident qualify to utilize the 100 days?Question: We have a resident who was admitted with a Peg tube about a year ago. He was hospitalized and had it replaced. The resident returned to us under Medicare. Does anyone know if you …
- Q&A: An ongoing pressure ulcer was initially noted by our wound nurse as unstageable related to slough and/or eschar. The most recent documentation in the look-back period states the wound is now a Stage 4. Should I continue to code it as unstageable or now code it as a Stage 4?Question: An ongoing pressure ulcer was initially noted by our wound nurse as unstageable related to slough and/or eschar. The most recent documentation in the look-back period states the wound is now a Stage 4. …
- Q&A: Our software auto-populates I0020B and I8000A with the same ICD-10 code. Is this an RAI User’s Manual requirement?Question: Our software auto-populates I0020B and I8000A with the same ICD-10 code. Is this an RAI User’s Manual requirement? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: The primary diagnosis coded in I0020B …
- Q&A: Do we still need to quarantine non-vaccinated residents?Question: Do we still need to quarantine non-vaccinated residents? Answer from Kellie VanRee, RN, LNHA: This document from the Centers for Disease Control and Prevention (CDC), Infection Control: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) | …
- 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: If a resident on a Medicare Part A stay expires the same day as admission, is it a billable day?Question: If a resident on a Medicare Part A stay expires the same day as admission, is it a billable day? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC:Yes, if a Medicare A …
- Q&A: A long-term resident has had a feeding tube for more than 10 years. He exhausted Medicare Part A benefits years ago. Can he be skilled with the new G-tube placement?Question: A long-term resident has had a feeding tube for more than 10 years. He exhausted his Medicare Part A benefits years ago. He recently experienced recurrent aspiration and had an extended hospitalization with a …
- Q&A: Is there a requirement regarding how abuse training is completed?Question: Is there a requirement regarding how abuse training is completed? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT:CMS requires education on certain topics for new and existing staff, specifically, training on abuse, neglect, …
- Q&A: What staff member in a skilled nursing facility (SNF) can complete data collection and entry for section GG items?Question: What staff member in a SNF can complete data collection and entry for section GG items? Answer from Melissa Brown, OTR/L, RAC-CT, CDP, CSRS: I think what may be causing confusion here is the …
- Q&A: If a Medicare Part A resident goes on a therapeutic leave of absence (LOA) of four days for a funeral, what MDS assessments/records, if any, are required?Question: If a Medicare Part A resident goes on a therapeutic leave of absence (LOA) of four days for a funeral, what MDS assessments/records, if any, are required? Answer from Jeff Taylor: No additional MDS …
- Q&A: Can a comprehensive MDS be completed before day 14, such as on day 9 or 10, as long as it is completed by day 14?Question: Can a comprehensive MDS be completed before day 14, such as on day 9 or 10, as long as it is completed by day 14? For example, we have a 5-Day combined with an …
- Q&A: Where can I obtain CMS training regarding the new MDS guidelines?Question: Where can I obtain CMS training regarding the new MDS guidelines? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP: The Centers for Medicare & Medicaid Services (CMS) has developed a two-part, training program …
- Q&A: Would therapy 5 times a week prevent a 60-day wellness period?Question: I have a resident who had a recent 3-day qualifying stay for Medicare Part A. He had exhausted all benefits in January but continued to have Medicare Part B therapy 5 days a week for …
- Q&A: When coding section E (Behaviors), does this need to be supported by episode charting in the medical record for each behavior or does this require progress notes stating what behavior occurred?Question: When coding section E (Behaviors), does this need to be supported by episode charting in the medical record for each behavior or does this require progress notes stating what behavior occurred? Answer from Jeff …
- Q&A: For the Nursing component of PDPM, a resident with a diagnosis of Parkinson’s disease with a function score of 15 was calculated into the Physical Function Reduced PA1 case-mix group and not into Clinically Complex. Is this a software error?Question: For the Nursing component of PDPM, a resident with a diagnosis of Parkinson’s disease with a function score of 15 was calculated into the Physical Function Reduced PA1 case-mix group and not into Clinically …
