Billing and Reimbursement
AAPACN’s billing and reimbursement resources include articles, tips, and tools to keep post-acute care leaders informed of changes and to ensure facility success under various payment models.
- PDPM Grouper JAR Package V2.4000This release was updated to support FY2026 ICD-10 codes which are used with MDS assessments with a target date on or after October 1, 2025. As part of this release, 487 clinical category mappings were added, …
- SNF QRP Measure Calculations and Reporting User’s Manual V7.0, Change Table, Risk Adjustment and Imputation Appendix Files, and HCC ICD-10 CrosswalksThe Skilled Nursing Facility Quality Reporting Program (SNF QRP) Measure Calculations and Reporting User’s Manual v7.0 and accompanying files are now available. These materials serve as an update to the specifications used to calculate quality measures that …
- MDS Item J2100 Feeds Into PDPM: Learn What’s at Stake and How to Boost AccuracyMDS item J2100 (Did the Resident Have a Major Surgical Procedure During the Prior Inpatient Hospital Stay That Requires Active Care During the SNF Stay?) is the gateway question for receiving enhanced reimbursement in the …
- Back to PDPM Basics – Part 3: The Nursing Component – Extensive Services and Special CareThe calculation for the nursing component of the Patient-Driven Payment Model (PDPM) can look deceptively simple. The two steps entail calculating a section GG nursing function score and then placing the resident into one of …
- IPA Quick Calculators – Urban and RuralWhen a resident’s condition changes during the Medicare Part A stay, the facility team must decide if an Interim Payment Assessment (IPA) is indicated. The AAPACN IPA Quick Calculator interactive tool can help the team …
- PDPM At-a-Glance ToolThe PDPM At-a-Glance tool breaks down the complex methodology of each component used in the Patient-Driven Payment Model—physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), non-therapy ancillaries (NTA), and nursing. This tool provides key …
- FY 2028 (CY 2026 Data) SNF QRP Reporting Requirements and Data Submission DeadlinesSNF QRP Data Collection and Final Submission Deadlines The SNF QRP Data Collection and Final Submission Deadlines have been updated to provide the data collection time frames and final submission deadlines for the FY 2028 …
- FY 2027 (CY 2025 Data) Revised SNF QRP MDS Reporting Requirements and Data Submission DeadlinesSNF QRP Data Elements Used for Reporting Assessment-Based QMs and Standardized Patient Assessment Data Elements Affecting FY 2027 APU Determination and Data Collection and Final Submission Deadlines for FY 2027 posted The Skilled Nursing Facility …
- FY 2026 ICD-10 PDPM Mappings FileThis file can be used by NACs to determine how ICD-10-CM codes entered on the MDS “map” to PDPM payment components. https://www.cms.gov/medicare/payment/prospective-payment-systems/skilled-nursing-facility-snf/patient-driven-model
- FY 2026 SNF QRP FAQsAn update to the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Frequently Asked Questions (FAQs) document is now available. This document has been updated to reflect the finalized policies for the SNF QRP in …
- New AAPACN Education Program Spotlight: PDPM Documentation Essentials for the IDTIn this LTC NAC Chat podcast episode, Jessie McGill, RN, BSN, RAC-MT, RAC-MTA, senior curriculum development specialist for AAPACN, and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist with AAPACN, discuss AAPACN’s latest …
- PDPM HIPPS Code At-a-GlanceThe Patient-Driven Payment Model (PDPM) 5-Character HIPPS code can be difficult to decipher. The PDPM HIPPS Code At-a-Glance tool will help nurse assessment coordinators quickly identify the key elements impacting Medicare reimbursement. This AAPACN resource …
- FY 2026 SNF PPS Final Rule: Section R Removal Tops the List of ChangesMDS section R (Health-Related Social Needs) is officially no more. The big news for nurse assessment coordinators (NACs) in the Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS) and Consolidated Billing Final Rule for …
