• Section GG: Assessing Usual Performance During the COVID-19 Pandemic

    By Caralyn Davis, Staff Writer - July 07, 2020

    The Centers for Medicare & Medicaid Services (CMS) makes clear in the title of MDS section GG (Usual Performance and Goals) that the assessment subitems in items GG0130 (Self-Care) and GG0170 (Mobility) are designed to capture a resident’s usual ability or usual performance. This begs the question: How can nurse assessment coordinators (NACs) and other members of the interdisciplinary team (IDT) ensure they capture usual performance in unusual times, such as in the middle of the ongoing COVID-19 pandemic?

     

    “Everyone’s nervous because nursing home residents are dealing with a new way of living, and staff are dealing with a new daily practice,” points out Melanie Tribe-Scott, BSN, RN, RAC-MTA, QCP, director of education and marketing for MDS Consultants in Medina, NY. “However, you still want to get the most complete picture of the resident possible, and you still should assess section GG the same way you always have—following the coding instructions in section GG of chapter 3 in the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual.”

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  • Q&A: If we skill a resident for nursing only related to the COVID-19 infection and therapy is not involved, how do we code section GG? How would you code goals?

    By Carol Maher, RN-BC, CPC, RAC-MT - April 21, 2020
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  • The Particulars of Coding Pre-Admission Data and PDPM

    By Jessie McGill, RN, RAC-MT, RAC-MTA - April 01, 2020

    When the nurse assessment coordinator (NAC) prepares to code the MDS, the process starts with data collected during the lookback period. However, one frequently-asked question is, “When can services that occurred prior to admission to the skilled nursing facility (SNF) be captured on the MDS?” There is no simple answer, because it depends on the coding instructions for each MDS item. Let’s take a look at the particulars of coding preadmission data, why it is collected, and how preadmission data is used under PDPM.

     

    Background

    Chapter 3 of the RAI User’s Manual contains the coding instructions for each MDS item; however, the overview of chapter 3, pages 3-1 through 3-6, are often overlooked. This brief section discusses coding conventions, which apply to all MDS items, and includes the instructions on preadmission data:

    With the exception of certain items (e.g., some items in Sections K and O), the lookback period does not extend into the preadmission period unless the item instructions state otherwise. In the case of reentry, the lookback period does not extend into time prior to the reentry, unless instructions state otherwise.

     

    MDS Item Set 1.17.1 Preadmission Data and Why It Is Collected

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  • Section G: Going, Going, Almost Gone – October 2020

    By Jessie McGill, RN, RAC-MT, RAC-MTA - February 04, 2020

    The Activities of Daily Living (ADLs) in section G of the MDS are interwoven throughout the Care Area Assessments (CAAs), Quality Measures, and reimbursement—and have been for years. Yet CMS took nurse assessment coordinators (NACs) by surprise when the draft MDS item sets released in early January 2020 revealed that section G will be removed from all OBRA and PPS assessments as of October 1, 2020. In fact, section G will only appear on the Optional State Assessment (OSA) item set.

    Today, facilities must confront Section G’s future removal, an upcoming development that raises more questions than answers. Many NACs are asking how this huge change will impact the accuracy of the functional data collected, which in turn affects CAAs, care plans, Quality Measures (QMs), and possibly even Medicaid reimbursement. While we do not know how the details of how this transition will play out, we can identify how this change will impact different items and programs. We can also begin to explore how facilities can prepare for this change.

    How can section GG replace section G?

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  • Coding Section GG: A Case Study Review

    By Jessie McGill, RN, RAC-MT, RAC-MTA - November 25, 2019

    Collaboration. It is one of the key terms used to describe data collection for section GG, Functional Abilities and Goals. Collaboration among clinicians, to identify usual, and baseline conditions—these are also important terms used throughout section GG. But in a profession that is used to coding section G, Activities of Daily Living (ADLs), and calculating the Rule of 3, the process of determining usual performance for section GG holds some challenges. Does the data collected and documentation actually support how we are coding section GG? Let’s take a look at a case study of Mrs. Georgia Geoffrey and how the clinicians determined usual performance for some of the key GG tasks on her 5-Day assessment.