- Q&A: How do I receive my continuing education credits for the sessions I attended at the 2023 AAPACN Conference?Question: How do I receive my continuing education credits for the sessions I attended at the 2023 AAPACN Conference? Answer from Alix Murrell: To receive your CE certificate, you must fill out the online form …
- Q&A: Where do I find the Five-Star reports in iQIES?Question: Where do I find the Five-Star reports in iQIES? Answer from Kim Steele RN, WCC, RAC-CT, RAC-CTA: It can’t be accessed in iQIES at this time. You will continue to access some reports or …
- Q&A: We have a resident who was in our facility in 2017 and then returned as a new admission this year. We noted her last name was misspelled on all assessments in 2017. Can I modify these assessments?Question: We have a resident who was in our facility in 2017 and then returned as a new admission this year. We noted her last name was misspelled on all assessments in 2017. Our billing …
- Q&A: A resident had a fall at home that resulted in a fracture but did not receive surgery. The provider’s progress notes indicated, “Unspecified fall, initial encounter” (W19.XXXA), as the primary medical diagnosis. Should I use this diagnosis?Question: A resident had a fall at home that resulted in an acetabular fracture but did not receive surgery. The provider’s progress notes indicated, “Unspecified fall, initial encounter” (W19.XXXA), as the primary medical diagnosis. Should …
- Q&A: The look-back period for J1800 is for falls since admission/entry or reentry or prior assessment (OBRA or scheduled PPS), whichever is more recent. For this look-back, is the Part A PPS Discharge assessment considered a “scheduled PPS” assessment?Question: The look-back period for J1800 is for falls since admission/entry or reentry or prior assessment (OBRA or scheduled PPS), whichever is more recent. For this look-back, is the Part A PPS Discharge assessment considered …
- Q&A: If a resident’s BIMS interview cannot be completed, when is it appropriate to code C0100, “Should the Brief Interview for Mental Status be Conducted?” as “No”? Question: If a resident’s BIMS interview cannot be completed, when is it appropriate to code C0100, “Should the Brief Interview for Mental Status be Conducted?” as “No”? Surveyors asked about our rationale for coding resident …
- Q&A: A resident on Medicare Part A went out on a leave of absence (LOA) for a temporary home visit on Saturday and returned on Monday. How do we bill this?Question: A resident on Medicare Part A went out on a leave of absence (LOA) for a temporary home visit on Saturday and returned on Monday. How do we bill this? Answer from Carol Maher, …
- Q&A: Should a complaint of rough handling during care involve a complete abuse investigation, even if they have cognitive impairment?Question: Should a complaint of rough handling during care involve a complete abuse investigation, even if they have cognitive impairment? Answer from Denise Winzeler BSN, RN, LNHA, DNS-MT, QCP-MT: The short answer is yes, this …
- Q&A: It appears that there were multiple QSO memos that were revised or expired. What does that mean?Question: It appears that there were multiple QSO memos that were revised or expired. What does that mean? Answer from Denise Winzeler, RN, BSN, LNHA, DNS-MT, QCP-MT: Yes, CMS did some housekeeping recently and either …
- Q&A: Five days after a fall, a resident had an x-ray completed showing a fracture of the second cervical vertebra. Would the fall injury be considered a major injury due to these findings?Question: A resident fell in the facility and hit the back of her head. She was evaluated in the emergency room and had a CAT scan completed the same day, but showed no injuries. Five …
- Q&A: The RAI User’s Manual states that respiratory therapy must be performed by a “respiratory therapist” or a “respiratory nurse.” What is a “respiratory nurse”?Question: The RAI User’s Manual states that respiratory therapy must be performed by a “respiratory therapist” or a “respiratory nurse.” What is a “respiratory nurse”? Answer from Jeff Taylor:Appendix A of the RAI User’s Manual provides …
- Q&A: If an interim payment assessment (IPA) is determined to have a new primary diagnosis, does therapy need to re-evaluate the resident or can they continue treatment based on the 5-Day diagnosis?Question: If an interim payment assessment (IPA) is determined to have a new primary diagnosis, does therapy need to re-evaluate the resident or can they continue treatment based on the 5-Day diagnosis? Answer from Carol …
- Q&A: Can an LVN who is a certified treatment nurse stage a pressure injury?Question: Can an LVN who is a certified treatment nurse stage a pressure injury? Answer from Denise Winzeler, BSN, RN, DNS-MT, QCP-MT: Many states do not allow LVNs to stage pressure injuries. I recommend you review your …
- Q&A: Can I cover a resident under Medicare Part A who is receiving hospice care at the same time, or does the resident need to disenroll from hospice first?Question: Can I cover a resident under Medicare Part A who is receiving hospice care at the same time, or does the resident need to disenroll from hospice first? Answer from Carol Maher, RN-BC, RAC-MTA, …
