Reimbursement

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Maximizing-Case-Mix-Index-in-Respiratory-Therapy
Oct 01 2024

Maximizing Case Mix with Special Programs: Respiratory Therapy and Restorative Nursing

Case mix is essential in skilled nursing facilities as it impacts both reimbursement and the care provided. Two key programs that significantly impact case mix scores when properly implemented and documented are Respiratory Therapy and Restorative Nursing. Both programs offer substantial benefits to residents and facilities alike by ensuring accurate reimbursement and enhancing resident outcomes.    Respiratory Therapy Programs Respiratory therapy is vital for residents with respiratory...
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Strategic-Admissions
Sep 01 2024

Strategic Admissions: The Path to Optimized Medicaid Reimbursement

Medicaid reimbursement plays a significant role in the financial health of long-term care facilities, particularly those serving a high percentage of Medicaid residents. While it may not be the sole source of revenue, it is an important component that supports the sustainability of facilities and ensures they can continue providing care to residents who rely on Medicaid coverage.   Optimizing Reimbursement By focusing on three key areas – insurance verification, optimizing the Case Mix...
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Interim-Payment-Assessment
Jun 01 2024
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Interim Payment Assessment (IPA) – To do or not to do?

The Patient-Driven Payment Model took effect in October of 2019. Along with this change came the optional IPA. We are now five years into this change and questions still arise on when to complete an IPA. The decision of when to complete lies with the team at the facility. This team is not prescribed but identified by facility. The key question: does the 5-day PPS MDS completed on admission capture the current clinical picture being reimbursed (PDPM classification) or is an updated assessment...
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Resident-Interviews-Capturing-the-Data
May 01 2024
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Resident Interviews – What are you doing to capture the data?

Effective October 1, 2023, several resident interviews were added to or updated on the MDS. Interview items in Section A and changes to the interviews in Section D, J, and Q have been implemented. Each of the interviews can be a great steppingstone in your path to creating a plan of care that puts each resident’s needs and preferences in focus and allows staff to support individual resident goals. Interviews in Sections C and D can affect PDPM scores and increase reimbursement based on...
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Social-Determinants-of Health-A-Global-Initiative
Mar 01 2024
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Social Determinants of Health (SDOH) – A Global Initiative Important to Skilled Nursing Providers

The Centers for Medicare & Medicaid Services’ (CMS) Office of Mental Health report CMS Framework for Health Equity 2022 and 2032 states that health equity is defined by the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and...
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PDPM-Or -OSA-A-State-Level-Decision
Nov 01 2023
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OSA or PDPM? A State-Level Decision

As of Oct. 1, 2023, the Centers for Medicare & Medicaid Services (CMS) has retired the A0300 Optional State Assessment (OSA) from the federally required MDS 3.0 v1.18.11 that is submitted by nursing facilities. The OSA is now a separate optional MDS assessment that may be completed at the discretion of each state’s government. The OSA is used by State Medicaid Agencies to calculate a case-mix score. States have the option to utilize the OSA for the collection of RUGS data pertinent to the...
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Achieving Accurate ADLs With The OSA
Oct 01 2023
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Achieving Accurate ADLs with the OSA

Section G of the MDS 3.0 was retired October 1, 2023, yet the MDS nurse may still need to use the knowledge of accurately coding ADLs with an assessment called the Optional State Assessment (OSA).  State-Optioned OSA Although the option to choose an OSA from the federally-mandated MDS assessment was similarly retired in October, some states have opted to require SNFs complete an OSA for Medicaid reimbursement. The OSA is now a separate optional MDS assessment that is completed at the...
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logo-skilled-nursing-news
Sep 07 2022
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MDS Changes Raise Medicaid Payment Questions

Tim Mullaney | September 7, 2022 | Excerpted from Skilled Nursing News The removal of a key section from the Minimum Data Set (MDS) will have massive repercussions, particularly for the future of nursing home reimbursements by states. ... The fate of Section G has been in question since the transition to the Patient-Driven Payment Model (PDPM), which made the section unnecessary from a Medicare reimbursement perspective. State-level Medicaid payments are another matter. Section G is used to...
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Jan 04 2022
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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 who contract COVID-19 have a higher risk of behaviors, depression, anxiety, impaired sleep, and worsening cognition long after the infection has...
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Sep 06 2021
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Prepare Your Team for FY2022

The Updated SNF PPS Final Rule Skilled nursing facilities should be preparing now for these upcoming changes. This On August 4th CMS 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 Model (PDPM) Implements a recently-enacted SNF consolidated billing exclusion, and Includes a discussion of a PDPM parity adjustment that...
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Jun 14 2021

