Light the Fuse on Five-Star Success – July 24, 2025

Members: $24 | Non-members: $48Continuing Education: 1.5 CE hoursRecording Date: July 24, 2025 Duration: 90 minutesSpeaker: Jessie McGill, RN, BSN, RAC-MT, RAC-MTA The Fourth of July fireworks are over, so now it’s time to light a new fuse—on Five-Star success! Nearly every piece of Minimum Data Set (MDS) coding plays a role in shaping …

Back to PDPM Basics – Part 1: The PT and OT Components

In skilled nursing facilities (SNFs), staff members often find the Patient-Driven Payment Model (PDPM) process complex and unfamiliar, especially when determining how Medicare (and, in many states, Medicaid) payment is calculated. PDPM is based on five separate case-mix adjusted components: Physical Therapy (PT), Occupational Therapy (OT), Speech Language Pathology (SLP), …

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?

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?

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?

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 …

TIP: Updated Five-Star Manual Available

Effective with the July 2025 refresh, the Centers for Medicare & Medicaid Services (CMS) is implementing a change to the methodology for calculating the Health Inspection domain, shifting from using the three most recent standard health inspection surveys to the two most recent standard health inspection surveys to calculate Health …

Five-Star Technical User’s Guide Plus Claims-Based Measures Appendix (Updated)

CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily. The Nursing Home Compare Web site features a quality rating system that gives each nursing home a rating of between 1 and 5 stars. Nursing homes with 5 stars are considered …

Myers and Stauffer Medicaid Links

Myers and Stauffer provides documentation resources and training opportunities for several state Medicaid programs. Learn more below. State Clients  Alabama Iowa North Carolina Arkansas Kentucky Ohio California Louisiana Oregon Colorado Maryland Tennessee Connecticut Minnesota Texas Florida Mississippi Utah Georgia Missouri Vermont Hawaii Montana Wisconsin Idaho Nevada West Virginia Indiana New …

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?

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 …