- FY 2026 SNF PPS Final Rule: Summary of Responses to AAPACN’s CommentsThe Centers for Medicare & Medicaid Services (CMS) released the Final Rule for the fiscal year (FY) 2026 Skilled Nursing Facility Prospective Payment System (SNF PPS), addressing several key recommendations submitted by the American Association …
- Back to PDPM Basics – Part 2: The SLP ComponentSince the implementation of the Patient-Driven Payment Model (PDPM), nursing facilities have had to take a more nuanced approach to how a resident’s needs are assessed and documented. As discussed in part 1 of this …
- SNF QRP and SNF VBP Validation Program FAQs UpdatedOverview What is the SNF Validation Program? The SNF Validation Program is an audit-driven initiative aimed at evaluating the accuracy of quality measure data elements derived from the Minimum Data Set (MDS), which are used …
- FY 2026 SNF VBP ResourcesFrom https://www.cms.gov/medicare/quality/nursing-home-improvement/value-based-purchasing From https://www.cms.gov/medicare/quality/nursing-home-improvement/value-based-purchasing/confidential-feedback-reporting-review-and-corrections From https://www.cms.gov/medicare/quality/nursing-home-improvement/value-based-purchasing/scoring-methodology-payment-adjustment
- FY 2026 ICD-10-CM Code Updates and Coding Guidelines for Oct. 1, 2025 From CMS/CDCCDC announces new ICD-10-CM codes effective October 1, 2025. The October 1, 2025 diagnosis code update files are now available. Use these files for discharges occurring from October 1, 2025 – September 30, 2026, and for …
- FY 2026 SNF PPS Final Rule: More Money and Consistency, Less BurdenThe Centers for Medicare & Medicaid Services (CMS) did not propose any changes to the previously adopted quality measure (QM) sets for either the Skilled Nursing Facility Quality Reporting Program (SNF QRP) or the Skilled …
- FY 2026 Final Rule ICD-10 Mapping File, Wage Index File, and Case-Mix RatesRegulation No. CMS-1827-F Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026; Final Rule Year 2026 Publication Date 2025-08-04 This rule …
- FY 2026 SNF PPS Final Rule PostedOn July 31, 2025, the Centers for Medicare & Medicaid Services (CMS) issued a final rule for updates to Medicare payment policies and rates for skilled nursing facilities under the Skilled Nursing Facility Prospective Payment …
- Back to PDPM Basics – Part 1: The PT and OT ComponentsIn 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 …
- Myers and Stauffer Medicaid LinksMyers 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 …
- Q&A: Did this resident achieve a 60-day break in skilled services when a nurse assisted with tube feedings at the assisted living facility?Question: A resident previously exhausted his 100 days of Medicare for a new feeding tube. He was discharged to an assisted living facility (ALF) for more than 60 days where an licensed practical nurse (LPN) …
- TIP: New Non-Pressure Chronic Ulcer Codes Effective Oct. 1, 2025The Centers for Disease Control and Prevention (CDC) recently released the updated codes for fiscal year (FY) 2026. These updates include the addition of the following locations to the category L98.4, non-pressure chronic ulcer of …
- Q&A: Can Z codes be used as the admitting diagnosis on the claim?Question: Can Z codes be used as the admitting diagnosis on the claim? Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC: Admission Diagnosis codes (Field Locator 69 on the claim) should be the code …
- Ethics in Medicare Part A Coverage in Skilled Nursing FacilitiesNavigating Medicare Part A coverage in skilled nursing facilities (SNFs) is a matter of regulatory compliance. But it’s also a daily ethical test for facility staff and administrators. In many ways it depends on the …
- Know the Rules, Win the Fight: Inside SNF Medicare AppealsIn this LTC NAC Chat podcast episode, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist with AAPACN, discuss the …
- SNF VBP Reminder: Performance-Period MDS Data Collection Is Now OngoingIn the Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS) and Consolidated Billing Proposed Rule for Fiscal Year (FY) 2026, the Centers for Medicare & Medicaid Services (CMS) does not reveal any firm proposals …
