Behavioral Health: Eight Ways to Boost Compliance—and Help Residents—Under F740

F740 (Behavioral Health Services) is not a frequently cited F-tag so far in calendar year (CY) 2023, according to QCOR data posted on Aug. 13, 2023. However, the consequences can be severe—surveyors often issue this citation at the level of immediate jeopardy (IJ) when it does occur. Specifically, F740 is …

Finalized RAI User’s Manual: Eight Key Points to Know

In preparation for the upcoming Oct. 1, 2023, implementation of the also-just-updated v1.18.11v5 MDS item sets, the Centers for Medicare & Medicaid Services (CMS) has released the final Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual version 1.18.11 and a draft-to-final change table. Highlights of these revisions include the …

Solving the Mystery: How to Document for Section GG

Section GG, Functional Abilities and Goals, will expand to all OBRA assessments starting Oct. 1, 2023, with the retirement of the section G activities of daily living (ADL) items. This change disrupts the long-standing practices and policies facilities have developed to capture episode-level-of-care information from nurse aides on the section …

RAI Manual v1.18.11 Surprises: PPS Discharges Get More Complex

Note: This is the third in a series of articles reviewing key issues in the draft v1.18.11 Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual that could prove to be disruptive for busy nurse assessment coordinators (NACs). The first two articles were “RAI Manual v1.18.11 Surprises: Section M and …

Infusion Therapy: Solve These Clinical and Documentation Issues to Provide Better Care

Infusion therapy services are so inherently complex that the Centers for Medicare & Medicaid Services (CMS) identifies “intravenous or intramuscular injections and intravenous feeding” and “enteral feeding that comprises at least 26 percent of daily calorie requirements and provides at least 501 milliliters of fluid per day” as two of …

Effective Business Case Development for Budget Wins and Better Care Outcomes

The phrase “budget development time” often elicits moans and groans from facility leadership. During this process, leadership usually asks the director of nursing services (DNS) if he or she has any requests of items to include in the budget. Often, the DNS makes a list of nursing department wants and …

Accurate PDPM Reimbursement: Four Areas of Focus to Shore Up MDS Documentation

The Patient-Driven Payment Model (PDPM) has been the case-mix classification model used for Medicare Part A skilled nursing facility (SNF) reimbursement since October 2019. Although this payment system has been in place for nearly four years for Medicare payment, some states have recently transitioned to PDPM for Medicaid payment. That …

RAI Manual v1.18.11 Surprises: Standout Issues in Sections D and K

Note: This is the second in a series of articles reviewing key issues in the draft v1.18.11 Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual that could prove to be disruptive for busy nurse assessment coordinators (NACs). The first article was RAI Manual v1.18.11 Surprises: Section M and N …

Psychotropic Medications in the Skilled Nursing Facility: How to Manage the Process

The use of psychotropic medications in the skilled nursing facility (SNF) is a controversial issue with implications for resident, regulatory, and financial outcomes. The many requirements can be confusing, especially for a relatively new director of nursing services (DNS). This article reviews psychotropic medication requirements and offers tips to manage …

F609 Abuse/Crime Reporting Obligations: Keys to Success

Nursing homes face significant risk and liability under F-tag 609 (Reporting of Alleged Violations), says Janet Feldkamp, RN, BSN, LNHA, CHC, JD, a partner in the Benesch Healthcare + Practice Group at Benesch, Friedlander, Coplan & Aronoff in Columbus, OH. “This risk is more than just regulatory. There may be …