The average cost of a hospital readmission is 12.4 percent higher than the average cost of the original hospital admission ($16,300 vs. $14,500), according to a 2023 analysis by the Agency for Healthcare Research and Quality (AHRQ). At the same time, hospital readmissions from skilled nursing facilities (SNFs) remain relatively …
MDS items E0100A (Hallucinations) and E0100B (Delusions) are qualifiers for the Behavioral Symptoms and Cognitive Performance category in the nursing component of the Patient-Driven Payment Model (PDPM). Even more importantly, these conditions that form the core of E0100 (Potential Indicators of Psychosis) can indicate an acute medical condition—or result in …
Historically, pain is underassessed and undertreated in the geriatric population, says Liz Barlow, RN, CRRN, RAC-CT, DNS-CT, QCP, vice president of marketing at Synchrony Health Services in Louisville, KY. “Up to 75 percent of community-dwelling people over the age of 65 in the United States report experiencing chronic pain.” The …
Beneficiary notification requirements under the Medicare program can be confusing for nurse assessment coordinators (NACs) who serve as the lead Medicare nurse and other interdisciplinary team members in skilled nursing facilities (SNFs), says Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC, director of education for Hansen, Hunter & Co. PC …
The continuing expansion of the Skilled Nursing Facility Value-Based Purchasing program (SNF VBP) quality measure (QM) set is part of a multi-pronged approach by the Centers for Medicare & Medicaid Services (CMS) to encourage improvements in the quality of care for nursing home residents. The SNF VBP focuses on financial …
In the Jan. 18, 2023, Quality, Safety, and Oversight (QSO) memo QSO-23-05-NH, the Centers for Medicare & Medicaid Services (CMS) announced plans to conduct offsite audits to assess whether nursing homes appropriately assess, document, and code diagnoses captured in MDS item I6000 (Schizophrenia (e.g., Schizoaffective and Schizophreniform Disorders)) that are …
On Oct. 1, 2023, the Centers for Medicare & Medicaid Services (CMS) kicked off a critical step in expanding the Skilled Nursing Facility Value-Based Purchasing program (SNF VBP) quality measure (QM) set. This expansion means that the director of nursing services (DNS) will need to work with both staff and …
Skilled nursing facilities (SNFs) are increasingly subject to skilled medical review audits from both fee-for-service Medicare (e.g., the SNF Five-Claim Probe and Educate initiative) and individual Medicare Advantage plans. Audit success ultimately hinges on documentation quality, but the presence of documentation in the medical record is no guarantee of the …
In May 2023—after the Comprehensive Error Rate Testing (CERT) program determined that skilled nursing facility (SNF) Medicare Part A services have been “a top driver” of the overall Medicare fee-for-service improper payment rate since the switch to the Patient-Driven Payment Model (PDPM) on Oct. 1, 2019—the Centers for Medicare & …
The Significant Change in Status Assessment (SCSA) was not a major focus of the revisions in the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual v1.18.11. However, some of the v1.18.11 MDS coding changes could have an outsized impact on the SCSA process if nurse assessment coordinators (NACs) fail …
