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: Am I able to code “yes” in item J1400, Prognosis, when the documentation supporting “life expectancy less than six months” is signed by nurse practitioners or physician assistants, or is a physician signature required?Question: Am I able to code “yes” in item J1400, Prognosis, when the documentation supporting “life expectancy less than six months” is signed by nurse practitioners or physician assistants, or is a physician signature required? …
- Q&A: Can I set a 5-Day PPS assessment on a non-billable day such as a skip day? The resident was sent to the hospital, did not return prior to midnight, and was not admitted.Question: Can I set a 5-Day PPS assessment on a non-billable day such as a skip day? The resident was sent to the hospital, did not return prior to midnight, and was not admitted. Answer …
- Q&A: What specialized training is needed to capture respiratory therapy provided by nurses? Question: What specialized training is needed to capture respiratory therapy provided by nurses? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC:The Glossary of the RAI User’s Manual (Appendix A-22) states this: Respiratory Therapy …
- Q&A: The SNF QRP Data Validation Audit notification letter requested Admission and Discharge assessments. What assessments should be submitted?Question: The Skilled Nursing Facility Quality Reporting Program (SNF QRP) Data Validation Audit notification letter requested Admission and Discharge assessments. What assessments should be submitted? Answer from Jessie McGill RN, BSN, RAC-MTA, RAC-MT: On the …
- Q&A: When a resident is discharged to the hospital and admitted with a diagnosis of UTI. Does the UTI get coded on the discharge return anticipated MDS? Question: When a resident is discharged to the hospital and admitted with a diagnosis of UTI. Does the UTI get coded on the discharge return anticipated MDS? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, …
- Q&A: How do I code the “Will [care area] be addressed in the care plan” question when a resident discharges return not anticipated before the care plan is complete? Question: How do I code the “Will [care area] be addressed in the care plan” question when a resident discharges return not anticipated before the care plan is complete? Answer from Jennifer LaBay RN, …
- Q&A: Is a Significant Change in Status Assessment (SCSA) required for a new pressure ulcer?Question: Is a Significant Change in Status Assessment (SCSA) required for a new pressure ulcer? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: A Significant Change in Status Assessment is required if there are …
- Q&A: When a resident changes payers from Medicare Advantage to Traditional Medicare, are the Medicare Advantage days subtracted from the Medicare 100-day benefit period?Question: When a resident changes payers from Medicare Advantage to Traditional Medicare, are the Medicare Advantage days subtracted from the Medicare 100-day benefit period? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: Yes, days …
- Q&A: If a Discharge – return not anticipated was completed for a resident discharge against medical advice (AMA), and he returned less than 30 days later, is a new OBRA Admission assessment required?Question: If a Discharge – return not anticipated was completed for a resident discharge against medical advice (AMA), and he returned less than 30 days later, is a new OBRA Admission assessment required? Answer from …
- Q&A: A resident has a healing pressure ulcer that was described as “100% epithelial, with slow blanching erythema” during the ARD window. Would this still be coded as a pressure ulcer? Question: A resident has a healing pressure ulcer that was described as “100 % epithelial, with slow blanching erythema” during the ARD window. Would this still be coded as a pressure ulcer? Answer from …
- Q&A: If a resident is losing weight and ordered supplements as an intervention, can we code as a therapeutic diet?Question: If a resident is losing weight and ordered supplements as an intervention, can we code as a therapeutic diet? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC:If the supplements were ordered by a …
- Q&A: If a resident on Medicare Part A admits and discharges to home on the same day, can we bill Medicare for that day?Question: If a resident on Medicare Part A admits and discharges to home on the same day, can we bill Medicare for that day? Answer from Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: …
- Q&A: Can I code a diagnosis of pneumonia when the nurse practitioner initiated antibiotics for a documented reason of pneumonia, but there was not a chest x-ray completed to confirm the diagnosis?Question: Can I code a diagnosis of pneumonia when the nurse practitioner initiated antibiotics for a documented reason of pneumonia, but there was not a chest x-ray completed to confirm the diagnosis? Answer from Carol …