- AAPACN Responds: FY 2026 SNF PPS Proposed RuleEvery spring, the American Association of Post-Acute Care Nursing (AAPACN) anticipates the Skilled Nursing Facility Prospective Payment System (SNF PPS) proposed rule. The Centers for Medicare & Medicaid Services (CMS) provides a 60-day comment period. …
- SNF QRP Quick Reference GuideAn updated Quick Reference Guide is now available. The Quick Reference Guide provides high-level information on the SNF Quality Reporting Program, including frequently asked questions and helpful links. PAC-SNF-QuickReferenceGuide-20250508 (PDF) From https://www.cms.gov/medicare/quality/snf-quality-reporting-program/submission-deadlines
- ICD-10-CM Diagnosis SequencingIn this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist with AAPACN, discuss the sequencing of ICD-10-CM diagnosis coding. Additional …
- TIP: SNF Value-Based Purchasing Fact Sheets ReleasedThe Centers for Medicare & Medicaid Services (CMS) recently released the FY 2026 Skilled Nursing Facility Value-Based Purchasing (VBP) fact sheet. This fact sheet details the program, measures used, case-minimums, the process for making correction, …
- SNF QRP Again Takes Center-Stage in the FY 2026 SNF PPS Proposed RuleIn the Medicare Skilled Nursing Facility Prospective Payment System (SNF PPS) and Consolidated Billing Proposed Rule for Fiscal Year (FY) 2026, officially published on April 30, 2025, the Centers for Medicare & Medicaid Services (CMS) …
- Deep Dive into ICD-10-CM: Diagnosis Sequencing GuidelinesThe International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code assignment continues to be a bit of an enigma in the long-term care setting. Members regularly ask questions about ICD-10-CM coding in AAPACN’s online …
- FY 2026 SNF VBP Program Fact Sheet and Incentive Payment Multiplier Calculation InfographicFY 2026 SNF VBP Program Fact Sheet (PDF) From https://www.cms.gov/medicare/quality/nursing-home-improvement/value-based-purchasing (also updated with FY 2026 information) SNF VBP Program: FY 2026 Incentive Payment Multiplier Calculation Infographic (PDF). From https://www.cms.gov/medicare/quality/nursing-home-improvement/value-based-purchasing/scoring-methodology-payment-adjustment
- SNF VBP QMs: What’s Coming Online to Impact Payment—and What’s ProposedThe Centers for Medicare & Medicaid Services (CMS) does not propose any new quality measures (QMs) for the pay-for-performance Skilled Nursing Value-Based Purchasing program (SNF VBP) in the Medicare Skilled Nursing Facility Prospective Payment System …
- Q&A: Is a Part A PPS Discharge assessment required if the resident exhausted the 100-day benefit?Question: Is a Part A PPS Discharge assessment required if the resident exhausted the 100-day benefit? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: Yes, the Part A PPS Discharge MUST be completed when …
- Medicare Advantage vs. FFS Part A Expedited Determinations: What’s the Difference?The expedited determination process (called “fast-track appeals” in regulation) for appeals of service terminations by Medicare Advantage (MA) plans is very similar to—but not exactly the same as—the expedited determination process for service terminations under …
- PDPM Audit by MDS SectionMost methods for auditing Patient-Driven Payment Model (PDPM) reimbursement focus on impacts to the HIPPS code. However, AAPACN’s PDPM Audit by MDS Section tool uses an approach that can result in identifying missed opportunities for …
- MDS Falsification: How MDS Coding Could Bring an OIG Referral During Survey“MDS coding accuracy is important” is not a revolutionary new concept for any nurse assessment coordinator (NAC), says Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC, director of education for Hansen, Hunter & Co. PC …
- Follow-Up Answers to Q&A from Beneficiary Notices Jan. 30, 2025, AAPACN WebinarIn this podcast, Jessie McGill, RN, BSN, RAC-MT, RAC-MTA, senior curriculum development specialist for AAPACN, and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist for AAPACN, address some of the questions that were …
- Acentra BFCC-QIO Postacute Newsletter: Recommendations for SNFs to Improve Medical Record DocumentationSeveral sections may be useful, including Recommendations for Skilled Nursing Facilities to Improve Medical Record Documentation https://acentraqio.com/newsletter/crc/February2025postacute
