This user guide addresses Minimum Data Set (MDS) error messages and troubleshooting. iQIES MDS Error Message Reference Guide v1.0 (posted 10/01/2025) iQIES MDS Error Messages v1.0 (posted 10/01/2025) From https://qtso.cms.gov/providers/nursing-home-mdsswing-bed-providers/reference-manuals
This user manual provides information for CMS, Providers, Vendors, Accrediting Organizations, Contractors, and State Agencies to effectively perform Reports functions and the processes necessary to request, view, download, and save reports in iQIES. From https://qtso.cms.gov/software/iqies/reference-manuals
Respiratory therapy, coded at O0390D and O0400D, must meet definitions and complex instructions per the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual (RAI User’s Manual). AAPACN’s Respiratory Therapy MDS Coding Checklist tool delineates the requirements …
Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, and Jessie McGill, RN, BSN, RAC-MTA, RAC-CTA: If the resident only walked with therapy, then the assessment for usual performance is based on the resident’s usual …
Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, and Jessie McGill, RN, BSN, RAC-MTA, RAC-CTA: Your team will need to assess each individual injury from a fall, using clinical standards of practice and clinical …
Answer from Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC, and Jessie McGill, RN, BSN, RAC-MTA, RAC-CTA: The term “will” in this coding tip is likely referring to the resident’s goals or preferences. The example in …
AAPACN’s QAPI Focus: Section GG tool can be used at quality assurance and performance improvement (QAPI) meetings to focus specifically on concerns regarding section GG documentation and coding accuracy. This tool identifies specific section GG …
On Sept. 24, 2025, the Centers for Medicare & Medicaid Services (CMS) released an updated RAI User’s Manual version 1.20.1 and updated MDS item sets v1.20.1v4. The last-minute updates aligned the MDS item sets with …
MDS section R (Health-Related Social Needs) did not go into effect on Oct. 1, 2025. The Centers for Medicare & Medicaid Services (CMS) followed through on its proposal and eliminated—prior to implementation—items R0310 (Living Situation), …
The Long-Term Care Resident Assessment Instrument (RAI) 3.0 User’s Manual (RAI User’s Manual) version 1.20.1, effective Oct. 1, 2025, will bring major changes to section O of the MDS 3.0. The most significant update introduces …
This 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, …
AAPACN Resources to Help Prepare for Oct. 1, 2025, MDS Changes The Long Term-Care Facility Resident Assessment Instrument (RAI) 3.0 User’s Manual version 1.20.1 from the Centers for Medicare & Medicaid Services (CMS) goes into …
Members: $24 | Non-members: $48Continuing Education: 1.25 CE hoursRecording Date: Sept 18, 2025 Duration: 75 minutesSpeaker: Jessie McGill, RN, BSN, RAC-MT, RAC-MTA Big changes are coming to the MDS this October—and SNF teams need to be ready. Join AAPACN …
NOTABLE CHANGES TO THE MDS QM USER’S MANUAL V17 Guidance on Selecting MDS Section GG Item Columns for Measure Calculation An updated .zip file for the Minimum Data Set (MDS) 3.0 Quality Measures (QM) User’s …
The 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 …
Issued on 09/15/2025 | Posted on 09/18/2025 | Report number: OEI-05-24-00180 Report Materials Why OIG Did This Review What OIG Found Nursing homes failed to report 43 percent of falls with major injury and hospitalization among Medicare-enrolled residents, as required, in …
The Centers for Medicare & Medicaid Services (CMS) released a revised memo, QSO-25-20-NH REVISED, on Sept. 10, 2025, delaying the changes to the long-stay (LS) Antipsychotic Measure. CMS had previously announced the measure would be …
The AAPACN Podcasts—LTC DON Chat and LTC NAC Chat—offer tips, strategies, updates, advice, and breaking news on the most important topics in long-term and post-acute care. Regular hosts and AAPACN staff members provide their own …
Question: We had a resident on a Medicare Part A stay admit and discharge back to the hospital that same evening after a few hours. We could not assess much information during that brief amount …
Question: The new definition of a fall includes an overwhelming external force, but the definition of fracture related to a fall states, “Do not include fractures caused by trauma related to car crashes or pedestrian versus …
MDS 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 …
The 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 …
Question: Can Isolation be coded for methicillin-resistant staphylococcus aureus (MRSA) on a wound? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: No, the RAI User’s Manual specifically states that isolation cannot be coded for …
When 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 …
The 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 …
SNF 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 …
SNF 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 …
This 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
An 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 …
QSO-25-20-NH REVISED Memorandum Summary • Post Performance Data for Nursing Home Chains – “Chains” refers to groups of Medicare-certified nursing homes that are connected through common owners, and operators (also called “affiliated entities”). CMS will …
Every month, AAPACN experts design tools that help our members perform their jobs with more ease, breaking down processes, synthesizing information, and aiding in ways to track required data. To help nurse assessment coordinators (NACs) …
In 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 …
Question: If an open area is found on day four after admission, is that still present on admission (7-day look-back period)? The definition of “present on admission” is “as close to admission as possible.” Answer from …