- Q&A: What date would be used in A2400C (Medicare end date) for an unplanned discharge to the hospital when the assessment is a combined a 5-Day, OBRA discharge, and a PPS discharge?Question: What date would be used in A2400C (Medicare end date) for an unplanned discharge to the hospital when the assessment is a combined a 5-Day, OBRA discharge, and a PPS discharge? Answer from Carol …
- Q&A: Can we still use dementia as a primary diagnosis for our long-term residents?Question: Can we still use dementia as a primary diagnosis for our long-term residents? Our facility was recently told we can no longer use the dementia diagnosis (F03.90) although it maps to medical management? Answer …
- Q&A: A resident was skilled under Medicare Part A and exhausted benefits. We completed a Significant Change in Status Assessment to capture the improvement before the end of the stay. Should I have completed an IPA or something else with the significant change MDS?Question: A resident was skilled under Medicare Part A and exhausted benefits. We completed a Significant Change in Status Assessment to capture the improvement before the end of the stay. Should I have completed an …
- Q&A: If the stay is only 15 days, how do I calculate the 30-day weight loss for section K?Question: If the stay is only 15 days, how do I calculate the 30-day weight loss for section K? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: You use the weight that is closest …
- Q&A: What ARD is used for a Death in Facility record if the resident expires before midnight, but the mortuary did not pick up until after midnight? Question: What ARD is used for a Death in Facility record if the resident expires before midnight, but the mortuary did not pick up until after midnight? Answer from Jeff Taylor: The actual time/date …
- Q&A: Can the physician certification be met through a detailed order versus a separate certification form?Question: Can the physician certification be met through a detailed order versus a separate certification form? Answer from Jessie McGill RN, BSN, RAC-MTA, RAC-MT: CMS does not mandate a specific form or format, but …
- Q&A: We have a resident that had a qualifying hospital stay (QHS), then went to an LTACH for more than 30 days. Can the resident utilize their Medicare benefits since the transfer from acute hospital to SNF is more than 30 days?Question: We have a resident that had a qualifying hospital stay (QHS), then went to a long-term acute care hospital (LTACH) for more than 30 days. Can the resident still utilize their Medicare benefits in …
- Q&A: What is the look-back period for K0100? The RAI User’s Manual does not mention the look-back period or if this can include days during the hospital stay?Question: What is the look-back period for K0100? The RAI User’s Manual does not mention the look-back period or if this can include days during the hospital stay? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, …
- Q&A: Is there a specific table that shows which items if dashed will count against us for the Skilled Nursing Facility Quality Reporting Program (SNF QRP)?Question: Is there a specific table that shows which items if dashed will count against us for the Skilled Nursing Facility Quality Reporting Program (SNF QRP)? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: …
- Q&A: Is a Pure Wick catheter coded as an external catheter? Question: Is a Pure Wick catheter coded as an external catheter? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: Yes, this would meet the definition of an external catheter in the …
- Q&A: When assessing a fall with an injury to the head, such as a laceration, bruise, or hematoma, would this automatically be considered a major injury? Question: When assessing a fall with an injury to the head, such as a laceration, bruise, or hematoma, would this automatically be considered a major injury? Answer from Jessie McGill RN, BSN, RAC-MTA, RAC-CTA and …
- Q&A: How do you code walking if the resident only walks with therapy staff?Question: How do you code walking if the resident only walks with therapy staff? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, and Jessie McGill, RN, BSN, RAC-MTA, RAC-CTA: If the resident only walked …
- Q&A: With the new definition of fall with major injury, would a bump on the head or a laceration be a head injury? With the new definition of fall with major injury, would a bump on the head or a laceration be a head injury?Question: With the new definition of fall with major injury, would a bump on the head or a laceration be a head injury? With the new definition of fall with major injury, would a bump …