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 result in unfair payment incentives and inequitable payments. In fact, CMS further commented that SNFs performance during the public health...
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Mar 16 2021
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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 to specific conditions. Points are added together for all conditions. The higher the total point value, the greater the payment (CMI). NF is the lowest grouper with a...
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Sep 23 2020
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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. The following changes will be effective October 1, 2020: Certain Cancer ICD-10 Codes- Previously specific cancer diagnoses that could require a major surgical procedure did...
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Sep 15 2020
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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, 2020. The purpose of these changes?  To allow State Medicaid Agencies to collect and compare RUG-III/IV payment codes to PDPM ones and thereby inform their future...
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Jul 27 2020
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Mind Your PHQs

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 rules as the BIMS. Both interviews should be conducted, preferably on the day of or the day before the ARD. The provider cannot complete the...
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Jul 22 2020
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Medicaid Changes Coming in October 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, 2020. The purpose of these changes?  To allow State Medicaid Agencies to collect and compare RUG-III/IV payment codes to PDPM ones and thereby inform their future...
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Apr 13 2020
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Summary of The Proposed PPS Final Rule

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 result, this year's Proposed Final Rule is more manageable when compared to previous years. The proposed rule includes: Proposals required by statute and that affect...
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Recent Blogs in All Topics

Dec 01 2024
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What is an MDS Coordinator?

"What do you do for a living?" It may not surprise you that when asked this question, most MDS Coordinators struggle to come up with an answer. The reality is that MDS Coordinators fully understand what this multifaceted job entails, but are at a...
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Nov 01 2024
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From the MDS to RAI System Management

With the introduction of the Minimum Data Set (MDS) through the Omnibus Budget Reconciliation Act (OBRA) of 1987, Centers for Medicare and Medicaid (CMS) implemented a method of standardized, comprehensive, and reproducible data collection for long...
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Oct 01 2024

Maximizing Case Mix with Special Programs: Respiratory Therapy and Restorative Nursing

Case mix is essential in skilled nursing facilities as it impacts both reimbursement and the care provided. Two key programs that significantly impact case mix scores when properly implemented and documented are Respiratory Therapy and Restorative...
Keep Reading
Sep 01 2024

Strategic Admissions: The Path to Optimized Medicaid Reimbursement

Medicaid reimbursement plays a significant role in the financial health of long-term care facilities, particularly those serving a high percentage of Medicaid residents. While it may not be the sole source of revenue, it is an important component...
Keep Reading
Aug 01 2024
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Internet Quality Improvement and Evaluation System (iQIES): A New Age

Just when we thought we had a handle on QIES (Quality Improvement and Evaluation System), the Centers for Medicare & Medicaid Services (CMS) transitioned to the Internet Quality Improvement and Evaluation System (iQIES) in 2023.   Reports...
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Jul 01 2024
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A Significant Change in Status Assessment – There are Options

The Resident Assessment Instrument (RAI) system includes a significant change in status assessment (SCSA). What might be forgotten is the State Operation Manual (SOM), Appendix PP, includes information that mirrors the RAI manual at 42 CFR...
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Jun 01 2024
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Interim Payment Assessment (IPA) – To do or not to do?

The Patient-Driven Payment Model took effect in October of 2019. Along with this change came the optional IPA. We are now five years into this change and questions still arise on when to complete an IPA. The decision of when to complete lies with...
Keep Reading
May 01 2024
,

Resident Interviews – What are you doing to capture the data?

Effective October 1, 2023, several resident interviews were added to or updated on the MDS. Interview items in Section A and changes to the interviews in Section D, J, and Q have been implemented. Each of the interviews can be a great steppingstone...
Keep Reading
Apr 01 2024
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Section GG Documentation – Questions Still Abound

Section GG remains a popular discussion topic among the Nurse Assessment Coordinator (NAC) and other members of the interdisciplinary team (IDT). Many have questioned their own practices and processes, designed to support coding this section of the...
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Mar 01 2024
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Social Determinants of Health (SDOH) – A Global Initiative Important to Skilled Nursing Providers

The Centers for Medicare & Medicaid Services’ (CMS) Office of Mental Health report CMS Framework for Health Equity 2022 and 2032 states that health equity is defined by the attainment of the highest level of health for all people, where...
Keep Reading
Feb 01 2024

Trauma and the MDS – A Sneak Peak

Trauma informed care has become an area of focus for Post Acute Care providers and survey agencies. Organizations are required to provide trauma-informed care that meets “professional standards of practice and accounting for residents’ experiences...
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Jan 01 2024

New Year….Same MDS Obstacle Course

As we ring in 2024, long term care professionals are still struggling to implement the October 2023 updates to the MDS. CMS is already talking about more changes in 2024, and the anticipation continues to create anxiety amongst PAC members. While...
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Dec 01 2023
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Schizophrenia Diagnosis Audits

