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PDPM Coding Question – If someone comes in at a more dependent level, such as 01 – total assist for majority of things, then seems to improve to 02 – max assist on the second day, are we supposed to continue doing GG for the full 3 days?
Q: If someone comes in at a more dependent level, such as 01 - total assist for majority of things, then seems to improve to 02 – max assist on the second day, are we supposed to continue doing GG for the full 3 days? A: The RAI Steps for Assessment (pg. GG-10)...
PBJ Staffing Data for Q2 Must be Submitted this Week
Nursing home providers must resume submission of payroll-based journal (PBJ) staffing data by the end of this week. While an 1135 federal blanket waiver related to the COVID-19 public health emergency had previously suspended these data submissions, this waiver was...
PDPM Coding Question – We have isolated new admissions in our facility during the Coronavirus pandemic. Can we report and get “credit” for this precautionary isolation or does the resident have to have an active infection?
Q: We have isolated new admissions in our facility during the Coronavirus pandemic. Can we report and get “credit” for this precautionary isolation or does the resident have to have an active infection? A: Precautionary isolation should not be reported in the...
SNF Censuses Shrink as COVID-19 Concerns Grow
In addition to the obvious concerns related to the current Public Health Emergency (PHE), the Coronavirus pandemic has created secondary challenges that numerous SNFs are facing including increased public scrutiny, changes in admission patterns, and declining census...
SNF PPS Final Rule, How Will It Impact Your Facility?
On July 31, 2020 the Centers for Medicare and Medicaid Services (CMS) issued the FY 2021 Skilled Nursing Facility Prospective Payment System (SNF PPS) Final Rule. This updates the Medicare payment rates and Value-Based Purchasing program for Skilled Nursing Facilities...
Q & A – A resident had a UTI in the hospital but their antibiotics were finished before admitting to the facility. The DC Summary notes “UTI-Resolved”. Should UTI be coded?
Q: A resident had a UTI in the hospital but their antibiotics were finished before admitting to the facility. The DC Summary notes “UTI-Resolved”. Should UTI be coded? A: Yes, UTI must be coded in I2300 if occurred in the last 30 days. The RAI Manual (page...
Updated CDC Guidance: Symptom-based Strategy for DC Isolation and Return to Work
On July 17, 2020, CDC updated the guidance related to Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance) and the Criteria for Return to Work for Healthcare Personnel with SARS-CoV-2...
PDPM Interrupted Stay Issue – You may need to modify claims
Per the MLN Connects news issued July 23, 2020, a new issue is affecting some inpatient hospital and Skilled Nursing Facility (SNF) claims when an interrupted stay is billed at the end of the month. The system incorrectly assigns edits U5601-U5608 (overlapping a...
SNF PEPPER Now Available: Is Your Facility an Outlier?
PEPPER summarizes Medicare claims data statistics for billed claims in target areas that may be at risk for improper payments. Your facility data is compared to all SNFs in the nation, in your state, and in your jurisdiction to assess how your past billing practices...
Q & A – Do I have to restart the Medicare physician certification process when a resident qualifies for an interrupted stay?
Q: Do I have to restart the Medicare physician certification process when a resident qualifies for an interrupted stay? A: The requirements for physician certifications and recertifications for the SNF PPS stay did not change with the implementation of PDPM....
COVID-19 Point of Care Testing, CLIA Waivers, Tracking & Reporting
Since July 20, skilled nursing facilities have the availability of various COVID-19 point-of-care (POC) rapid results tests for both residents and staff in order to fulfill the CMS guidance that recommends a baseline test and weekly testing thereafter. Facilities...
CLIA Waiver Required for COVID-19 Point of Care Testing
Is your facility CLIA certified? Beginning this week, COVID-19 point of care (POC) testing instruments and supplies will start to be provided to skilled nursing facilities, prioritizing “hot spots” first. Only facilities with a Clinical Laboratory Improvement...
Medicare Medical Review Activity Expected to Resume in August
CMS suspended most Medicare Fee-For-Service (FFS) medical review in late March due to the public health emergency (PHE). However, CMS has recently updated the COVID-19 Provider Burden Relief FAQ related to claim audit waivers. This update states that Medical Review...
Q & A – How often do restorative progress notes need to be written?
Q: How often do restorative progress notes need to be written? A: The RAI Manual, p. O-43 states, “Evidence of periodic evaluation by the licensed nurse must be present in the resident’s medical record.” Facility policy should determine the frequency of the...
All In! Interdisciplinary Supportive Documentation to Succeed Under PDPM
Working together for the best clinical outcomes and for reimbursement accuracy requires good systems for communication – both verbally and in our documentation. The fundamental expectations for documentation to support skilled level of care, medical necessity, and...