    Mrs. Georgia Geoffrey admitted to Happy Valley Nursing Facility following a knee replacement due to osteoarthritis. The wheelchair transport van wheeled her into the nursing home, and the nurse aide assigned to her alerted the nurse of her arrival and propelled her down the hall to her room. 

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  • TIP: Section GG Coding and IPAs

    By AANAC - September 24, 2019
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  • Balancing Sections G and GG Requirements

    By Jessie McGill, RN, RAC-MT, RAC-MTA - July 10, 2019

    With the enormous focus on the transition from RUG-IV to PDPM, some may consider abandoning their section G Activities of Daily Living (ADLs) training materials, audits, and tools— but wait just a moment! Although section GG is stepping into the Medicare reimbursement spotlight, section G still plays a big role in other types of reimbursement and Quality Measures. To ensure success, the nurse assessment coordinator (NAC) must have a full understanding of the coding instructions, documentation requirements, impact on Quality Measures, and reimbursement for both section G and GG. Here are four key differences between the two sections and tips for successfully managing both.

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  • TIP: New Section GG Training Videos

    By AANAC - June 05, 2019
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  • Q&A: Can therapy code section GG based on their clinical judgment of what the resident is capable of doing?

    By Carol Maher, RN-BC, CPC, RAC-MT - June 05, 2019
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  • IPAs: Basic Rules of the Road

    By Caralyn Davis, Staff Writer - March 06, 2019

    With the next version of the RAI User’s Manual not slated to be released until late spring, there are still some unknowns about the new Interim Payment assessment (IPA), but the Centers for Medicare & Medicaid Services (CMS) has established the basic rules of the road. Here’s a handy summary of the information CMS has provided thus far.

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  • Q&A: We had to dash a few GG items on the PPS Discharge assessment, is this going to count against us for SNF QRP?

    By Carol Maher, RN-BC, CPC, RAC-MT - March 06, 2019
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  • No. 1 Sign of GG Dysfunction? Therapy Runs the Show Alone

    By Caralyn Davis - February 20, 2019

    Providers have been collecting data for MDS section GG (Functional Abilities and Goals) since October 2016, largely to meet the data submission threshold for the Skilled Nursing Facility Quality Reporting Program (SNF QRP). “In many SNFs, nursing has generally abdicated responsibility for section GG to the therapy department because there is no payment attached to section GG under the RUG-IV case-mix classification system,” says Joel VanEaton, BSN, RN, RAC-MT, vice president of compliance and regulatory affairs for Broad River Rehab in Asheville, NC.

     

    “That’s a big mistake when it comes to the Patient-Driven Payment Model (PDPM), which implements on Oct. 1,” says VanEaton. “To correctly define the resident’s functional profile in section GG, you have to figure out how to shift from that therapy-only paradigm to a paradigm of true collaboration, particularly among the MDS department, nursing, and rehab.”

     

    “The most significant problem with section GG is that coding often isn’t interdisciplinary,” agrees Tracy Montag, BSN, RN, RAC-MT, clinical consultant with the Senior Living Services Consulting Group at RKL LLP in York, PA. “There are still a lot of facilities that don’t look at usual performance over three days because coding is so therapy-driven. For example, for the 5-day PPS MDS, they input information directly into section GG from the documentation the therapist completes during the therapy evaluation. Sometimes facilities don’t even have information collected for some components of section GG because therapy is not seeing the resident for those components.”

     

    To improve section GG coding accuracy, nurse assessment coordinators (NACs) should consider the following steps:

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  • TIP: PDPM Resources Updated

    By AANAC - February 20, 2019
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  • TIP: CMS Releases GG Tool

    By AANAC - February 06, 2019
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  • Section GG’s Role in PDPM: The Basics

    By Caralyn Davis, Staff Writer - February 06, 2019
    MDS section GG (Functional Abilities and Goals) will replace section G (Functional Status) as a key payment driver for fee-for-service Medicare Part A residents paid under the Skilled Nursing Facility Prospective Payment System (SNF PPS) when the Patient-Driven Payment Model (PDPM) implements on Oct. 1, 2019. Using items from section GG instead of section G “advances CMS’s goal of using more standardized assessment items across payment settings,” said officials with the Centers for Medicare & Medicaid Services during the Dec. 11, 2018, SNF PPS: PDPM National Provider Call (NPC).
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