Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2025 Filed on: 03/28/2024 at 4:15 pm Scheduled Pub. Date: 04/03/2024 …
The Five Star Preview Reports will be available on or around March 20, 2024. Provider Preview Reports have moved to iQIES as of August 2023. Please follow the steps below to locate the Provider Preview …
Enhanced Barrier Precautions in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms (MDROs) Memo #QSO-24-08-NH Posting Date 2024-03-20 Fiscal Year 2024 Memorandum Summary • CMS is issuing new guidance for State Survey Agencies and long term care …
The care area assessments (CAAs) are a vital part of the Resident Assessment Instrument (RAI) process to develop a plan for individualized resident care. Taking shortcuts with the CAA process can result in generic care …
The nurse assessment coordinator (NAC) who also serves as the primary Medicare nurse doesn’t always complete either the physician certification/recertification process or the beneficiary notification process for Medicare residents, says Scott Heichel, RN, RAC-MT, RAC-CTA, …
In early March, the Centers for Medicare & Medicaid Services (CMS) released the MDS Data Specifications V3.02.0 (DRAFT). These draft files detail the following changes tentatively scheduled for Oct. 1, 2024: CMS also clarified that …
In this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist with AAPACN, discuss strategies for simplifying the care …
Question: A resident discharged from hospice with one company and enrolled with a different hospice provider a week later. Do I need to complete a Significant Change in Status Assessment (SCSA) for both the hospice …
Question: On a discharge assessment, the documentation showed that the resident refused the last three weekly skin assessments and there is no other documentation in the medical record regarding skin condition. How do I code …
Question: We have a resident on a traditional Medicare Part A stay who was discharged back to the hospital on day three. How should I schedule the 5-Day PPS assessment and the Admission assessment, and …
The HCP Flu Vaccination Module, which is part of the HCP component in NHSN, is used to input required NHSN data for the SNF QRP. This site provides access to the HCP Vaccination Module: Influenza …
The March 2024 Quarterly Confidential Feedback Reports for the fiscal year (FY) 2025 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program are now available to download via the Internet Quality Improvement and Evaluation System (iQIES). …
COVID-19 Vaccination Rates – State and National Averages State and National averages for facility resident and healthcare personnel COVID-19 vaccination rates. Data are presented as one row per state or territory plus a row for …
The MDS Data Specifications V3.02.0 (DRAFT) are now available for download under the Downloads section at the bottom of this webpage. The Section GG goal items will be removed, and three new items will be added: O0350 …
Question: How do you set section GG discharge goals for a resident who is also receiving care for end of life? Answer from Jeff Taylor: Goals can include maintenance or even managed decline. This AAPACN …
Question: A resident was on Hospice in community. He revoked hospice and had a qualifying hospital stay. He opted to receive rehab in the skilled nursing facility and then return to home. Medicare guidelines state …
Question: What is the consequence of a late MDS submission? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: There is no impact on Medicare payment if an MDS is submitted late. The facility could …
The Office of Inspector General (OIG), released the third and final report in a three-part series about the effects of the COVID-19 pandemic on nursing homes, Lessons Learned During the Pandemic Can Help Improve Care …
The interrupted-stay policy in the Patient-Driven Payment Model (PDPM) of the Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS) governs when multiple SNF stays are combined into a single interrupted stay (i.e., …
In the ever-evolving realm of healthcare data management, the transition of the Minimum Data Set (MDS) submission process to the Internet Quality Improvement and Evaluation System (iQIES) in April 2023 marked a significant milestone for …
Nurse assessment coordinators (NACs) are responsible for the coordination and completion of the MDS assessments; however, to ensure these assessments are accepted without error into the National Submissions Database, the Final Validation Report must also …
The February update of Appendix B to the RAI 3.0 User’s Manual contains changes to the list of State RAI Coordinators, MDS Automation Coordinators, and CMS locations and contacts. To ensure accurate formatting, use a current version of …
It’s that time of year again! The AAPACN 2024 Conference will be held this year in Hollywood, FL, on April 10 – 13. AAPACN is excited to gather to celebrate outstanding post-acute care professionals, meet …
Issued on 02/26/2024 | Posted on 02/29/2024 | Report number: OEI-02-20-00492 Report Materials Full Report (PDF, 1.5 MB) Why OIG Did This Review Nursing home residents and staff have been especially impacted by the COVID‑19 pandemic. Now, it is critical to learn from …
