The MDS Expert Blog

Read on for insights from our expert staff and our commentary in the press.

What’s up with the Five-Star Quality Rating System

What’s up with the Five-Star Quality Rating System

May 9, 2022

What’s up with the Five-Star and Care Compare? The Nursing Home Compare Five-Star Quality Rating System was developed by the Centers for Medicare & Medicaid Services (CMS) to assist residents and their families with information to “understand assessment of nursing home quality.”  The domains of the Five-Star Quality Rating System are State Health InspectionsStaffing and Quality Measures Recently CMS…

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Pulling the MDS nurse to the Floor

Pulling the MDS nurse to the Floor

April 6, 2022

Pulling the MDS nurse Onto the Floor: Minimum Nursing Staffing Levels   CMS is now showing consumers staff turnover and weekend staffing levels on Nursing Home Care Compare. These added metrics show families the history of staffing levels and staff retention for every nursing home facility and are key factors in assessing quality of care.…

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Are You Paying Attention to Resident Discharge?

Are You Paying Attention to Resident Discharge?

March 3, 2022

Are you Paying Attention to Resident Discharge? CMS & OIG Are   In 2017, CMS put into effect the final rule that focused on discharge planning for residents from the nursing home setting. From monitoring deficiencies data, we know some facilities still do not follow current guidelines. What has become important when it comes to…

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OIG Report Cites Challenges

OIG Report Cites Challenges

February 3, 2022

Top SNF Challenges from the OIG Report OIG released a report of the 2021 Top Management and Performance Challenges Facing the Department of Health and Human Services (HHS). The report from the Office of Inspector General (OIG) is titled, “2021 Top Management and Performance Challenges Facing HHS.”  It is worth a closer look at how this information will…

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COVID-19 Effects on Dementia

COVID-19 Effects on Dementia

January 4, 2022

Known Impact of COVID-19 on Dementia Patients As we start to shift our attention to the long term effects that this pandemic has had on our residents, a key area of focus is dementia outcomes.  Early on, many quick decisions were made to protect one of our most vulnerable patient populations. Recent studies have found that residents with dementia…

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Spotting Depression in Medicare Patients

Spotting Depression in Medicare Patients

December 2, 2021

The PHQ-9 patient intervew for depression affects the nursing component of PDPM and directly relates to the categories of special care high, special care low, and clinically complex. Not completing the PHQ-9 can result in a loss of over $40 dollars a day and there are no allowances for when the interview is missed due to…

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Section F Drives Better Quality Care

Section F Drives Better Quality Care

November 4, 2021

While Section F is not utilized for financial reimbursement or quality measures its critical to creating a patient-centered care plan.  The RAI Manual states, “A lack of attention to lifestyle preferences can contribute to depressed mood and increased behavior symptoms.”  However, are we utilizing the interview for daily and activity preferences appropriately to ensure that…

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Is Your Facility Coding UTI’s Correctly?

October 1, 2021

Let’s start with an example. This facility completed an MDS Quarterly assessment with an ARD of 9/16. There is a physician’s order dated 9/1 that states Cipro 500mg twice daily for UTI. Should the facility code the UTI as an active diagnosis in section I?  The scenario does not give enough information to code the…

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Prepare Your Team for FY2022

September 6, 2021

On August 4th CMS published the SNF PPS Final Rule.  Skilled nursing facilities should be preparing now for these upcoming changes. This Rule refresh: Updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for the fiscal year 2022 Updates the diagnosis code mappings used under the Patient-Driven Payment…

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Use MDS Section B to Improve Holistic Discharge Planning

August 17, 2021

By Caralyn Davis, Staff Writer August 17, 2021   Full article available to Members at https://www.aapacn.org/ Successfully using section B in discharge planning hinges on the accuracy of the coding, says Melanie Tribe-Scott, BSN, RN, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, QCP, director of education and marketing for MDS Consultants in Medina, NY. “With such a heavy focus…

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ICD-10 Coding and Guideline Updates for FY 2022

August 2, 2021

Earlier this summer, the Centers for Medicare & Medicaid Services (CMS) released the ICD-10-CM code descriptions, tables and index, and addendum for the fiscal year 2022. Then on July 12th, the Official Guidelines for Coding and Reporting of ICD-10-CM became available online. The updated manual and guidelines for FY 2022 revealed 159 new codes, along…

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Can I interrupt? Understanding the Interrupted Stay Policy

July 22, 2021

According to the RAI Manual, chapter 6: “The interruption window is a 3-day period, starting with the calendar day of Part A discharge and including the two immediately following calendar days, ending at midnight. In other words, the resident must return to the same SNF by 11:59 p.m. at the end of the third calendar…

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Is the Value Based Purchasing Program Changing?

June 14, 2021

The Centers for Medicare & Medicaid Services (CMS) issued its fiscal year (FY) 2022 proposed rule for the skilled nursing facility (SNF) prospective payment system (PPS) in April. CMS believes that scores on the one quality measure used in the SNF VBP program (30-day All-cause Readmissions) have been impacted by the COVID-19 pandemic, which would…

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SNF QRP Changes are Coming

May 30, 2021

The Proposed Rule for Fiscal Year (FY) 2022 for the Skilled Nursing Facility Prospective Payment System was released early April 2021. Now that providers have had a chance to digest the proposed SNF payment updates and the PDPM parity adjustment, attention turns to the quality initiatives that have been updated. Just 1 NTA point can…

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The Struggle with Antipsychotic Reduction

April 1, 2021

Since CMS began to monitor antipsychotic use in 2011, skilled nursing facilities have done well to reduce the use of antipsychotic medications from the original rate of 23.9%. However, over the past few years, the rate has remained around 14%. Some facilities believe they have done everything possible and this 14% represents residents that truly…

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Non-Therapy Ancillaries: What are you missing?

