Using non-pharmacological approaches, not psychotropic medications (i.e., antipsychotic, antidepressant, anti-anxiety, and hypnotic dugs), as the first line of treatment for behavior management is not a new concept for nursing homes, says Amy Lee, RN, BSN, MSN, CRRN, QCP, president and CEO of Coretactics Healthcare Consulting in Rexford, NY. “However, the …
The expedited determination process (called “fast-track appeals” in regulation) for appeals of service terminations by Medicare Advantage (MA) plans is very similar to—but not exactly the same as—the expedited determination process for service terminations under fee-for-service (FFS) Medicare Parts A and B, notes Maureen McCarthy, RN, BS, RAC-MT, QCP-MT, DNS-MT, …
Some nurse assessment coordinators (NACs) may believe that having a care conference (aka care plan meeting) with the resident and/or their responsible party or family member is a regulatory requirement. “However, no regulations actually use the term care conference,” says Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, IPCO, QCP, ICC, director …
Nurses play a key role in the early identification and treatment of sepsis, assessing the resident and reporting to the physician or nonphysician practitioner (NPP), as well as potentially managing residents with sepsis in-house in some cases. Nurse leaders can take the following steps to help nursing staff effectively assess …
On Oct. 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released the draft MDS version 1.20.1 item sets and item matrix for implementation on Oct. 1, 2025. The change history included with the item sets indicates planned changes to sections A (Identification Information), B (Hearing, Speech, and Vision), …
Nurse assessment coordinators (NACs) who manage Medicare services typically are at least familiar enough with the beneficiary notice requirements that skilled nursing facilities (SNFs) must meet under fee-for-service (FFS) Medicare Part A to monitor those processes. “However, NACs may not always be as aware that facilities also have a responsibility …
Since the COVID-19 pandemic began in 2020, the risk of developing sepsis has increased nationwide, according to the September 2024 report An Assessment of Sepsis in the United States and Its Burden on Hospital Care (Sepsis Assessment) from the Agency for Healthcare Research and Quality (AHRQ). Sepsis-related inpatient stays in …
The ability to exercise clinical judgment to define usual performance in MDS items GG0130 (Self-Care) and GG0170 (Mobility) offers nursing homes unprecedented opportunity to impact quality measures (QMs), says Rosanna Benbow, RN, CCM, ICC, IP, DNS-CT, QCP, RAC-CTA, regional director of operations at Proactive LTC Consulting in Evansville, IN. “You …
Effective Oct. 31, 2024, skilled nursing facilities (SNFs) now are required to use an updated Skilled Nursing Facility Advance Beneficiary Notice of Noncoverage (SNF ABN), also known as form CMS-10055, and the corresponding revised instructions to provide financial liability notifications to residents under fee-for-service (FFS) Medicare Part A. Note: The …
Sepsis—a key driver of hospital readmissions—can have negative clinical impacts for residents and negative financial, quality, survey, and even legal impacts for nursing homes. Here is a review of important basics: What is sepsis? The current clinical definition of sepsis is “life-threatening organ dysfunction caused by a dysregulated host response …