Question: A long-term resident went out to the hospital and returned on a skilled stay using his Managed Care plan. He has both a 5-Day and Annual scheduled for the same day, but at separate …
Question: For section GG, the nurse aides use a mechanical lift transfer with two-person assist for transfers four times, but physical therapy transfers with one person and maximal assist once. Part of the dependent definition …
The nurse assessment coordinator (NAC) plays an essential role in capturing a resident’s cognitive status by coordinating and coding the Staff Assessment for Mental Status in the Minimum Data Set (MDS). The Brief Interview for …
The strict coding criteria for O0110M1, Isolation or quarantine for active infectious disease, requires precise documentation to support the MDS. AAPACN’s new Documentation Template: Isolation for Active Infectious Disease tool can help nurse assessment coordinators …
The Centers for Medicare & Medicaid Services (CMS) recently released the final version of the RAI User’s Manual, version 1.20.1, which goes into effect Oct. 1, 2025. While the draft version has been available for …
Effective Oct. 1, 2023, the full Patient Health Questionnaire (PHQ)-9 will only be completed if the resident responds to the gateway PHQ-2 questions in a certain way. The Patient Health Questionnaire Completion Determination chart clarifies …
The Centers for Medicare & Medicaid Services (CMS) released unexpected changes in the final RAI User’s Manual, version 1.20.1, which goes into effect Oct. 1, 2025. The AAPACN MDS Changes At-a-Glance tool provides a high-level …
The importance of accurate coding of section GG, Functional Abilities, continues to grow as this data is used in care planning, Quality Measures, reimbursement, and regulatory compliance. The Centers for Medicare & Medicaid Services (CMS) …
The 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 …
The MDS Data Specifications V3.10.2 (FINAL) are now available for download. This version reflects changes finalized in the FY 2026 SNF PPS final rule (90 FR 37310). Note that there are some minor changes since DRAFT 3 …
MDS 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 …
The 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 …
Since 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 …
The Centers for Medicare & Medicaid Services (CMS) recently announced the August 2025 Performance Score Reports for the fiscal year (FY) 2026 Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program are available for download via …
Question: Can I count IV fluids and IV antibiotics that were administered in the hospital before admission and within the 7-day look-back period? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: IV fluid provided …
Question: I miscalculated the ARD window for a 5-Day and scheduled the 5-Day/PPS Discharge on day 9 of the Medicare stay. What do I need to do? Answer from Jeff Taylor:Leave everything as it is …
Question: Please clarify if section O “while a resident.” Per the RAI User’s Manual, “Check all treatments, procedures, and programs that the resident received or performed after admission/entry or reentry to the facility and within …
Overview 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 …
This document shows how to upload assessments, create and manage assessments, complete change requests, and review Final Validation Reports (FVR) in iQIES. CMS iQIES Assessment Management for Assessment Submitter v2.0 From https://qtso.cms.gov/software/iqies/reference-manuals
The Centers for Medicare & Medicaid Services (CMS) convened a Technical Expert Panel (TEP) on May 12 and 14, 2025, to obtain input on potential cross-setting updates to the Falls with Major Injury (FMI) measure. …
This job aid outlines the user roles and privileges in iQIES. All users must have a role in iQIES. iQIES User Roles Matrix Job Aid v4.5 – 07/29/2025 (PDF 2.56 MB)
From 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
CDC 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 …
Question: When should I set an assessment reference date (ARD) for a Significant Change in Status Assessment (SCSA) after a resident elected hospice? Answer from Scott Heichel RN, RAC-MT, RAC-CTA, DNS-CT, QCP, ICC, IPCO: The …
Question: I know that McGeer criteria must be met when coding a UTI that develops in-house during the SNF stay, but what is required when a resident is transferred to the hospital and returns to …
Question: The Five-Star Preview Report for July 2025 still shows the standard survey from three years ago. I thought the third survey would no longer be used? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, …
The Centers for Medicare & Medicaid Services (CMS) noted in the FY 2026 SNF PPS Final Rule, “After consideration of the public comments, we are finalizing our proposal to remove four standardized patient assessment data …
Written by Kristine Martinez, BSN, RN, RAC-CT, RAC-CTA, QCP, DNS-CT, MDS Consultants Often, section K on the minimum data set (MDS), along with the associated care area assessments (CAAs) and care planning are delegated to …
The American Association of Post-Acute Care Nursing (AAPACN) surveys nurse assessment coordinators (NACs) every other year on aspects of their work, salary, and time. The 2025 AAPACN NAC Work Study and Salary Report offers valuable …
AAPACN has re-released the Nurse Assessment Coordinator (NAC) FTE Calculator for SNF leaders to estimate the time needed to complete assessments as well as project how many hours the NAC needs for meetings and other …
Regulation 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 …
On 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 …
This ZIP file contains resources for surveyors conducting initial surveys under the Long-term Care Survey Process (LTCSP). It is a one-stop shop containing a multitude of reference materials that are provided to the surveyors going …
