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 …

MDS Item J2100 Feeds Into PDPM: Learn What’s at Stake and How to Boost Accuracy

Article / Billing and Reimbursement / MDS 3.0 and the RAI Process / NAC

MDS item J2100 (Did the Resident Have a Major Surgical Procedure During the Prior Inpatient Hospital Stay That Requires Active Care During the SNF Stay?) is the gateway question for receiving enhanced reimbursement in the Physical Therapy (PT) and Occupational Therapy (OT) payment components of the Patient-Driven Payment Model (PDPM), …

Back to PDPM Basics – Part 3: The Nursing Component – Extensive Services and Special Care

Article / Billing and Reimbursement / NAC

The calculation for the nursing component of the Patient-Driven Payment Model (PDPM) can look deceptively simple. The two steps entail calculating a section GG nursing function score and then placing the resident into one of six nursing categories. But completing these two steps correctly requires understanding a number of coding …

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 …

FY 2026 SNF QRP FAQs

Billing and Reimbursement / DNS / NAC / Post-Acute Care News

An update to the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Frequently Asked Questions (FAQs) document is now available. This document has been updated to reflect the finalized policies for the SNF QRP in Fiscal Year (FY) 2026 and includes other useful resources available to providers. From https://www.cms.gov/medicare/quality/snf-quality-reporting-program/faqs