As a screening tool to identify potential weight problems for adults, body mass index (BMI) has always been important to document, but it gained new importance as a reimbursement factor for Medicare Part A residents under the Patient-Driven Payment Model (PDPM). Here’s what nurse assessment coordinators (NACs) need to know …
The nurse assessment coordinator and team members can easily convert the case-mix groups achieved under the Patient-Driven Payment Model (PDPM) to the five-digit Medicare billing code by using the PDPM Case-Mix Group Conversion to HIPPS Characters tool. For permission to use or reproduce this tool in full or in …
Are you prepared to collect the needed information at the time of admission for residents under PDPM? The AAPACN PDPM Admission Checklist Tool can help SNFs collaborate with hospital discharge planners to collect the necessary preadmission records needed to make informed decisions and projections on referrals and planned admissions. SNFs …
Question: Does the primary diagnosis that physical therapy and occupational therapy use need to match the primary ICD-10 code used by nursing? Answer: Often confusion stems from the terms used across different disciplines. Therapists use medical and treatment diagnoses, while the SNF uses other terms, such as admission diagnosis, …
Question: Under RUG-IV PPS, if the resident returns to a skilled level of care within 30 days the reason for skilled care would have to be something that was present/treated during the first qualifying hospital stay or developed during the skilled period. How does that work with PDPM and the Interrupted …
To date, the accuracy of section GG (functional abilities and goals) hasn’t mattered from a payment perspective. Section GG doesn’t affect payment under the RUG-IV case-mix classification system, and the Skilled Nursing Facility Quality Reporting Program (SNF QRP) only penalizes providers financially for failing to meet the data submission threshold …
An Additional Development Request or Additional Documentation Request letter can cause a lot of stress in the SNF if there’s not a process in place to respond to it. Use this Responding to ADRs Tool to help your team more confidently approach medical reviews. For permission to use or reproduce this …
In today’s fast-paced world, we often try to solve problems by simply “googling” the answer. However, when it comes to ICD-10-CM coding, using the Internet or a cheat sheet to determine diagnosis codes can be detrimental to the process and result in selecting the wrong codes. As we begin preparing …
An overview of the final rule and PDPM structure with Judi Kulus and Jessie McGill
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In many skilled nursing facilities (SNFs), the responsibility for obtaining Medicare Part A physician or nonphysician practitioner certifications/recertifications (certs/recerts) for skilled care has shifted to the nurse assessment coordinators (NACs) from medical records. “But often, the NACs or other staff members who are responsible for certs/recerts learned how to fill …