- Q&A: What is required if a resident passes away the day after the ARD for a Significant Change in Status Assessment (SCSA) due to hospice initiation?Question: What is required if a resident passes away the day after the ARD for a Significant Change in Status Assessment (SCSA) due to hospice initiation? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, …
- Q&A: A resident on Medicare Part A admitted during the weekend. How much time do I have to open the 5-Day PPS assessment?Question: A resident on Medicare Part A admitted during the weekend. How much time do I have to open the 5-Day PPS assessment? Answer from Jeff Taylor:The 5-Day PPS assessment must be opened before the …
- Q&A: Can I still register for the AAPACN 2023 Conference?Question: Can I still register for the AAPACN 2023 Conference? Answer from AAPACN: Absolutely! Registration is open and available on the AAPACN conference webpage until April 10, 2023. This page also includes information regarding the …
- Q&A: How does the new CMS memo, QSO-23-05-NH, for the schizophrenia diagnosis apply to OBRA assessments for residents who have been in the facility long-term?Question: How does the new CMS memo, QSO-23-05-NH, for the schizophrenia diagnosis apply to OBRA assessments for residents who have been in the facility long-term? Answer from Jeff Taylor: I would say that memo, the …
- Q&A: When a resident is admitted with a diagnosis of UTI from the hospital, and has physician documentation and a lab from the hospital in the medical record, do we code UTI at I2300 on the MDS?Question: When a resident is admitted with a diagnosis of UTI from the hospital, and has physician documentation and a lab from the hospital in the medical record, do we code UTI at I2300 on …
- Q&A: If the dietitian documents a resident is at risk of malnutrition, can I code this diagnosis on the MDS at item I5600? Question: If the dietitian documents a resident is at risk of malnutrition, can I code this diagnosis on the MDS at item I5600? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: I would …
- Q&A: Would padded upper bedrails that are raised for a resident who experiences seizures be coded as a restraint?Question:Would padded upper bedrails that are raised for a resident who experiences seizures be coded as a restraint? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC:You must assess the effect the padded rails …
- Q&A: Therapy is discharging a Medicare Part A resident, but he will continue to be skilled for daily nursing services. Do I need to complete any MDS assessments to reflect this change?Question:Therapy is discharging a Medicare Part A resident, but he will continue to be skilled for daily nursing services. Do I need to complete any MDS assessments to reflect this change? Answer from Janine Cortesa, …
- Q&A: Which role should the MDS coordinator request to be able to submit assessments when signing up for the new iQIES?Question:Which role should the MDS coordinator request to be able to submit assessments when signing up for the new iQIES? Answer from Sandy Baker, RN, RAC-CT, RAC-CTA: Looking at page 11 of the “Provider User …
- Q&A: I am struggling with the MDS and Medicare Process Essentials course for the DNS-CT. Does anyone have any pointers on what more I can study to make this test easier for me? Question: I am struggling with the MDS and Medicare Process Essentials course for the DNS-CT. Does anyone have any pointers on what more I can study to make this test easier for me? Answer from …
- Q&A: Do we need to obtain an order from a physician to be able to place a new admission or move a current resident to the secured (locked) unit in our care facility?Question: Do we need to obtain an order from a physician to be able to place a new admission or move a current resident to the secured (locked) unit in our care facility? Answer from …
- Q&A: Can we code respiratory therapy in section O for incentive spirometry with documentation of 15 minutes a day?Question: Can we code respiratory therapy in section O for incentive spirometry with documentation of 15 minutes a day? Answer from Karen White, LPN, RAC-CT: Read through the RAI manual carefully, page 0-18. The therapy must …
- Q&A: If I have a resident who had a Stage 4 pressure ulcer to his coccyx that healed and then six months later it reopened and appears to be a Stage 2, is it still coded as a Stage 4?Question: If I have a resident who had a Stage 4 pressure ulcer to his coccyx that healed and then six months later it reopened and appears to be a Stage 2, is it still …
- Q&A: Is there an interrupted stay policy quick guide for billers that I can use as a reference?Question: Is there an interrupted stay policy quick guide for billers that I can use as a reference? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: AAPACN has a lot of great resources on …