- Q&A: I am confused by the new section GG guidance for when the activity “is being/will be” routinely performed. What does “will” mean?Question: I am confused by the new section GG guidance for when the activity “is being/will be” routinely performed. What does “will” mean? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, and Jessie McGill, …
- Q&A: We had a resident on a Medicare Part A stay admit and discharge back to the hospital that same evening after a few hours. We could not assess much information during that brief amount of time. What are all the required MDS assessments that need to be completed on this resident? I know an entry tracker and an OBRA discharge, but do we need to also complete a 5-Day PPS?Question: We had a resident on a Medicare Part A stay admit and discharge back to the hospital that same evening after a few hours. We could not assess much information during that brief amount …
- Q&A: The new definition of a fall includes an overwhelming external force, but the definition of fracture related to a fall states, “Do not include fractures caused by trauma related to car crashes or pedestrian versus car accidents or impact of another person or object against the resident.” Does this instruction contradict the new definition of a fall?Question: The new definition of a fall includes an overwhelming external force, but the definition of fracture related to a fall states, “Do not include fractures caused by trauma related to car crashes or pedestrian versus …
- Q&A: Can Isolation be coded for methicillin-resistant staphylococcus aureus (MRSA) on a wound?Question: Can Isolation be coded for methicillin-resistant staphylococcus aureus (MRSA) on a wound? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: No, the RAI User’s Manual specifically states that isolation cannot be coded for …
- Q&A: If an open area is found on day four after admission, is that still present on admission (7-day look-back period)? The definition of “present on admission” is “as close to admission as possible.”Question: If an open area is found on day four after admission, is that still present on admission (7-day look-back period)? The definition of “present on admission” is “as close to admission as possible.” Answer from …
- Q&A: A long-term resident went out to the hospital and returned on a skilled stay using his Managed Care plan. He has both a 5-Day and Annual scheduled for the same day, but at separate times. Do both of these get coded as “the first assessment” in A0310E?Question: A long-term resident went out to the hospital and returned on a skilled stay using his Managed Care plan. He has both a 5-Day and Annual scheduled for the same day, but at separate …
- Q&A: For section GG, the nurse aides use a mechanical lift transfer with two-person assist for transfers four times, but physical therapy transfers with one person and maximal assist once. Part of the dependent definition is “helper does all the effort” – but this was not true for all transfers—would this be dependent or maximal assistance?Question: For section GG, the nurse aides use a mechanical lift transfer with two-person assist for transfers four times, but physical therapy transfers with one person and maximal assist once. Part of the dependent definition …
- Q&A: Can I count IV fluids and IV antibiotics that were administered in the hospital before admission and within the 7-day look-back period?Question: Can I count IV fluids and IV antibiotics that were administered in the hospital before admission and within the 7-day look-back period? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: IV fluid provided …
- Q&A: I miscalculated the ARD window for a 5-Day and scheduled the 5-Day/PPS Discharge on day 9 of the Medicare stay. What do I need to do?Question: I miscalculated the ARD window for a 5-Day and scheduled the 5-Day/PPS Discharge on day 9 of the Medicare stay. What do I need to do? Answer from Jeff Taylor:Leave everything as it is …
- Q&A: Does the 14-day look-back period for section O include days prior to entry into the facility?Question: Please clarify if section O “while a resident.” Per the RAI User’s Manual, “Check all treatments, procedures, and programs that the resident received or performed after admission/entry or reentry to the facility and within …
- Q&A: When should I set an assessment reference date (ARD) for a Significant Change in Status Assessment (SCSA) after a resident elected hospice?Question: When should I set an assessment reference date (ARD) for a Significant Change in Status Assessment (SCSA) after a resident elected hospice? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: The …