- Compliance in Diagnosis Selection for Skilled RehabilitationFor skilled nursing facilities (SNFs), diagnosis selection and accurate ICD-10-CM coding are essential for both quality resident care and compliance with regulations. For therapists providing skilled rehabilitation services, the ability to choose the correct diagnosis …
- A New Method for Auditing PDPMIn this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Jessie McGill, RN, BSN, RAC-MT, RAC-MTA, senior curriculum development specialist with AAPACN, discuss a new method for auditing the …
- PDPM Overview for Supporting SNF StaffThe Centers for Medicare & Medicaid Services (CMS) implemented the Patient-Driven Payment Model (PDPM) in October 2019 for residents receiving Medicare Part A coverage in the skilled nursing facility (SNF). PDPM replaced the previous legacy …
- NHSN Healthcare Personnel (HCP) Flu Vaccination Module for SNF QRP ReportingThe HCP Flu Vaccination Module, which is part of the HCP component in NHSN, is used to input required NHSN data for the SNF QRP. This site provides access to the HCP Vaccination Module: Influenza …
- NOMNC and DENC: New Forms Must Be Used Starting Jan. 1, 2025; Different Start Date for DENC Only for Medicare AdvantageFFS & MA NOMNC/DENC What’s New 11/18/2024: New NOMNC and DENC for Original Medicare and Medicare Advantage The Office of Management and Budget (OMB) has approved a revised Notice of Medicare Non-Coverage (NOMNC / CMS-10123) …
- Residents on Part B Therapy? Provide Beneficiary Notices to Avoid a Financial HitNurse assessment coordinators (NACs) who manage Medicare services typically are at least familiar enough with the beneficiary notice requirements that skilled nursing facilities (SNFs) must meet under fee-for-service (FFS) Medicare Part A to monitor those …
- OIG: Nursing Facility Industry Segment-Specific Compliance Program GuidanceFrom https://oig.hhs.gov/compliance/nursing-facility-icpg/ The Nursing Facility ICPG—together with OIG’s General Compliance Program Guidance (GCPG) that applies to all individuals and entities involved in the health care industry—serves as OIG’s updated and centralized source of voluntary compliance program guidance for …
- SNF ABN Update: What Changed and How to Keep the Process Running SmoothlyEffective Oct. 31, 2024, skilled nursing facilities (SNFs) now are required to use an updated Skilled Nursing Facility Advance Beneficiary Notice of Noncoverage (SNF ABN), also known as form CMS-10055, and the corresponding revised instructions …
- Beneficiary Notice Guidelines ToolAre you confused about which beneficiary notices are needed and when? The Beneficiary Notice Guidelines tool lists scenarios that you might run into, clarifying exactly what notices are needed to reduce the risk of claim denials and …
- At-a-Glance QM, QRP, and VBP ToolWith so many Quality Measures originating from three different payment initiative programs, it’s a lot to keep track of. AAPACN’s At-a-Glance QM, QRP, and VBP tool organizes all of the measures for you. This tool has been …
- SNF PPS MedPAC Payment Basics Fact Sheet / Educational ToolPAYMENT BASICS: SNF PPS Skilled nursing facility services payment system Additional payment basics tools: https://www.medpac.gov/document-type/payment-basic/
- SNF QRP Quick Facts ToolsThe Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) has developed a variety of measures that use data from the MDS 3.0, Medicare Fee-for-Service Claims, and Centers for Disease Control and Prevention (CDC) National Healthcare …
- Updated Fiscal Years 2026 and 2027 SNF VBP Performance StandardsThis communication pertains to the Fiscal Year (FY) 2026 and FY 2027 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program performance standards for the Total Nursing Staff Turnover (Nursing Staff Turnover) measure which the Centers …
- Updates to ICD-10-CM Coding Guidelines: Key Revisions and Their ImplicationsThe International Classification of Diseases, Clinical Modification, 10th revision (ICD-10-CM), coding system is an essential tool needed to document and bill accurately for healthcare services in the long-term care (LTC) setting. Annual updates to both …