- Q&A: Does AAPACN have any webinars on the changes coming this year with the elimination of G to GG for CNA documentation?Question: Does AAPACN have any webinars on the changes coming this year with the elimination of G to GG for CNA documentation? Answered by Jessie McGill, RN, RAC-MT AAPACN offers an on-demand workshop for section GG, …
- Q&A: Where can I find information about iQIES?Question: Where can I find information about iQIES? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT: The Centers for Medicare & Medicaid Services (CMS) recently released the new iQIES Reports User Manual. This manual …
- Q&A: How long can a COVID-19 positive resident who met the criteria of strict isolation be covered under Medicare Part A?Question: How long can a COVID-19 positive resident who met the criteria of strict isolation be covered under Medicare Part A? Answer from Janine Cortesa RN, BSN:Isolation is not a daily skilled need, so that …
- Q&A: If a resident has a chronic urinary tract infection (UTI) and the physician ordered a prophylactic antibiotic, do I code UTI on the MDS as an active diagnosis?Question: If a resident has a chronic urinary tract infection (UTI) and the physician ordered a prophylactic antibiotic, do I code UTI on the MDS as an active diagnosis? Answer from Carol Maher, RN-BC, RAC-MTA, …
- Q&A: We have a resident on Medicare Part A that had a planned discharge return not anticipated to another facility. The resident came back to our facility after 24 hours. What assessments are required?Question: We have a resident on Medicare Part A that had a planned discharge return not anticipated to another facility. The resident came back to our facility after 24 hours. What assessments are required? Answer …
- Q&A: What is a reasonable amount of time to skill a resident on Medicare Part A for being COVID-19 positive?Question: What is a reasonable amount of time to skill a resident on Medicare Part A for being COVID-19 positive? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: I would refer you …
- Q&A: I have heard different rules on completing OBRA discharge assessments – that an assessment is required if the resident’s head isn’t in the bed at midnight and if the resident is out less than 24 hours, it isn’t necessary. Which is correct?Question: I have heard different rules on completing OBRA discharge assessments. Some say an assessment is required if the resident’s head isn’t in the bed at midnight, others say if the resident is out less …
- Q&A: If the DNS is on the schedule Monday through Friday for 8-hour shifts each day and 40 hours per week, and serves primarily as RN coverage, are they allowed to leave the building for a quick lunch break or something else?Question: If the DNS is on the schedule Monday through Friday for 8-hour shifts each day and 40 hours per week, and serves primarily as RN coverage, are they allowed to leave the building for …
- Q&A: What is the difference between a Stage I pressure injury and a deep tissue injury?Question: What is the difference between a Stage I pressure injury and a deep tissue injury? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT: The National Pressure Injury Advisory Panel (NPIAP) defines a stage one …
- Q&A: What assessments are required when a resident ends skilled care under a Managed Care plan and remains in long-term care?Question: What assessments are required when a resident ends skilled care under a Managed Care plan and remains in long-term care? Answer from Janine Cortesa RN, BSN: Typically, there are no MDS assessments to complete …
- Q&A: How is weight loss in the last six months assessed if the resident has only been in the facility for 14 days?Question: How is weight loss in the last six months assessed if the resident has only been in the facility for 14 days? Answer from Jeff Taylor: Looking at the steps for assessment on page …
- Q&A: We missed a first recertification (due by day 14), and we had the physician sign a delayed certification form. When is the next certification due?Question: We missed a first recertification (due by day 14), and we had the physician sign a delayed certification form. When is the next certification due? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, …
- Q&A: What are some best practices for providing a welcoming and thorough clinical orientation for nurses and unlicensed staff? Question: What are some best practices for providing a welcoming and thorough clinical orientation for nurses and unlicensed staff? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT: AAPACNS’s Onboarding Essentials: Welcoming Staff to Promote …
- Q&A: What does a facility have to do to maintain compliance if they use bedrails or grab bars?Question: What does a facility have to do to maintain compliance if they use bedrails or grab bars? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT: F700 in Appendix PP of the State Operations …
- 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 …