Q&A: I miscalculated the ARD window for a 5-Day and scheduled the 5-Day/PPS Discharge on day 9 of the Medicare stay. What do I need to do?

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

Question: I miscalculated the ARD window for a 5-Day and scheduled the 5-Day/PPS Discharge on day 9 of the Medicare stay. What do I need to do? Answer from Jeff Taylor:Leave everything as it is and bill one day default for the late assessment. Since the 5-Day is one day …

Q&A: Can I count IV fluids and IV antibiotics that were administered in the hospital before admission and within the 7-day look-back period?

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

Question: Can I count IV fluids and IV antibiotics that were administered in the hospital before admission and within the 7-day look-back period? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: IV fluid provided during the hospital stay within the 7-day look-back period of the ARD can be coded …

Q&A: When should I set an assessment reference date (ARD) for a Significant Change in Status Assessment (SCSA) after a resident elected hospice?

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

Question: When should I set an assessment reference date (ARD) for a Significant Change in Status Assessment (SCSA) after a resident elected hospice? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: The completion date for the SCSA is the “determination date +14 days.” The ARD can be …

Q&A: I know that McGeer criteria must be met when coding a UTI that develops in-house during the SNF stay, but what is required when a resident is transferred to the hospital and returns to the SNF with a documented UTI diagnosis (e.g., listed on the discharge summary and on antibiotics)?

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

Question: I know that McGeer criteria must be met when coding a UTI that develops in-house during the SNF stay, but what is required when a resident is transferred to the hospital and returns to the SNF with a documented UTI diagnosis (e.g., listed on the discharge summary and on …

Q&A: The Five-Star Preview Report for July 2025 still shows the standard survey from three years ago. I thought the third survey would no longer be used?

NAC / Q&A / QAPI and Quality Initiatives

Question: The Five-Star Preview Report for July 2025 still shows the standard survey from three years ago. I thought the third survey would no longer be used? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: CMS has stated that the third survey would be shown on the Care Compare …

Q&A: A resident elected hospice on July 9, 2025. What is the required completion date for the Significant Change in Status Assessment (SCSA), and what steps should be taken if the resident passes away before the assessment is completed?

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

Question: A resident elected hospice on July 9, 2025. What is the required completion date for the Significant Change in Status Assessment (SCSA), and what steps should be taken if the resident passes away before the assessment is completed? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: …

Q&A: Is aspirin coded as an antiplatelet in N0415I?

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

Question: Is aspirin coded as an antiplatelet in N0415I? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: The RAI User’s Manual includes aspirin as an antiplatelet medication on page N-9: “N0415I1. Antiplatelet: Check if an antiplatelet medication (e.g., aspirin/extended release, dipyridamole, clopidogrel) was taken by the resident at any …

Q&A: How do we code interviews that were not complete when a Medicare resident has an unplanned discharge to the hospital?

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

Question: How do we code interviews that were not complete when a Medicare resident has an unplanned discharge to the hospital? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: If the interviews were not completed, you would need to answer the gateway question that ‘Yes’ the resident interview should …

Q&A: If a resident initiates his/her discharge for the following day and the facility was able to organize home care, equipment, etc., is this considered a planned or unplanned discharge?

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

Question: If a resident initiates his/her discharge for the following day and the facility was able to organize home care, equipment, etc., is this considered a planned or unplanned discharge? Answer from Jessie McGill RN, BSN, RAC-MTA, RAC-CTA: There is a distinct difference between being able to prepare for a …

Q&A: Did this resident achieve a 60-day break in skilled services when a nurse assisted with tube feedings at the assisted living facility?

Billing and Reimbursement / NAC / Q&A

Question: A resident previously exhausted his 100 days of Medicare for a new feeding tube. He was discharged to an assisted living facility (ALF) for more than 60 days where an licensed practical nurse (LPN) assisted with the 100% tube feedings. Did this resident achieve a 60-day break in skilled …