- Skilled Teaching and Training: Benefit From the Care Team’s ExpertiseLike care plan management and evaluation and observation and assessment of a resident’s condition, teaching and training activities are a core nonskilled component of resident care that can rise to the level of a skilled …
- Revised SNF ABN (Form CMS-10055) Mandatory Oct. 31, 2024With the help of contractors, CMS revised the SNF ABN, Form CMS-10055, and the form instructions. The SNF ABN form and instructions are located in the download section and are available for immediate use, but …
- Documentation and Monitoring for a Skilled StayIn this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialist with AAPACN, discuss documentation and monitoring for a …
- Skilled Observation and Assessment Hinges on a Reasonable Probability of ComplicationDirect skilled services under Medicare Part A often are easy to identify because these services involve specific, complex caregiver-to-resident actions. Their “inherent complexity” means that they can “be performed safely and/or effectively only by or …
- Care Plan Management and Evaluation Can Be a Skilled Service for At-Risk ResidentsThe development, management, and evaluation of the resident care plan is the OBRA backbone of the Resident Assessment Instrument (RAI) process for all residents regardless of payer source, so it may surprise some nurse assessment …
- How to Use the ICD-10-CM Coding ManualSince the start of the Patient-Driven Payment Model (PDPM) in October 2019, the International Classifications of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) has been thrust into the forefront of daily tasks for the nurse assessment …
- SNF VBP Early Look Performance Score Report Webinar and MaterialsOverview of the Early Look Performance Score Report for the SNF VBP Program The Centers for Medicare & Medicaid Services (CMS) developed and published the Overview of the Early Look Performance Score Report for the Skilled …
- Common Myths about SNF Medicare Advantage Plan ManagementIn this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Maureen McCarthy, RN, BS, RAC-MT, QCP-MT, DNS-MT, RAC-MTA, president and CEO of Celtic Consulting, and AAPACN board member, …
- NAC Preparation Guide for the Triple Check Meeting ToolGathering all of the necessary reports for the triple check meeting is a lot for nurse assessment coordinators (NACs) to keep track of. AAPACN’s NAC Preparation Guide for the Triple Check Meeting tool can help …
- A Closer Look at the Medicare Part A Presumption of CoverageSkilled nursing facility (SNF) staff must understand the intricate guidelines that regulate Medicare Part A coverage for SNF stays. Several technical requirements must be met before a resident qualifies for a Medicare Part A SNF …
- Part A Basics: 30-Day Transfers and the Medical Appropriateness ExceptionThe 30-day transfer rule and its medical appropriateness exception typically don’t come up on a daily basis in skilled nursing facilities (SNFs), yet these requirements—and flexibilities—are a key component of the fee-for-service Medicare Part A …
- Updated Medicare Enrollment Guide for Institutional Providers, Including SNFsThis site includes access to a provider enrollment and certification roadmap: https://www.cms.gov/medicare/provider-enrollment-and-certification/enroll-as-an-institutional-provider
- FY 2025 Final MDS 3.0 Item Sets version 1.19.1 Effective Oct. 1, 2024The final Minimum Data Set (MDS) 3.0 Item Sets version (v)1.19.1 are now available. The MDS Item Sets v1.19.1 will be effective beginning October 01, 2024. Items in sections A, B, D, GG, I, J, …
- PDPM Clinically Complex Nursing Qualifiers: Coding and Documentation RefresherThe Patient-Driven Payment Model (PDPM) includes four ways for a resident to classify into the Clinically Complex category of the Nursing payment component. If a resident has conditions or is receiving services that qualify for …
- Tricky NAC Issues Even Some Experts MissNurse assessment coordinators (NACs) definitely experience variety in their jobs, to state the obvious. Management and completion of the Minimum Data Set/Resident Assessment Instrument (MDS/RAI) process, Medicare management, and ICD-10-CM coding are just a few …
