OIG: Nursing Homes Failed To Report 43 Percent of Falls With Major Injury and Hospitalization Among Their Medicare-Enrolled Residents

DNS / MDS 3.0 and the RAI Process / NAC / Post-Acute Care News / Survey and Regulatory Compliance

Issued on 09/15/2025 | Posted on 09/18/2025 | Report number: OEI-05-24-00180 Report Materials Why OIG Did This Review What OIG Found Nursing homes failed to report 43 percent of falls with major injury and hospitalization among Medicare-enrolled residents, as required, in resident assessments. Nursing homes’ failure to report falls on MDS assessments leads to inaccurate fall …

TIP: CMS Delayed Long-Stay Antipsychotic Measure Changes

NAC / QAPI and Quality Initiatives / Tip

The Centers for Medicare & Medicaid Services (CMS) released a revised memo, QSO-25-20-NH REVISED, on Sept. 10, 2025, delaying the changes to the long-stay (LS) Antipsychotic Measure. CMS had previously announced the measure would be expanded to include Medicare and Medicaid claims and encounter data, in addition to Minimum Data …

Everything You Need to Know About the AAPACN Podcasts—LTC DON Chat and LTC NAC Chat

Administrator / Blog / DNS / IDT member / NAC

The AAPACN Podcasts—LTC DON Chat and LTC NAC Chat—offer tips, strategies, updates, advice, and breaking news on the most important topics in long-term and post-acute care. Regular hosts and AAPACN staff members provide their own best practices and insights, as well as a breakdown of updates and regulations. They also …

Q&A: We had a resident on a Medicare Part A stay admit and discharge back to the hospital that same evening after a few hours. We could not assess much information during that brief amount of time. What are all the required MDS assessments that need to be completed on this resident? I know an entry tracker and an OBRA discharge, but do we need to also complete a 5-Day PPS?

MDS 3.0 and the RAI Process / NAC / Q&A

Question: We had a resident on a Medicare Part A stay admit and discharge back to the hospital that same evening after a few hours. We could not assess much information during that brief amount of time. What are all the required MDS assessments that need to be completed on …

Q&A: The new definition of a fall includes an overwhelming external force, but the definition of fracture related to a fall states, “Do not include fractures caused by trauma related to car crashes or pedestrian versus car accidents or impact of another person or object against the resident.” Does this instruction contradict the new definition of a fall?

MDS 3.0 and the RAI Process / NAC / Q&A

Question: The new definition of a fall includes an overwhelming external force, but the definition of fracture related to a fall states, “Do not include fractures caused by trauma related to car crashes or pedestrian versus car accidents or impact of another person or object against the resident.” Does this instruction …

Q&A: Can Isolation be coded for methicillin-resistant staphylococcus aureus (MRSA) on a wound?

MDS 3.0 and the RAI Process / NAC / Q&A

Question: Can Isolation be coded for methicillin-resistant staphylococcus aureus (MRSA) on a wound? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: No, the RAI User’s Manual specifically states that isolation cannot be coded for a wound infection. See page O-8 (bold text added for emphasis): Code only when the …

IPA Quick Calculators – Urban and Rural

Billing and Reimbursement / NAC / Tool

When a resident’s condition changes during the Medicare Part A stay, the facility team must decide if an Interim Payment Assessment (IPA) is indicated. The AAPACN IPA Quick Calculator interactive tool can help the team analyze the changes in HIPPS codes, case-mix groups, case-mix indexes, and rates. Two tools are …

PDPM At-a-Glance Tool

Billing and Reimbursement / DNS / NAC / Tool

The PDPM At-a-Glance tool breaks down the complex methodology of each component used in the Patient-Driven Payment Model—physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), non-therapy ancillaries (NTA), and nursing. This tool provides key payment information organized to provide the nurse assessment coordinator (NAC) with quick access to understanding …

FY 2028 (CY 2026 Data) SNF QRP Reporting Requirements and Data Submission Deadlines

Billing and Reimbursement / DNS / MDS 3.0 and the RAI Process / NAC / Post-Acute Care News

SNF QRP Data Collection and Final Submission Deadlines The SNF QRP Data Collection and Final Submission Deadlines have been updated to provide the data collection time frames and final submission deadlines for the FY 2028 SNF QRP.  From https://www.cms.gov/medicare/quality/snf-quality-reporting-program/submission-deadlines SNF QRP Data Elements Used for Reporting Assessment-Based QMs and Standardized Patient …

FY 2027 (CY 2025 Data) Revised SNF QRP MDS Reporting Requirements and Data Submission Deadlines

Billing and Reimbursement / DNS / MDS 3.0 and the RAI Process / NAC / Post-Acute Care News

SNF QRP Data Elements Used for Reporting Assessment-Based QMs and Standardized Patient Assessment Data Elements Affecting FY 2027 APU Determination and Data Collection and Final Submission Deadlines for FY 2027 posted The Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Overview of Data Elements Used for Reporting Assessment-Based Quality Measures …