- Q&A: I know that McGeer criteria must be met when coding a UTI that develops in-house during the SNF stay, but what is required when a resident is transferred to the hospital and returns to the SNF with a documented UTI diagnosis (e.g., listed on the discharge summary and on antibiotics)?Question: I know that McGeer criteria must be met when coding a UTI that develops in-house during the SNF stay, but what is required when a resident is transferred to the hospital and returns to …
- Q&A: The Five-Star Preview Report for July 2025 still shows the standard survey from three years ago. I thought the third survey would no longer be used?Question: The Five-Star Preview Report for July 2025 still shows the standard survey from three years ago. I thought the third survey would no longer be used? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, …
- Q&A: A resident elected hospice on July 9, 2025. What is the required completion date for the Significant Change in Status Assessment (SCSA), and what steps should be taken if the resident passes away before the assessment is completed?Question: A resident elected hospice on July 9, 2025. What is the required completion date for the Significant Change in Status Assessment (SCSA), and what steps should be taken if the resident passes away before …
- Q&A: Is aspirin coded as an antiplatelet in N0415I?Question: Is aspirin coded as an antiplatelet in N0415I? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: The RAI User’s Manual includes aspirin as an antiplatelet medication on page N-9: “N0415I1. Antiplatelet: Check if …
- Q&A: How do we code interviews that were not complete when a Medicare resident has an unplanned discharge to the hospital?Question: How do we code interviews that were not complete when a Medicare resident has an unplanned discharge to the hospital? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: If the interviews were not …
- Q&A: If a resident initiates his/her discharge for the following day and the facility was able to organize home care, equipment, etc., is this considered a planned or unplanned discharge?Question: If a resident initiates his/her discharge for the following day and the facility was able to organize home care, equipment, etc., is this considered a planned or unplanned discharge? Answer from Jessie McGill RN, …
- Q&A: Did this resident achieve a 60-day break in skilled services when a nurse assisted with tube feedings at the assisted living facility?Question: A resident previously exhausted his 100 days of Medicare for a new feeding tube. He was discharged to an assisted living facility (ALF) for more than 60 days where an licensed practical nurse (LPN) …
- Q&A: The RAI User’s Manual guidance for mechanically altered diet mentions “soft solids.” Would that include solids that are naturally soft or solids that we would “soften”?Question: The RAI User’s Manual guidance for mechanically altered diet mentions “soft solids.” Would that include solids that are naturally soft or solids that we would “soften”? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, …
- Q&A: If the resident was in the emergency department (ED) and then admitted to the hospital before readmitting to the nursing home, can I capture IV fluids at the ED visit? Question: If the resident was in the emergency department (ED) and then admitted to the hospital before readmitting to the nursing home, can I capture IV fluids at the ED visit? Answer from Jessie …
- Q&A: Can Z codes be used as the admitting diagnosis on the claim?Question: Can Z codes be used as the admitting diagnosis on the claim? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC: Admission Diagnosis codes (Field Locator 69 on the claim) should be the code …
- Q&A: A long-term care resident has a Quarterly assessment due on 6/19 and an Annual assessment due on 6/27. Can I do the Annual assessment early, before the Quarterly deadline?Question: A long-term care resident has a Quarterly assessment due on 6/19 and an Annual assessment due on 6/27. Can I do the Annual assessment early, before the Quarterly deadline? Answer from Carol Maher, RN, …
- Q&A: When a resident returns from an interrupted stay, is an IPA required or any kind of readmission assessment if no change?Question: When a resident returns from an interrupted stay, is an IPA required or any kind of readmission assessment if no change? Answer from Jeff Taylor: IPAs are always optional. In an interrupted stay, no …
- Q&A: A resident on a Medicare Part A stay discharged return not anticipated. His last covered day of Medicare was the day before. Can I combine the Part A PPS Discharge with the OBRA discharged return not anticipated?Question: A resident on a Medicare Part A stay discharged return not anticipated. His last covered day of Medicare was the day before. Can I combine the Part A PPS Discharge with the OBRA discharged …