March 16, 2021

The Non-Therapy Ancillaries (NTA) component of PDPM can significantly increase revenue depending on MDS and ICD-10 coding. Just 1 NTA point can have an average worth of anywhere from $18 to $55 per day. (difference of NE-NF and NA-NB). The general method for calculation of any NTA category is as follows: Points (1-8) are assigned…

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Coding N2001 – N2005: Part A Drug Regimen Review

March 2, 2021

By Caralyn Davis, Staff Writer – March 2, 2021   Full article available to Members at https://www.aanac.org/ “CMS has been concerned about medication-related adverse events for many years. Identifying potential and actual clinically significant medication issues, communicating those issues to the physician, and then implementing physician-prescribed or physician-recommended interventions in a timely manner-at admission and throughout…

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SNF Physician Certifications for Medical Review

January 27, 2021

One of the requirements of payment is a valid Physicians Certification for Medicare part A services. If SNF certifications and re-certifications are not completed and signed following CMS regulations, then the facility is at risk of losing payment for an entire claim period. According to the Medicare Administrative Contractor, Noridian: “Analysis of claim denials from…

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Five-Star Preview: Not All Good News

January 20, 2021

The transition from Nursing Home Compare to Care Compare and unexpected Five Star Quality Rating updates brought disappointment to some Skilled Nursing Facilities. Due to the public health emergency (PHE), the rating system’s three domains had previously been held constant.  Centers for Medicare and Medicaid Services (CMS) announced that the Five Star Quality Rating system…

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Focused Infection Control Surveys and Directed Plan of Correction

January 10, 2021

It’s a dreary Monday morning, and the state surveyors walk into your facility to conduct a Focused Infection Control survey. You and your team have been trying your hardest to comply with infection control procedures throughout the pandemic. At the end of the survey, you are issued several citations and the state is requiring the…

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Five Star Updates

November 22, 2020

The Centers for Medicare & Medicaid Services (CMS) recently released the October 2020 version of the Five-Star Quality Measure System Technical Users’ Guide. It includes several revisions and updates for the Staffing, Quality Measure, and Health Inspection ratings in response to the Public Health Emergency (PHE). Health Inspection Since the Nursing Home Compare (NHC) refresh…

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New Advanced Beneficiary Notice

November 15, 2020

Is your facility using the proper ABN form? The Centers for Medicare & Medicaid Services (CMS) recently updated the Advanced Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131. The new ABN will be mandatory for use on 1/1/2021, but the new form can be implemented now. CMS debuted an updated ABN for use this summer but…

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PDPM ICD-10 Mapping Changes Effective Oct 1, 2020

September 23, 2020

With the beginning of fiscal year 2021 October 1, there will be the expected changes to our MDS and billing processes. This year the number of changes is limited due to the unprecedented public health emergency we are experiencing with COVID-19.  Despite that, we can expect updates to the PDPM ICD-10 Mapping Tool this year.…

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Covid-19 and Skilled Status

September 15, 2020

In late June, CMS addressed two issues and posted MDS 3.0 Final Item Sets (V1.17.2).  The two edits were changes to facilitate the calculation of Patient-Driven Payment Model payment codes on OBRA assessments for states that wish to have this calculation performed.  These two edits will be revised and go into production on October 1,…

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Mind Your PHQs

July 27, 2020

Some skilled nursing facilities (SNFs) are concerned about accurate payment when a resident unexpectedly discharges and the Brief Interview for Mental Status (BIMS) has not yet been completed. However, they should be just as concerned about the PHQ-9. The PHQ-9 identifies depressive symptoms to be captured on the MDS. The interview follows the same basic…

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Medicaid Changes Coming in October 2020

July 22, 2020

In late June, CMS addressed two issues and posted MDS 3.0 Final Item Sets (V1.17.2).  The two edits were changes to facilitate the calculation of Patient-Driven Payment Model payment codes on OBRA assessments for states that wish to have this calculation performed.  These two edits will be revised and go into production on October 1,…

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

July 8, 2020

By Caralyn Davis, Staff Writer – July 07, 2020 Full article available to Members at https://www.aanac.org/ 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…

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Isolation and COVID

June 1, 2020

Many providers have have cohorted residents in the same isolation room – applying recent CMS and CDC guidance during the COVID-19 emergency. This cohorting leaves many providers with the question: Can we code isolation on the MDS for cohorted residents? These facilities recognize that coding isolation will result in higher reimbursement in the PDPM, State…

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Section 1135 Waivers

May 18, 2020

When the President and HHS Secretary declared a national health emergency in response to the COVID-19 pandemic, they triggered section 1135 of the Social Security Act.  Section 1135 allows the Secretary to temporarily waive or modify certain Medicare and Medicaid requirements to ensure sufficient health care for enrollees. Skilled Nursing Facilities (SNFs) were issued multiple…

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Summary of The Proposed PPS Final Rule

April 13, 2020

Every April a Proposed PPS Final Rule is put forth by CMS. The proposed rule this year (2020) would update the SNF prospective payment rates for fiscal year (FY)2021 as required under the Social Security Act. CMS recognizes that the entire healthcare system is focused on responding to the COVID-19 public health emergency. As a…

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