• 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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  • Get Back to Nursing Basics to Determine Skilled Services

    By Caralyn Davis, Staff Writer - February 04, 2020

    With the rush to understand the Patient-Driven Payment Model (PDPM) under the Skilled Nursing Facility Prospective Payment System (SNF PPS), it’s easy to get caught up in meeting the technical criteria for payment—and not pay enough attention to the clinical criteria for meeting a Medicare skilled level of care, says Jennifer LaBay, RN, RAC-MT, RAC-MTA, CRC, an MDS/policy consultant for Triad Health Care LLC in Providence, RI.

     

    “PDPM puts the focus on the primary medical condition that is coded in MDS item I0020B using an ICD-10-CM diagnosis code,” explains LaBay. “However, there is a general misunderstanding about what the ICD-10 code in I0020B means. Some nurse assessment coordinators (NACs) look at an ICD-10 code and ask, ‘Is this a skilled diagnosis?’ That’s the wrong question, and you need to avoid falling into the trap of thinking that an ICD-10 code in I0020B that does not return to provider (RTP) means you have a skilled service.”

     

    The primary medical diagnosis in I0020B only sets the payment. “Specifically, it determines a resident’s default clinical category for PDPM’s physical therapy (PT), occupational therapy (OT), and a portion of the speech-language pathology (SLP) payment components,” she notes.

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  • SNF QRP Table for Reporting Assessment-Based Measures and SPADEs for the FY 2022 (Calendar Year 2020) SNF QRP APU

    By CMS - February 03, 2020
    The SNF QRP Table for Reporting Assessment-Based Measures and SPADEs for the FY 2022 SNF QRP APU is now available. This table indicates the MDS data elements CMS will use for FY 2022 SNF QRP APU determinations.
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  • SNF PPS Fact Sheet From Medicare Learning Network - Revised (1/20)

    By CMS - February 03, 2020
    The basics of SNF PPS and consolidated billing.
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  • Oct. 1, 2020 DRAFT MDS 3.0 v1.18.0 Item Sets, Plus Detailed Change Document (1/20)

    By CMS - January 27, 2020
    A new DRAFT version of the 2020 MDS item sets (v1.18.0) was posted. This version is scheduled to become effective October 1, 2020. Please note that Section G has been removed from all Federal item sets. The MDS 3.0 Item Set Change History for October 2020 report also has been released.
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  • CMS to Provide Consumer Portal to Nursing Home Compare, Other Compare Sites (1/20)

    By CMS - January 27, 2020

    Making it Easier to Compare Providers and Care Settings on Medicare.gov

    CMS plans to improve online comparison tools to inform health care decisions

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  • In the World of Restorative Care, One Size Does Not Fit All

    By Jane Belt, MS, RN, QCP, RAC-MT, RAC-MTA - January 22, 2020

    In long term care, the importance and value of restorative nursing programs cannot be overstated. The residents can reap such wonderful benefits. The Omnibus Budget Reconciliation Act (OBRA) philosophy—of providing services to help residents maintain or attain their highest practicable level of physical, mental, and psychosocial well-being—is well served with restorative programming. What considerations should be foremost for a facility developing or implementing a restorative nursing program?

     

    With an eye to federal regulatory compliance, we observe that numerous F-tags are potentially affected by restorative nursing. When delivered appropriately, restorative programming can be an important spoke in the wheel of a “successful survey.” Yet given the variety of regulatory topics that restorative activities can support, it’s important to get it right. To name just a few examples:

    F552:  Right to Be Informed/Make Treatment Decisions

    F676:  Activities of Daily Living (ADLs)/Maintain Abilities

    F677:  ADL Care Provided for Dependent Residents

    F684:  Quality of Care

    F686:  Treatment/Services to Prevent/Heal Pressure Ulcers

    F688:  Increase/Prevent Decrease in Range of Motion/Mobility

    F689:  Free of Accident Hazards/Supervision/Devices

    F690:  Bowel/Bladder Incontinence, Catheter, UTI

    F692:  Nutrition/Hydration Status Maintenance

    F725:  Sufficient Nursing Staff

    F825:  Provide/Obtain Specialized Rehabilitative Services

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  • Master the Complexities of Dysphagia Coding Under PDPM

    By Caralyn Davis, Staff Writer - January 22, 2020

    Dysphagia coding plays a key role in the Patient-Driven Payment Model (PDPM) through both section I (Active Diagnoses) and section K (Swallowing/Nutritional Status) of the MDS. Here are the keys to getting it right:

     

    Don’t assume IDT members understand PDPM

    Sometimes nurse assessment coordinators (NACs) assume that speech-language pathologists and registered dietitians (RDs) already understand PDPM and the Resident Assessment Instrument (RAI) process when they walk in the door, notes Brenda Richardson, MA, RDN, LD, FAND, a long-term care nutrition expert based in Salem, IN, who is the past chair of the Academy of Nutrition and Dietetics Political Action Committee (ANDPAC) and recipient of the 2019 Academy Lenna Frances Cooper Memorial Lecture Award.

     

    “However, dysphagia’s role in PDPM is complex. Not only do IDT members need to understand each resident’s dysphagia diagnosis, they also need to understand how that diagnosis maps—or doesn’t map—to the ICD-10-CM codes that impact PDPM, as well as how that corresponds to the MDS and the coding instructions for sections I and K,” she points out. “Employers, including contract service employers, often do not prioritize training related to payment models, so taking the time to sit down with speech pathologists and RDs to discuss the rules will only improve your ability to capture dysphagia accurately on the MDS.”

