The MDS Expert Blog
Read on for insights from our expert staff and our commentary in the press.
Pillars of Care
The US Department of Health and Human Services (HHS) developed a roadmap for behavioral health integration to address a national mental health crisis. The current Administration’s strategy is based on three core pillars:1. Strengthen System Capacity 2. Connect Americans to Care3. Support Americans by Creating Healthy EnvironmentsWhile the HHS Roadmap does not specifically address Skilled Nursing…
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Section I and Schizophrenia
In July 2022, CMS released an erratum to the RAI (Resident Assessment Instrument) Manual that included more detailed guidance on the use of diagnoses for section I, including the schizophrenia diagnoses that have been used as exclusion criteria for psychotropic medication use. You may be wondering why was this change made? When it comes to…
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Achieving Accurate ADL’s
The MDS nurse faces challenges when ADL documentation is sparse or even conflicting. Everyone wants accurate ADL’s, but how often do we fall short? How have pandemic staffing issues affected ADL accuracy? The “Rule of Three” indicates we should use the most dependent level that occurred at least three times (with certain exceptions). The RAI…
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Stars for Staffing
CMS released revisions to the staffing methodology in July through an updated Design for Care Compare Nursing Home Five-Star Quality Rating System: Technical Users’ Guide July 2022. The staffing star rating includes expanded from two to six compenents and introduced a new scoring calculation. The updated Five Star rating is calculated from the following…
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Disorganized Diagnoses
Section I is often a source of inaccurate coding. Inaccurate coding may cause loss of reimbursement, poor quality ranking, and poor resident care. The RAI Manual describes active diagnoses as: “Physician-documented diagnoses in the last 60 days that have a direct relationship to the resident’s current functional status, cognitive status, mood or behavior, medical…
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What’s New from CMS?
As the world tries to find a new normal, long-term care (LTC) professionals are watching what changes will come down from various White House initiatives. These initiatives to improve nursing homes include: CMS modifications for reimbursement and Continued changes related to COVID-19 reporting and care in the facilities. LTC professionals seeking to improve care, deal…
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What’s up with the Five-Star Quality Rating System
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 Inspections…
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Pulling the MDS nurse to the Floor
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? 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
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
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
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
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?
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
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
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
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
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?
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
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
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?
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
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
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
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
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
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
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
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
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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