Members: $24 | Non-members: $48Continuing Education: 1.5 CE hoursRecording Date: Aug. 21, 2025 Duration: 90 minutesSpeaker: Jennifer LaBay, RN, RAC-MT, RAC-MTA, QCP, CRC It is time to prepare for the FY 2026 ICD-10-CM coding updates, which go into effect …
Members: $24 | Non-members: $48Continuing Education: 1.5 CE hoursRecording Date: July 24, 2025 Duration: 90 minutesSpeaker: Jessie McGill, RN, BSN, RAC-MT, RAC-MTA The Fourth of July fireworks are over, so now it’s time to light a new fuse—on Five-Star …
In 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 …
Question: A resident elected hospice on July 9, 2025. What is the required completion date for the Significant Change in Status Assessment (SCSA), and what steps should be taken if the resident passes away before …
Question: Is aspirin coded as an antiplatelet in N0415I? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: The RAI User’s Manual includes aspirin as an antiplatelet medication on page N-9: “N0415I1. Antiplatelet: Check if …
Question: How do we code interviews that were not complete when a Medicare resident has an unplanned discharge to the hospital? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, CPC: If the interviews were not …
Effective with the July 2025 refresh, the Centers for Medicare & Medicaid Services (CMS) is implementing a change to the methodology for calculating the Health Inspection domain, shifting from using the three most recent standard …
When completing any Minimum Data Set (MDS) assessment, accurate coding of A0310E is critical. This item is completed on OBRA (Omnibus Budget Reconciliation Act), scheduled PPS (Prospective Payment System), and OBRA discharge assessments. It asks, …
CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily. The Nursing Home Compare Web site features a quality rating system that gives each nursing home …
Myers 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 …
Question: If a resident initiates his/her discharge for the following day and the facility was able to organize home care, equipment, etc., is this considered a planned or unplanned discharge? Answer from Jessie McGill RN, …
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) …
Question: The RAI User’s Manual guidance for mechanically altered diet mentions “soft solids.” Would that include solids that are naturally soft or solids that we would “soften”? Answer from Carol Maher, RN, GERO-BC, RAC-MTA, RAC-MT, …
N0415 (High-Risk Drug Classes: Use and Indication) is much more than just paperwork. This MDS item impacts resident care through the care area triggers (CATs) and the care area assessments (CAAs), as well as facility …
In the fast-paced position of a nurse assessment coordinator (NAC), keeping track of all the residents’ whereabouts can be challenging. The NAC must know who is coming into the facility and if this resident is …
At Eventide Senior Living, people come first. From residents to staff, the organization understands that delivering high-quality care starts with a confident, well-supported team. That’s why Eventide has taken a thoughtful and proactive approach to …
The 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 …
Provider Information General information on currently active nursing homes, including number of certified beds, quality measure scores, staffing and other information used in the Five-Star Rating System. Data are presented as one row per nursing …
MDS section N (Medications)—in particular item N0415 (High-Risk Drug Classes: Use and Indication)— plays a key role in a nursing home’s ability to provide comprehensive, resident-centered care via the care area triggers (CATs) and the …
Question: If the resident was in the emergency department (ED) and then admitted to the hospital before readmitting to the nursing home, can I capture IV fluids at the ED visit? Answer from Jessie …
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 …
Question: A long-term care resident has a Quarterly assessment due on 6/19 and an Annual assessment due on 6/27. Can I do the Annual assessment early, before the Quarterly deadline? Answer from Carol Maher, RN, …
The AAPACN Resident Interview Toolkit helps nursing home staff conduct effective resident interviews as part of the MDS 3.0 assessment process. It provides clear guidance and resources for the entire interdisciplinary team—nurses, dietary managers, social …
The Centers for Medicare & Medicaid Services (CMS) released a memo that will have a significant impact on the health inspection star rating and how the long-star antipsychotic measure is calculated, among other changes: Health …
Navigating 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 …
The Centers for Disease Control and Prevention (CDC) has updated the “Staying Up to Date with COVID-19 Vaccines” guidance several times since requiring COVID-19 vaccinations to be coded on the MDS as of October 2024. …
Memo # QSO-25-20-NH Posting Date 2025-06-18 Fiscal Year 2025 Memorandum Summary • Post Performance Data for Nursing Home Chains – “Chains” refers to groups of Medicare-certified nursing homes that are connected through common owners, and operators (also …
Question: When a resident returns from an interrupted stay, is an IPA required or any kind of readmission assessment if no change? Answer from Jeff Taylor: IPAs are always optional. In an interrupted stay, no …
Question: A resident on a Medicare Part A stay discharged return not anticipated. His last covered day of Medicare was the day before. Can I combine the Part A PPS Discharge with the OBRA discharged …
Question: For section GG documentation, the direct care staff was given the wrong dates. It was supposed to be the ARD and the two days before, but they did the first 3 days of the …