- Q&A: For section GG documentation, the direct care staff was given the wrong dates. It was supposed to be the ARD and the two days before, but they did the first 3 days of the look-back period. Am I able to use any of the GG documentation they completed?Question: For section GG documentation, the direct care staff was given the wrong dates. It was supposed to be the ARD and the two days before, but they did the first 3 days of the …
- Q&A: Do I code J1400, Prognosis, as yes when a resident is under palliative care and not hospice? There is no physician documentation certifying or stating the physician’s belief that the resident’s terminal illness is that their life expectancy is six months or less. Question: Do I code J1400, Prognosis, as yes when a resident is under palliative care and not hospice? There is no physician documentation certifying or stating the physician’s belief that the resident’s terminal illness is that their …
- Q&A: What is considered as the most updated COVID-19 vaccine to code on the MDS?Question: What is considered as the most updated COVID-19 vaccine to code on the MDS? Answer from Jessie McGill RN, BSN, RAC-MTA, RAC-CTA: To determine up to date, we must reference the Staying Up to …
- Q&A: For the PHQ-2 to 9 interview, if the resident is at least sometimes understood and the interview is attempted, but the resident did not respond to the first two questions, how is this coded and can we proceed to the Staff Interview of Mood?Question: For the PHQ-2 to 9 interview, if the resident is at least sometimes understood and the interview is attempted, but the resident did not respond to the first two questions, how is this coded …
- Q&A: A resident discharged to the hospital with an unstageable pressure ulcer due to eschar (occurred in house). The wound was debrided in the hospital and then the resident returned with it being a Stage 3 pressure ulcer. Would this be presented upon reentry since it’s now a Stage 3?Question: A resident discharged to the hospital with an unstageable pressure ulcer due to eschar (occurred in house). The wound was debrided in the hospital and then the resident returned with it being a Stage …
- Q&A: A resident had a chest tube placed in the hospital and removed prior to re-admission. In the 5-Day look-back period, we have orders for an ointment and dressing to the area daily until resolved. Would I capture this under surgical wound and surgical wound care?Question: A resident had a chest tube placed in the hospital and removed prior to re-admission. In the 5-Day look-back period, we have orders for an ointment and dressing to the area daily until resolved. …
- Q&A: Is an OBRA Discharge assessment required when a non-skilled resident has an unplanned transfer to the hospital, was not admitted, but was there for 30 hours?Question: Is an OBRA Discharge assessment required when a non-skilled resident has an unplanned transfer to the hospital, was not admitted, but was there for 30 hours? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, …
- Q&A: On admission, our infection control nurse asks about the COVID-19 vaccine and documents the resident’s vaccine status and acceptance or refusal of the vaccine. Since we are no longer providing the vaccine in the facility, should I be dashing this item? Question: On admission, our infection control nurse asks about the COVID-19 vaccine and documents the resident’s vaccine status and acceptance or refusal of the vaccine. Since we are no longer providing the vaccine in the …
- Q&A: Is a Part A PPS Discharge assessment required if the resident exhausted the 100-day benefit?Question: Is a Part A PPS Discharge assessment required if the resident exhausted the 100-day benefit? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: Yes, the Part A PPS Discharge MUST be completed when …
- Q&A: Do the medications gabapentin/Neurontin get coded in section J, Scheduled pain medication regimen, if the doctor noted they are for pain management, and are they also coded as anticonvulsants in section N?Question: Do the medications gabapentin/Neurontin get coded in section J, Scheduled pain medication regimen, if the doctor noted they are for pain management, and are they also coded as anticonvulsants in section N? Answer from …
- Q&A: When coding urinary tract infection (UTI) at I2300, if the diagnosis of UTI was made prior to resident admission, is it optional to use evidence-based criteria (e.g., NHSN), which would exclude the UTI prior to admission? Question: When coding urinary tract infection (UTI) at I2300, the RAI User’s Manual states that if diagnosis of UTI was made prior to resident admission it is not necessary to evaluate for evidence-based criteria and …