On January 18th, 2023, CMS announced they will be conducting off-site audits in nursing homes for assessment accuracy and coding of residents with a diagnosis of Schizophrenia. Along with auditing for appropriate diagnosis, the audits will review...
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Nov 01 2023
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OSA or PDPM? A State-Level Decision

As of Oct. 1, 2023, the Centers for Medicare & Medicaid Services (CMS) has retired the A0300 Optional State Assessment (OSA) from the federally required MDS 3.0 v1.18.11 that is submitted by nursing facilities. The OSA is now a separate...
Keep Reading
Oct 02 2023

The Physician and “I”

The physician’s role in the nursing facility is essential to delivering skilled, quality care for Skilled and Long-Term Care residents. Physicians are our lead in providing clinical decision making and properly defining, clarifying, and verifying...
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Oct 01 2023

Coding UTIs on the MDS 3.0

Urinary Tract Infections (UTIs) are a commonly miscoded data element on the MDS. Are you over coding UTIs? Are you not coding them at all? Should you? Shouldn’t you? The MDS has historically left data collectors asking themselves these questions....
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Oct 01 2023
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Achieving Accurate ADLs with the OSA

Section G of the MDS 3.0 was retired October 1, 2023, yet the MDS nurse may still need to use the knowledge of accurately coding ADLs with an assessment called the Optional State Assessment (OSA).  State-Optioned OSA Although the option to choose...
Keep Reading
Jul 05 2023

What Is an MDS Coordinator?

It’s a bit odd that when asked what you do for a living most MDS coordinators struggle to come up with an answer. Who struggles to explain what they do every day? The reality is that MDS Coordinators fully understand what this multifaceted job...
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May 13 2023
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MDS 2023 Countdown Wrap-Up

This post is part of the MDS 2023 Countdown series.  Disclaimer: Current as of May 13, 2023.   What You Can Expect to See CMS released the first MDS draft item set (v1.18.11) in September 2022, which generated many questions for the long-term...
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May 13 2023
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Rx Reconciliation – New SNF QRP and QMs

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of October 1, 2023 What You Can Expect to See The reconciled medication list will have a new documentation requirement that will go into effect with the October 1, 2023...
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May 13 2023
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Away with Q0300 and in with Q0310 – New Section Q Changes

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of May 13, 2023 What You Can Expect to See This new Section Q update presents a key change to the wording: GOAL vs expectation. The Cambridge American Dictionary defines...
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Apr 08 2023
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Updated Entered From and Discharge Status options

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of October 1, 2023 Section A1800 "Entered From" and A2100 "Discharged Status" have Changed One of the changes you will see when coding section A of the MDS this October 1,...
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Apr 01 2023
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Transportation – New Item A1250

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of October 1, 2023 What You Can Expect to See An additional item we will see in the upcoming MDS 3.0 v.1.18.11 in October 2023 is A1250 - Transportation. This is included...
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Mar 24 2023
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New 3-day Lookbacks | Assessment Periods

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of March 24, 2023 What You Can Expect to See New 3-day lookback/assessment periods are coming to the MDS world. There are different sections of the MDS that the Nurse...
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Feb 22 2023
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New Pain Interview in Section J

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of February 22, 2023 What You Can Expect to See The most noticeable changes to Section J are evident in the pain interview, specifically questions J0510, J0520 and J0530....
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Feb 15 2023
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Section B – Hearing, Speech and Vision Changes

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of October 1, 2023 What You Can Expect to See Section B on the MDS is a component of the Standardized Patient Assessment Data Elements (SPADEs), which is utilized across...
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Feb 07 2023
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Race and Ethnicity – Changes in Section A

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of October 1, 2023 What You Can Expect to See Section A, Identification Information for Race/Ethnicity has expanded. One of the major changes is the deletion of section...
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Dec 23 2022
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The New Section N: Use and Indication of High-risk Drug Classes

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of December 23, 2022 WHAT YOU CAN EXPECT TO SEE We will see changes in Section N of the MDS 3.0 effective on October 1, 2023.  Section N0410 (Medications Received) has been...
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Dec 16 2022
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Where did Physician Examinations and Orders Go?

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of December 16, 2023 WHAT YOU CAN EXPECT TO SEE CMS does not require the completion of the physician examinations and orders, but they remain a requirement for some states...
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Dec 09 2022
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What’s New in Section O – Special Treatments, Procedures, Programs?

This post is part of the MDS 2023 Countdown series.  Disclaimer. Current as of December 9, 2023 WHAT YOU CAN EXPECT TO SEE What is Changing with Section O? When you first look at the draft of section O item O0110 special treatments, procedures, and...
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