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Highlights from the CMS SNF Follow-Up Webinar on Section N

By AANAC - September 07, 2018

Highlights from the CMS SNF Follow-Up Webinar on Section N

AANAC’s vice president of curriculum development, Judi Kulus, live tweeted last week during the CMS SNF QRP Follow-Up Webinar on Section N on Aug. 27, 2018. There were many important takeaways from this training and with limited capacity for registration, Kulus used social media to share important information to help those who were unable to attend to learn what they needed to know about section N and the new SNF QRP DRR requirements.

Here are some important highlights you should take note of from last week’s CMS SNF QRP training:

  • Start getting ready now! The DRR data collection begins October 1, 2018 and is captured on the start of the PPS stay.

  • SNF QRP DRR includes: Prescribed and over the counter, including nutritional supplements, vitamins, and homeopathic and herbal products.

  • What is a clinically significant DRR issue? The SNF QRP says: effects, results, or consequences that materially affect or are likely to affect an individual’s mental, physical, or psychosocial well-being.

  • SNF QRP DRR compliance must include 2-way communication with the physician (including physician extenders per your state license act).

  • A DRR must have documentation and data on the MDS that is consistent with information reported in the resident’s medical record.

  • When should a DRR be conducted? CMS says, "Complete a DRR upon admission (start of SNF PPS stay) or as close to the actual time of admission as possible to identify any potential or actual clinically significant medication issues."

  • MDS N2003 (Med follow-up) involves two steps.

1.       Two-way communication between the clinician(s) and the physician was completed by midnight of the next calendar day, AND

2.       All physician-prescribed/recommended actions were completed by midnight of the next calendar day.

  • CMS emphasized that the DRR occurs ASAP after admission AND throughout the resident's stay. Monitoring and responding is key.

  • CMS recommends staff training on DRR to be in compliance. Med issues can occur anytime during the resident stay - all staff need to be trained to recognize and report.

  • Who should conduct the MDS section N Drug Regimen Review at admission? The CMS training examples include a nurse conducting the review. Who will you train to do it in your facility? More on this later...

  • Three musts of MDS DRR coding section N:

1.       Have a process for DRR upon admission.

2.       Make sure physicians are aware of timely follow-up on concerns.

3.       Educate staff on the DRR process and rationale.

  • The SNF QRP measure is a positive measure indicating compliance with conducting DRR and all medication issues noted and follow-up conducted by midnight of next day. It is ONLY for SNF PPS Medicare Part A residents.

  • If a pharmacist conducts the DRR electronically and remotely, the information should still be found in the resident's medical record.

  • SNF QRP SNF MDS section N DRR items are only used on SNF PPS Start of Medicare 5-day and the SNF PPS Discharge (end of stay) assessments.

  • DRR: CMS does not mandate who can conduct the med review, the facility can determine based on state and federal guidelines for practice acts.

  • Question: If a resident is admitted late Friday can the DRR be done Friday?

Answer: No, must be done ASAP after admission.

  • Question: Do we need to gather hospital and home medication lists to do a DRR? 

Answer: Though best practice, no, it's not required. Conduct the patient interview, use hospital discharge instructions, and other info as able.

  • Question: If a resident comes off Medicare and then resumes Medicare, is another DRR required? 

Answer: Yes, each time a Medicare PPS Start of Medicare 5-day MDS is done the DRR is required.

  • Question: Do we need to do period formal DRR reviews throughout the resident stay? 

 Answer: While there is no specific requirement for multiple reviews, best practices means having a way to monitor for med issues.

  •  Question: Is a pharmacist required to do the DRR for section N of the MDS?

  Answer: The process required by the SNF/NF in the SOM is a different process. A nurse can be used to do the SNF QRP section N review for the resident's safety.


You can access the SNF QRP Provider Training slides here.


Interested in more information on the other RAI User’s Manual section changes from CMS?

AANAC members also receive access to the following At-a-Glance Updates to the RAI User’s Manual Effective Oct. 1, 2018 Tool to help them prepare for the coming MDS changes.

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