- Q&A: We recently had a state case-mix audit, and I had to correct an error that resulted in a new Care Area Assessment (CAA) triggering. My software gave me a warning that a significant correction was indicated. How do I know if a significant correction is needed and how do I schedule this?Question: We recently had a state case-mix audit, and I had to correct an error that resulted in a new Care Area Assessment (CAA) triggering. My software gave me a warning that a significant correction …
- Q&A: Should MDS Item I0020B always be the diagnosis from the qualifying hospital stay? How do I code this for a resident who has been in long-term care for many years and has no recent hospital stays?Question: Should MDS Item I0020B always be the diagnosis from the qualifying hospital stay? How do I code this for a resident who has been in long-term care for many years and has no recent …
- Q&A: When coding K0100, Swallowing Disorders, can we capture signs and symptoms if they were identified when the resident was working with speech-language pathology (SLP) and on a trial diet?Question: When coding K0100, Swallowing Disorders, can we capture signs and symptoms if they were identified when the resident was working with speech-language pathology (SLP) and on a trial diet? Answer from Jennifer LaBay RN, …
- Q&A: For the Quality Measure (QM) for Long-stay Antipsychotic medication, if a resident expires in the facility and the appropriate Death in Facility record is completed and submitted, when will the resident stop triggering?Question: For the Quality Measure (QM) for Long-stay Antipsychotic medication, if a resident expires in the facility and the appropriate Death in Facility record is completed and submitted, when will the resident stop triggering? Answer …
- Q&A: A resident enrolled in hospice services and expired the next day. Do I still need to complete a Significant Change in Status Assessment (SCSA)?Question: A resident enrolled in hospice services and expired the next day. Do I still need to complete a Significant Change in Status Assessment (SCSA)? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC The …
- Q&A: We have a Medicare Part A resident who was only skilled by nursing at the end of the stay. How do we code GG items that only therapy perform, such as car transfers and stairs, if the resident was no longer receiving therapy services during the 3-day look-back window at the time of discharge? Question: We have a Medicare Part A resident who was only skilled by nursing at the end of the stay. How do we code GG items that only therapy perform, such as car transfers and …
- Q&A: A Medicare Part A resident passed away in the emergency department. I know a Death in Facility record needs to be completed, but do I also need to complete a Medicare Part A PPS discharge assessment?Question: A Medicare Part A resident passed away in the emergency department. I know a Death in Facility record needs to be completed, but do I also need to complete a Medicare Part A PPS …
- Q&A: To code K0300A for a physician-ordered weight loss, does the physician need to write a progress note that weight loss is intended or will an order for a diuretic automatically make the weight loss planned?Question: To code K0300A for a physician-ordered weight loss, does the physician need to write a progress note that weight loss is intended or will an order for a diuretic automatically make the weight loss …
- Q&A: Our facility had an influenza-A outbreak with testing from lab. Can we write an ICD-10 code for this for all impacted residents?Question: Our facility had an influenza-A outbreak with testing from lab. Can we write an ICD-10 code for this for all impacted residents? Answer from Jeff Taylor: You need a provider (physician or physician extender) …
- Q&A: For GG0130A, Eating, the RAI User’s Manual states this is the ability to bring food/liquids to the mouth once the meal is placed in front of the resident. How do you code if the resident only needs help opening cartons? Question: For GG0130A, Eating, the RAI User’s Manual states this is the ability to bring food/liquids to the mouth once the meal is placed in front of the resident. How do you code if the …
- Q&A: A resident elected hospice with one company on 1/31 and we scheduled a Significant Change in Status Assessment (SCSA) on 2/10. The family decided to change companies and enrolled with a different hospice company on 2/6. Do I need to complete two SCSAs or just one?Question: A resident elected hospice with one company on 1/31 and we scheduled a Significant Change in Status Assessment (SCSA) on 2/10. The family decided to change companies and enrolled with a different hospice company …
- Q&A: A resident came to our facility for a short stay with a Stage 4 pressure ulcer. The resident has since exhausted his 100 days of Medicare, became a long-term resident, and still has the Stage 4 pressure ulcer. Will this resident trigger the long-stay pressure ulcer measure?Question: A resident came to our facility for a short stay with a Stage 4 pressure ulcer. The resident has since exhausted his 100 days of Medicare, became a long-term resident, and still has the …
