• Finetune Section GG Coding to Prevent Inaccurate Payments

    By Caralyn Davis, Staff Writer - August 01, 2019

    In the current RUG-IV case-mix classification system used in the Medicare Part A Skilled Nursing Facility Prospective Payment System (SNF PPS), the activities-of-daily living (ADL) score derived from MDS section G (Functional Status) factors into the calculation of every case-mix group. Effective October 1, that all changes. While section G will still be important for care planning and some quality measures (QMs), section GG (Functional Abilities and Goals) will take over on the payment front, providing functional scores that will be used in case-mix classification for three of the five case-mix-adjusted payment components under the new Patient-Driven Payment Model (PDPM): physical therapy (PT), occupational therapy (OT), and nursing.

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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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  • Q&A: What are some notable differences between G and GG scoring methodologies?

    By CMS - January 09, 2019
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  • Holiday Challenge Question: How would you document this toileting activity?

    By AANAC - December 17, 2018
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  • TIP: Are you ready for PDPM?

    By AANAC - December 03, 2018
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  • Q&A: How do we establish section GG goals when a resident is not on therapy’s caseload?

    By Carol Maher, RN-BC, CPC, RAC-MT - November 12, 2018
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  • Q&A: Why am I receiving warning message, -3907, on the Final Validation Report when we did code at least one goal in section GG?

    By Jessie McGill, RN, RAC-MT - November 12, 2018
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