With the rush to understand the Patient-Driven Payment Model (PDPM) under the Skilled Nursing Facility Prospective Payment System (SNF PPS), it’s easy to get caught up in meeting the technical criteria for payment—and not pay enough attention to the clinical criteria for meeting a Medicare skilled level of care, says …
Question: When I received training for ICD-10 coding as it relates to billing, I was taught that the primary diagnosis code for long term SNF residents on a UB-04 claim would be their primary diagnosis for why they remain in the nursing facility. Therefore, if the primary diagnosis code was …
Question: Are we responsible for dental appointments (toothache) on our Medicare Part A residents or does the dentist bill the family? Answer: Dental coverage is not part of the Medicare Part A program, so the cost is also not the facility’s responsibility. In other words, there is no dental money …
Question: I understand that the diagnosis in I0020B should be listed as the principal diagnosis on the UB-04 claim; however, should the remaining diagnoses be listed in order according to the main reasons the resident is skilled how we list the codes in I8000, to include the codes that are …
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 …