One of the frustrations nursing home providers have experienced since the transition to the Minimum Data Set (MDS) 3.0 version 1.18.11 that went into effect on Oct. 1, 2023, is being able to effectively monitor …
Pressure-related deep tissue injury (DTI) coded in M0300G (Unstageable Pressure Injuries Related to Deep Tissue Injury) does not play a role in Medicare payment under the Patient-Driven Payment Model (PDPM). While DTI is an unstageable …
Question: An audit found a missed Significant Change in Status Assessment (SCSA) after a hospice election. The resident is still in the facility. Is an SCSA still needed? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, …
Question: If a resident is dependent on staff for functional items in section GG and they also had a decline in their bowel or bladder status, will they trigger for the New or Worsened Bowel …
Question: When a resident is admitted to the nursing facility for hospice services, do we have to use the admitting hospice diagnosis as the primary diagnosis? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, …
The Center of Excellence for Behavior Health in Nursing Facilities (COE-NF) released a two-part podcast series addressing how to manage substance use disorders (SUDs) in skilled nursing facilities. This AAPACN resource is copyright protected. AAPACN …
Updated February 2024 The FY 2024 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Final Rule (88 FR 53200) revised data collection and submission requirements for the SNF Quality Reporting Program (QRP) affecting the Fiscal …
Announcements This is a friendly reminder to log into NHSN and make sure your facility has an active Facility Administrator. Please note that only the Facility Administrator can enroll a facility in a one or …
Long-term care facilities can track weekly vaccination data for residents and healthcare personnel (HCP) through NHSN. February 2024 Updates Resources January 2024 Updates Training Data Collection Forms and Instructions COVID-19 Vaccination Data Collections Forms Note: …
The FY2024 ICD-10-CM codes are to be used from April 1, 2024 through September 30, 2024. Note: This replaces the FY 2024 – October 1, 2023 release. These files listed below represent the ICD-10-CM FY2024 April …
SUMMARY REPORT PUBLISHED: SNF QRP Listening Session: Possible Expansion of MDS Data Submission to All SNF Patients Regardless of Payer CMS has published a summary report on the virtual SNF QRP Listening Session that was …
Medicare covers skilled nursing care and skilled therapy services under skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care to maintain function or to prevent or slow decline, as …
iQIES is the Internet Quality Improvement and Evaluation System, which is the system that the MDS submissions system is being transferred to. The QIES Technical Support Office maintains a website with iQIES reference materials, including …
Question: If a resident on a Medicare Part A stay leaves the facility on a leave of absence (LOA) with the family and is back in the facility after two midnights, are any assessments required? …
Question: Are we required to complete physician certifications and recertifications for Medicare Advantage or just for Original Medicare? Where is the source guidance? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: It is …
Question: I have a question about coding Functional Abilities in section GG for self-care and mobility on admission for a Medicare A resident. When the RAI User’s Manual states this is to reflect the resident’s …
In this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Jessie McGill, RN, BSN, RAC-MT, RAC-MTA, curriculum development specialist for AAPACN, discuss the common challenges nurse assessment coordinators …
Care Compare refreshes MDS 3.0 Quality Measure (QM) data quarterly in January, April, July, and October with the most recent four full quarters of data. AAPACN’s 2024 Five-Star and Care Compare MDS 3.0 Quality Measure …
With the influenza season in full swing plus the ongoing peaks and valleys of COVID-19 and respiratory syncytial virus (RSV) outbreaks across the United States, nurse assessment coordinators (NACs) should take steps both to protect …
The year 2024 brings a plethora of updates to the Medicare program, several significantly impacting skilled nursing facilities (SNFs). SNF staff must stay well informed about these updates to ensure proper billing and adequate coverage …
Question: If a resident is discharged to the hospital on day 14, does an Admission MDS need to be completed? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: Per the Federal rules …
Question: When does the Pain Assessment interview need to be conducted? Answer from Jennifer LaBay RN, RAC-MT, RAC-MTA, QCP, CRC: The questions must be asked during the 7-day observation period, but the resident must answer …
Question: Is there a standard letter or beneficiary notice that we have to use when a resident exhausts Medicare benefits? Answer from Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC: No, there isn’t a required …
In this podcast, Kim Hicks, vice president of business development for AAPACN, and Jessica Stucin, RN, BSN, LNHA, RAC-CT, RAC-CTA, assistant director of education for MDS Consultants, LLC, an AAPACN Diamond Business Partner, discuss some …