- Q&A: When a resident received IV fluids (K0520A) for hydration, but did not have any calories from the fluids, do we code K0710A (Proportion of total calories the resident received through parenteral or tube feeding) as 1. 25% or less?Question: When a resident received IV fluids (K0520A) for hydration, but did not have any calories from the fluids, do we code K0710A (Proportion of total calories the resident received through parenteral or tube feeding) …
- Q&A: A resident was admitted to our facility on Medicare Part A and passed in facility after only a couple of hours. I had scheduled a 5-Day/Admission for the 7th day before she passed. How do I set up MDS assessments?Question: A resident was admitted to our facility on Medicare Part A and passed in facility after only a couple of hours. I had scheduled a 5-Day/Admission for the 7th day before she passed. How …
- Q&A: Please clarify when a device would or would not be considered a restraint?Question: Can a winged versus a concave mattress be considered a restraint if it fits the definition? Can a tilt and space wheelchair be considered a restraint? It is being explained to me that it …
- Q&A: We have a resident that is in our facility for skilled services under Medicare Part A. The family took the resident out for a funeral, and she did not return within 24 hours. Is this a Medicare Part A discharge?Question: We have a resident that is in our facility for skilled services under Medicare Part A. The family took the resident out for a funeral, and she did not return within 24 hours. Is …
- Q&A: Does an inpatient rehab stay count toward a qualifying hospital stay for Medicare coverage?Question: We have a referral for a resident with Medicare Part A who has been in an inpatient rehab facility (IRF) for six weeks. Is the IRF still considered acute and can qualify for the …
- Q&A: Where can I find the latest guidance regarding health care personnel returning to work after COVID-19?Question: Where can I find the latest guidance regarding health care personnel returning to work after COVID-19? Answer: The Work Restrictions for HCP Table on the Center for Disease and Prevention’s (CDC) webpage provides information …
- Q&A: If hospital documentation supports a diagnosis of hip fracture as the initial encounter, do I need to query the physician for the subsequent encounter diagnosis to be used in the SNF?Question: If a resident had a hospital stay for hip fracture repair, with no complications documented, and the hospital documentation supports a diagnosis of hip fracture as the initial encounter, do I need to query …
- Q&A: Where can I find resources to assist me with increasing COVID-19 vaccine and booster uptake?There are several great resources for facility leaders to utilize. The Society for Post-Acute and Long-term Care Medicine (AMDA) has several great resources in their COVID-19 Vaccine Education Toolkit. These resources are free to everyone, …
- Q&A: If a mechanically altered diet is being trialed during a speech therapy visit to facilitate oral intake, could K0510C, mechanically altered diet, be coded on the MDS?Question: We are seeking clarification on MDS item K0510C, mechanically altered diet. If a resident is being trialed on a mechanically altered diet or given thickened liquids provided during a speech therapy visit to facilitate …
- Q&A: What are the changes affecting SNFs in the updated blanket waiver that was recently released?The COVID-19 Emergency Blanket Waivers for Health Care Providers that was updated and released on Nov 29, 2021 adds a new waiver that allows more flexibility in the education and training requirements for individuals serving …
- Q&A: Has anyone encountered surveyors requesting consents for assist bars/enabler bars used for functional mobility not posing as a restraint per the interdisciplinary team assessment?Question: Has anyone encountered surveyors requesting consents for assist bars/enabler bars used for functional mobility not posing as a restraint per the interdisciplinary team assessment? Answer by Carol Maher, RN-BC, CPC, RAC-MT : A restraint …
- Q&A: Is there a waiting period to continue therapy services when a resident transitions from Medicare Part A to Medicare Part B therapy services?Question: Is there a waiting period to continue therapy services when a resident transitions from Medicare Part A to Medicare Part B therapy services? Answer by Kim Steele RN, WCC, RAC-CT, RAC-CTA: There is no …
- Q&A: Where can I find the CMS Quality Safety and Oversight (QSO) memos?Question: Where can I find the CMS Quality Safety and Oversight (QSO) memos? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT AAPACN Curriculum Development Specialist: QSO memos issued from CMS can be found on …