- Seven Ways NACs Can Be Proactive With New Medicare Advantage Plan RulesA skilled nursing facility (SNF) accepts a resident in a Medicare Advantage plan for admission after the plan provides a prior authorization. The resident receives skilled services for the allotted amount of time, and the …
- MDS Tools to Make the NAC’s Job EasierIn this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Jessie McGill, RN, BSN, RAC-MT, RAC-MTA, and Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, curriculum development specialists for …
- Skilled Nursing Care & Skilled Therapy Services to Maintain Function or Prevent or Slow Decline: CMS ReminderMedicare covers skilled nursing care and skilled therapy services under skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care to maintain function or to prevent or slow decline, as …
- Navigating the 2024 Landscape: Updates and Changes in Medicare Impacting Skilled Nursing FacilitiesThe year 2024 brings a plethora of updates to the Medicare program, several significantly impacting skilled nursing facilities (SNFs). SNF staff must stay well informed about these updates to ensure proper billing and adequate coverage …
- Expedited Determination Notices: Keys to Avoiding Financial Liability, Survey IssuesThe expedited determination beneficiary notification process covers a lot of ground in skilled nursing facilities (SNFs), affecting residents in the fee-for-service (FFS) Medicare Part A program and Medicare Advantage plans, as well as residents who …
- SNF QRP and SNF VBP Claims-Based Measure Manual and Accompanying Files – AvailableThis document presents technical specifications for the production of Medicare fee-for-service (FFS) claims-based measures (CBMs) for the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) and Value-Based Purchasing (VBP) program maintained by the Centers for …
- Medicare Expedited Determination vs. Financial Liability Notices: What’s the Difference?Beneficiary notification requirements under the Medicare program can be confusing for nurse assessment coordinators (NACs) who serve as the lead Medicare nurse and other interdisciplinary team members in skilled nursing facilities (SNFs), says Carol Maher, …
- MDS Items Impacting Reimbursement for PDPM and SNF QRPDo you know what MDS items impact reimbursement under the Patient-Driven Payment Model (PDPM) or the Skilled Nursing Facility Quality Reporting Program (SNF QRP)? Use this quick guide, MDS Items Impacting Reimbursement for PDPM and …
- Stop and Read: Skilled Documentation Audit and Education Lessons for the NACSkilled nursing facilities (SNFs) are increasingly subject to skilled medical review audits from both fee-for-service Medicare (e.g., the SNF Five-Claim Probe and Educate initiative) and individual Medicare Advantage plans. Audit success ultimately hinges on documentation …
- Lessons From TPE Audits: How the DNS Can Lead Toward Better Skilled DocumentationIn May 2023—after the Comprehensive Error Rate Testing (CERT) program determined that skilled nursing facility (SNF) Medicare Part A services have been “a top driver” of the overall Medicare fee-for-service improper payment rate since the …
- Preparing for Success with ICD-10-CM Changes Oct. 1: How the Facility Coder and Provider Can Ensure Accurate Diagnosis CodesEffective International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM) coding relies on meticulous clinical documentation. It’s not just about assigning codes; it’s about ensuring consistent and comprehensive documentation that substantiates every facet and the …
- Provider ICD-10-CM Documentation Tip Sheet for Long-Term CareICD-10-CM coding requires consistent and complete documentation from the provider (physician/nonphysician practitioner) to support all aspects and specific details of the diagnosis. This AAPACN Provider ICD-10-CM Documentation Tip Sheet for Long-Term Care tool serves as …
- Oct. 1, 2023 Will See Performance Period Data Collection for Five SNF VBP QMsThe key takeaway of the Fiscal Year (FY 2024) Skilled Nursing Facility Prospective Payment System (SNF PPS) final rule, published on Aug. 7, 2023, is that the director of nursing services (DNS) will need to …