The Centers for Medicare & Medicaid Services (CMS) recently posted the draft Minimum Data Set (MDS) 3.0 Item Sets, version (v)1.19.1 and Item Matrix in the Downloads section on the Minimum Data Set (MDS) 3.0 …
The expedited determination beneficiary notification process covers a lot of ground in skilled nursing facilities (SNFs), affecting residents in the fee-for-service (FFS) Medicare Part A program and Medicare Advantage plans, as well as residents who …
The Centers for Medicare & Medicaid Services (CMS) announced on the Dec. 7 Skilling Nursing Facilities/Long-Term Care Open Door Forum that the drug classification of anticonvulsants will be added to the Minimum Data Set (MDS) …
Updated guideline offers the latest in evidence-based research to reduce pain, expand function and improve quality of life ROSEMONT, Ill. , Jan. 23, 2024 /PRNewswire/ — The American Academy of Orthopaedic Surgeons (AAOS) issued an update to the Clinical Practice Guideline (CPG) …
Skilled Nursing Facility CERT reports Skilled nursing facilities (SNF) is defined as all services with a provider type of SNF, including SNF inpatient, SNF outpatient, and SNF inpatient Part B. The projected improper payment amount …
In 2023, the AAPACN Leading in Care Blog brought you inspiration, personal member stories, clarification on need-to-know topics such as the iQIES transition, Quality Measures, and MDS updates, as well as details about important events …
The draft Minimum Data Set (MDS) 3.0 Item Sets version (v)1.19.1 and Item Matrix are now available. The MDS Item Sets v1.19.1 will be effective beginning October 01, 2024. From https://www.cms.gov/medicare/quality/nursing-home-improvement/resident-assessment-instrument-manual
Therapy Services: Per-Beneficiary CY 2024 Threshold Amounts The CY 2024 KX modifier threshold amounts are: More Information: Therapy Code List: 2024 Annual Update CMS updated the list of codes (ZIP) that sometimes or always describe therapy services and …
This user guide addresses Minimum Data Set (MDS) error messages and troubleshooting. CMS iQIES MDS Error Message Reference Guide v1.1 (posted 01/08/2024) From https://qtso.cms.gov/providers/nursing-home-mdsswing-bed-providers/reference-manuals
Effective communication is the glue holding the MDS process together, says Stacy Grondel, BSN, RN, RAC-MT, CMAC, QCP. director of reimbursement operations at QRM in Addison, TX. “The nurse assessment coordinator (NAC) who is a …
Question: A resident was admitted to the hospital while on a leave of absence (LOA). He had a qualifying hospital stay and was readmitted to our SNF on Medicare Part A. What date do I …
Question: A resident was admitted skilled, under managed Medicare, on 11/28. He transferred from managed care to traditional Medicare Part A, on 12/29. Are we required to complete another 5-Day for the Medicare stay starting …
Question: We have a resident on traditional Medicare Part A who was issued a NOMNC on 12/22, with a last covered day of 12/24. Can staff interviews for the PPS discharge assessment be performed after …
In this podcast, Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist for AAPACN, and Jessie McGill, RN, BSN, RAC-MT, RAC-MTA, curriculum development specialist for AAPACN, discuss a few outstanding questions that members asked …
In late December, the Centers for Medicare & Medicaid Services (CMS) released an updated MDS 3.0 Quality Measures User’s Manual v16.0. This manual has been updated to remediate a previous error in the Exclusions list …
The PDPM At-a-Glance tool breaks down the complex methodology of each component used in the Patient-Driven Payment Model—physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), non-therapy ancillaries (NTA), and nursing. This tool provides key …
Note: The audio file listed in the title may not be available. Thursday, December 7, 2023: Transcript, Q&A, Agenda and Audio File- Skilled Nursing Facilities/Long Term Care Open Door Forum (ZIP) From https://www.cms.gov/training-education/open-door-forums/about/odf-podcast-and-transcripts
In response to provider questions related to the MDS 3.0 QM User’s Manual posted on September 20, 2023, an updated MDS 3.0 QM User’s Manual v16.0, effective 10-1-2023, is now posted. Additionally, the updated .zip file titled MDS …
ADD Effective 10/1/2023 Major Category I. C. – Magnetic Resonance Imaging (MRI) Major Category II. A. – Dialysis, EPO, Aranesp, Other Related Services for ESRD Major Category III. A. -Chemotherapy Major Category III.D.-Customized Prosthetic Devices …
When the nurse assessment coordinator (NAC) goes on vacation, there’s a lot to keep track of while they are out of office. The MDS Daily Startup for the NAC Backup tool is intended to help …
The nurse assessment coordinator (NAC) role is a complex one that requires managing numerous deadlines, compliance regulations, and the involvement of the interdisciplinary team (IDT) in the Minimum Data Set (MDS) assessment. The job can …
MDS items E0100A (Hallucinations) and E0100B (Delusions) are qualifiers for the Behavioral Symptoms and Cognitive Performance category in the nursing component of the Patient-Driven Payment Model (PDPM). Even more importantly, these conditions that form the …
In this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, Marti Wdowicki, PharmD, director of clinical operations for PharMerica, and Jeff Herr, PharmD, manager of clinical operations in the …