- Q&A: Is a Significant Change in Status Assessment required for a new stage 3 pressure ulcer?Question: Is a Significant Change in Status Assessment required for a new stage 3 pressure ulcer? Answer from Janine Cortesa RN, BSN: A stage 3 pressure ulcer may signify the need for a Significant Change …
- Q&A: When a Medicare Part A resident discharges to another SNF and will continue skilled Medicare there, what assessments are required and what is the date used in A2400C?Question: I have a Medicare Part A resident discharging to another SNF and will continue skilled Medicare there. Would I combine the OBRA Discharge with a PPS Part A Discharge assessment? In A2400, would I …
- Q&A: Where can I find information on the new CMS COVID-19 vaccination requirements?Question: Where can I find information on the new CMS COVID-19 vaccination requirements? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-CT, QCP: CMS has developed a FAQ document regarding the Interim Final Rule that answers …
- Q&A: A resident discharged to the hospital, return anticipated, but went to a sister facility from the hospital for a few days because we did not have a bed available. Now that he is returning, is a new OBRA Admission assessment required?Question: We have a resident who discharged to the hospital (completed an OBRA DC Return-Anticipated). When he was ready to be discharged from the hospital, we did not have a bed available, so he discharged …
- Q&A: Where can I find resources to help our facility prevent and manage sepsis?Question: Where can I find resources to help our facility prevent and manage sepsis? Answer: TMF, a Quality Improvement Organization, offers a free toolkit called the Sepsis Post-Acute Care Training Toolkit for Nursing Homes. This …
- Q&A: Would you code a positive nasal swab for MRSA as a multidrug-resistant organism (MDRO) in section I?Question: Would you code a positive nasal swab for MRSA as a multidrug-resistant organism (MDRO) in section I? Answer from Heide Keen, RN, BSN, RAC-CT: Most often, we find that MRSA of nares is colonized …
- Q&A: Is there specific guidance regarding staff working in multiple facilities?Question: Is there specific guidance regarding staff working in multiple facilities? Answer from Denise Winzeler, BSN, RN, LNHA, DNS-CT, QCP: Currently, there are no federal guidelines specific to staff who work in multiple facilities. However, …
- Q&A: How do you determine “while a resident” or “while not a resident” when a resident goes out to the hospital and returns?Question: How do you determine “while a resident” or “while not a resident” when a resident goes out to the hospital and returns? Answer from Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: The …
- Q&A: Can a resident disenroll in a Medicare Advantage (MA) plan and revert back to Original Medicare when the 3-day qualifying hospital stay was waived for the MA plan?Question: A resident admitted for skilled care under a Medicare Advantage (MA) plan. The plan did not require a 3-day qualifying hospital stay (QHS) and the resident was hospitalized for observation only. The resident has …
- Q&A: What will happen to the online AADNS communities, discussion groups, and libraries?Question: What will happen to the online AADNS communities, discussion groups, and libraries? Answer from AAPACN: The AADNS Network has become a new member community named the Management/Leadership General Discussion community on AAPACN.org. The discussion …
- Q&A: Will I still be able to access AADNS courses that I am currently taking on the new AAPACN website?Question: Will I still be able to access AADNS courses that I am currently taking on the new AAPACN website? Answer from AAPACN: Yes. You still have access to any courses that have not expired …
- Q&A: Is overseeing the Therapy department within the scope of the DNS position?Question: I am a relatively new DNS and my job description includes overseeing the Therapy Department. Is this within my scope? Answer: In most SNFs, the therapy department usually has its own director/manager, with ultimate oversight …
- Q&A: Does anyone have an ‘International Dysphagia Diet Standardization Initiative’ policy?Question: Does anyone have an ‘International Dysphagia Diet Standardization Initiative’ policy? Answer: The IDDSI framework has many resources and guidance on how to implement the framework. https://iddsi.org/framework/ Consider convening a meeting with the dietitian, ST, …
- Q&A: How do I code the primary diagnosis on the UB-04 for a Medicare Part A resident?Question: When I received training for ICD-10 coding as it relates to billing, I was taught that the primary diagnosis code for long term SNF residents on a UB-04 claim would be their primary diagnosis …