- SNFRM: Technical Specifications for This SNF VBP Measure2023 Measure Updates and Specifications Report Skilled Nursing Facility Value-Based Purchasing Program Skilled Nursing Facility 30-Day All-Cause Readmission Measure –Version 2.0 This report describes updates that have been made to the Skilled Nursing Facility 30-Day …
- FY 2024 SNF PPS Final Rule Initial Timeline for NACs: How/When the MDS Takes Center-StageBreathing room will be in short supply for nurse assessment coordinators (NACs) and other interdisciplinary team members who need to implement and monitor the multitude of changes to the Skilled Nursing Facility Quality Reporting Program …
- Business Case TemplateThere are times when the nursing department needs new solutions or process changes to enhance resident care or improve staff workload. Often, these are high-cost solutions that require approval from the governing body, executive staff, …
- Effective Business Case Development for Budget Wins and Better Care OutcomesThe 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 …
- The DNS’s Role in the Annual BudgetIn this podcast, Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, RAC-MTA, chief nursing officer for AAPACN, and Denise Winzeler, BSN, RN, LNHA, DNS-MT, QCP-MT, curriculum development specialist for AAPACN, discuss the director of nursing services’ …
- BIMS MDS Coding Video Tutorial UpdatedThe Centers for Medicare & Medicaid Services (CMS) is offering an updated video tutorial to assist providers with guidance application and interview strategies for the cognitive assessment known as the Brief Interview for Mental Status …
- OSA Crash Course: Keys to Navigating this Medicaid-Only Payment AssessmentIn a number of Medicaid case-mix states, the MDS v1.18.11 item sets won’t be the only MDS item sets that are implemented on Oct. 1, 2023—a fact that should temper some excitement about certain MDS …
- How Will October 2023 MDS Changes Impact PDPM and Medicare Payment?Many changes are coming to the Minimum Data Set (MDS) effective Oct. 1, 2023. The Centers for Medicare & Medicaid Services (CMS) released the draft of the Long-Term Care Resident Assessment Instrument (RAI) User’s Manual …
- Medicare Managed Care Basics: Critical Intel for the DNSData from the Centers for Medicare & Medicaid Services (CMS) shows that, as of January 2023, half of all Medicare beneficiaries are now enrolled in a Medicare Advantage plan, according to a recent Kaiser Family …
- Restorative Nursing Payment and Documentation Issues: Keys to SuccessRestorative nursing can impact fee-for-service Medicare Part A payment in the Behavioral Symptoms and Cognitive Performance category and the Reduced Physical Function category of the nursing component in the Patient-Driven Payment Model (PDPM), says Carol …
- MLN Publication: SNF Three-Day Qualifying Hospital Stay and Medicare Billing RulesSkilled Nursing Facility 3-Day Rule Billing Format Fact Sheet ICN: MLN9730256 Publication Description: Learn communication of coverage, claims processing edits, and financial responsibility. https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/snf3dayrule-mln9730256.pdf
- Best Practices to Dispute Takebacks for Medicare/Insurance Begin With PreventionIn the 1730s, Benjamin Franklin wrote “An ounce of prevention is worth a pound of cure” to inspire the city of Philadelphia to adopt better fire prevention techniques. What he delivered to history was a …
- NAC Quick Reference Guide to the End of the COVID-19 PHE WaiversThe Centers for Medicare & Medicaid Services (CMS) has announced the COVID-19 public health emergency (PHE) will end on May 11, 2023. The end of the PHE declaration also marks the end of temporary waivers …
- ABN (Form CMS-R-131) for Part B SNF ServicesThe ABN, Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. The use of the renewed form with the expiration date of 01/31/2026 will be mandatory on 6/30/23. …
- Proposed CoreQ: Short Stay Discharge Survey Measure Survey Protocols and Guidelines ManualCoreQ: Short Stay Discharge Survey CoreQ Short Stay Discharge Survey Protocols and Guidelines Manual and additional resources CMS-10852 (ZIP) From https://www.cms.gov/regulations-and-guidance/legislation/paperworkreductionactof1995/pra-listing/cms-10852