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  • At A Glance QM, QRP, and VBP Tool

    By AANAC - January 14, 2020
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  • MDS Item O0110: Keys to Coding Under PDPM

    By Caralyn Davis, Staff Writer - January 08, 2020

    Ten subitems in MDS item O0100 (Special Treatments, Procedures, and Programs) can affect from one to three of the case-mix-adjusted payment components in the Patient-Driven Payment Model (PDPM): speech-language pathology (SLP), nontherapy ancillaries (NTA), and/or nursing. The following chart shows the potential impacts:

     

    O0100 Item

    Potential PDPM Impact

    O0100A2 (Chemotherapy While a Resident)

    Nursing Clinically Complex

    O0100B2 (Radiation While a Resident)

    NTA (1 point), Nursing Special Care Low, Nursing Clinically Complex

    O0100C2 (Oxygen Therapy While a Resident)

    · Must be in combination with I6300 (Respiratory Failure) to qualify for Nursing Special Care Low

    Nursing Special Care Low, Nursing Clinically Complex

    O0100D2 (Suctioning While a Resident)

    NTA (1 point)

    O0100E2 (Tracheostomy Care While a Resident)

    SLP, NTA (1 point), Nursing Extensive Services, Nursing Clinically Complex

    O0100F2 (Invasive Mechanical Ventilator (ventilator or respirator) While a Resident)

    SLP, NTA (4 points), Nursing Extensive Services, Nursing Clinically Complex

    O0100H2 (IV Medications While a Resident)

    NTA (5 points), Nursing Clinically Complex

    O0100I2 (Transfusions While a Resident)

    NTA (2 points), Nursing Clinically Complex

    O0100J2 (Dialysis While a Resident)

    Nursing Special Care Low, Nursing Clinically Complex

    O0100M2 (Isolation or Quarantine for Active Infectious Disease (does not include standard body/fluid precautions) While a Resident)

    NTA (1 point), Nursing Extensive Services, Nursing Clinically Complex


    Note: When more than one nursing category is listed, the resident may be classified into the lower category depending on other MDS data, e.g., the resident’s nursing function score.


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  • CASPER Reporting User’s Guide for MDS Providers UPDATED (1/20)

    By QTSO - January 04, 2020
    Provides information and instructions pertaining to CASPER Reporting, including accessing Final Validation Reports.
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  • J2100: How Do Interim Hospital Stays Impact Coding?

    By Caralyn Davis, Staff Writer - December 19, 2019

    MDS item I0020B (ICD Code/Resident’s Primary Medical Condition) sets a Medicare Part A resident’s default primary diagnosis clinical category for determining case-mix classification in the physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) payment components of the Patient-Driven Payment Model (PDPM). However, a major surgery in the resident’s immediately preceding inpatient hospital stay that is coded in MDS items J2100 – J5000 can push the resident into a surgical category that takes precedence over the default category, resulting in a higher-paying case-mix group.

     

    Item J2100 (Recent Surgery Requiring Active SNF Care) is the lynchpin to achieving a surgical clinical category, serving as the gateway question that determines whether or not a surgery can be captured in J2300 – J5000 (Recent Surgeries Requiring Active SNF Care). Note: See the PDPM Calculation Worksheet for SNFs in chapter 6 of the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual for details on how items in J2300 – J5000 impact classification.

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  • PDPM Cognitive Level Still Confuses Some SNFs

    By Caralyn Davis, Staff Writer - December 18, 2019

    PDPM Cognitive Level Still Confuses Some SNFs

    The Patient-Driven Payment Model (PDPM) cognitive level plays a key role in determining a Medicare Part A resident’s speech-language pathology (SLP) case-mix component. The Brief Interview for Mental Status (BIMS), coded in MDS items C0200 – C0500, is its primary driver. If the BIMS cannot be completed, the items C0700 (Short-term Memory OK) and C1000 (Cognitive Skills for Daily Decision-Making) from the Staff Assessment for Mental Status combine with items B0100 (Comatose) and B0700 (Makes Self Understood) to determine the PDPM cognitive level. So it’s no surprise that questions about the PDPM cognitive level came fast and furious at the December 12 Skilled Nursing Facility Long-term Care Open Door Forum (ODF).

     

    Here are the primary issues raised by callers:

     

    If neither the BIMS nor the Staff Assessment is completed, what happens with regard to obtaining a PDPM cognitive level?

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  • J2100: How Do Interim Hospital Stays Impact Coding?

    By Caralyn Davis, Staff Writer - December 18, 2019

    MDS item I0020B (ICD Code/Resident’s Primary Medical Condition) sets a Medicare Part A resident’s default primary diagnosis clinical category for determining case-mix classification in the physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) payment components of the Patient-Driven Payment Model (PDPM). However, a major surgery in the resident’s immediately preceding inpatient hospital stay that is coded in MDS items J2100 – J5000 can push the resident into a surgical category that takes precedence over the default category, resulting in a higher-paying case-mix group.

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  • How Can the NAC Take Time Off? Build a Supportive Team

    By Jessie McGill, RN, RAC-MT, RAC-MTA - December 17, 2019

    Planning for time off over the holidays often takes coordination across the entire interdisciplinary team (IDT) to ensure processes and systems continue to operate smoothly while key players are missing. The nurse assessment coordinator (NAC) must ensure MDS assessments are in place, skilled Medicare decisions are being made appropriately, significant changes or the need for an Interim Payment Assessment are identified, determinations of whether a resident meets the criteria of an interrupted stay occur, and the list can go on and on. With some pre-planning, though, the NAC can have a stress-free holiday—at least from work-related stress.

    Here are some strategies NACs can use to achieve time off.


    1. Share the knowledge.

    Often, the NAC will find him- or herself the only nurse in the facility who knows how to open an MDS assessment, request a Medicare physician certification or recertification, or even locate the RAI User’s Manual. This is not a good strategy for success.

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