Question: A resident was unable to complete the PHQ-2 interview, therefore my software did not allow us to complete the staff interview. Is this correct? D0100 was coded as “Yes”, interview should be conducted. D0150 …
Question: While most facilities require two-person assist with stand lift transfers, I have found that not all do. The RAI User’s Manual only addresses a stand lift transfer with two helpers as dependent. Is there …
Question: A resident went on a leave of absence (LOA) home for a few days and expired in his home. Would a discharge assessment be required? Answer from Jeff Taylor: Since this isn’t a discharge, …
During the Dec. 7, 2023, Skilled Nursing Facility/Long-Term Care Open Door Forum, Centers for Medicare & Medicaid Services (CMS) officials clarified that column 3, Discharge Performance, is required on all OBRA discharge assessments, regardless of …
Since the implementation of the RAI User’s Manual version 1.18.11 on Oct. 1, 2023, several long-term care nursing facilities have experienced electronic health record (EHR) software issues as well as complications with the MDS 3.0 …
This document presents technical specifications for the production of Medicare fee-for-service (FFS) claims-based measures (CBMs) for the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) and Value-Based Purchasing (VBP) program maintained by the Centers for …
Some items of potential interest: HHS/FDA Proposed Rule Stage Medical Devices; General and Plastic Surgery Devices; Classification of Certain Solid Wound Dressings, Wound Dressings Formulated as a Gel, Cream, or Ointment, and Liquid Wound Washes …
The Centers for Medicare & Medicaid Services (CMS) is alerting Skilled Nursing Facility (SNF) providers of upcoming measure removals from the SNF Quality Reporting Program (QRP). The following quality measures are planned for removal from …
Beneficiary notification requirements under the Medicare program can be confusing for nurse assessment coordinators (NACs) who serve as the lead Medicare nurse and other interdisciplinary team members in skilled nursing facilities (SNFs), says Carol Maher, …
The role of the nurse assessment coordinator (NAC) can often be an enigma to many nursing home staff. Misunderstandings about the position abound, and NACs may find it frustrating that no one knows what they …
Do you know what MDS items impact reimbursement under the Patient-Driven Payment Model (PDPM) or the Skilled Nursing Facility Quality Reporting Program (SNF QRP)? Use this quick guide, MDS Items Impacting Reimbursement for PDPM and …
The Centers for Medicare & Medicaid Services (CMS) recently released the MDS Data Specifications V3.01.1 (FINAL) Errata, which updated the previous MDS Data Specifications file. CMS addressed six additional issues that will be implemented on …
Effective Oct. 1, 2023, the Centers for Medicare & Medicaid Services (CMS) added columns for MDS items K0520 and O0110 to assess services provided “on admission” and “at discharge.” This change results in different assessment …
Question: A wound certified physical therapist staged a sore as a Stage 3 pressure ulcer. This was also verified with the physician and coded on the last MDS assessment. We have a new wound specialist …
Question: What is the best practice for capturing the three days of discharge performance for section GG for an unplanned or emergent transfer? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: I …
Question: For a long-term patient readmitted from the hospital, what are the clinical conditions that would require a Significant Change in Status Assessment on readmission? Also, can I combine this assessment with a Medicare 5-Day …
Errata V3.01.4 for MDS Data Specifications V3.01.1 (FINAL) is now available for download. Six issues were added to the errata. As a result, four edits were revised, and there were several mapping changes of items …
This job aid outlines the user roles and privileges in iQIES. All users must have a role in iQIES. Version 4.1 is now available at https://qtso.cms.gov/system/files/qtso/iQIES%20User%20Roles%20Matrix%20Job%20Aid%20v4.1%20FINAL%2011.14.2023_0.pdf
This video will help providers and physicians understand the need and importance of medical record documentation to support the services billed. Watch this video to learn more about what the CERT program has identified as …
With so many Quality Measures originating from three different payment initiative programs, it’s a lot to keep track of. AAPACN’s At-a-Glance QM, QRP, and VBP tool organizes all of the measures for you. This tool has been …
In the Jan. 18, 2023, Quality, Safety, and Oversight (QSO) memo QSO-23-05-NH, the Centers for Medicare & Medicaid Services (CMS) announced plans to conduct offsite audits to assess whether nursing homes appropriately assess, document, and …
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 …
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 …
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 …
In this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist with AAPACN, discuss some of the common concerns …
The Centers for Medicare & Medicaid Services (CMS) recently released a Questions and Answers document from the Oct. 12, 2023, Skilled Nursing Facility/Long-Term Care Open Door Forum. A question was asked regarding if it was …