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 …
Since March 8, all hospitals and critical-access hospitals are required to issue the Medicare Outpatient Observation Notice (MOON) to fee-for-service Medicare and Medicare Advantage beneficiaries who receive observation services as outpatients for more than 24 hours. The MOON informs these patients that they are outpatients receiving observation services, not inpatients …
The Centers for Medicare & Medicaid Services (CMS) has issued a precursor to a proposed rule that could lay the groundwork for retiring the existing case-mix classification model, the Resource Utilization Groups, Version 4 (RUG-IV), in the skilled nursing facility prospective payment system (SNF PPS). Switching to the Resident Classification …
