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MDS Alert

QUALITY OF CARE:
Shore Up ADL Care Safety With 4 Pivotal Strategies
Don't overlook these triggers for revisiting how much help a resident needs. Envision thi... Read more
Workplace Safety:
Tap OSHA Guidelines, Other Recs to Prevent Ergonomic Injuries
Take advantage of the wealth of info available. Many nursing facilities are implementing ... Read more
MDS 3.0:
The Countdown Continues: CMS Hits Milestone for Achieving Oct. 1, 2010 Rollout
Find out what instructions to expect when. The final MDS 3.0 debuted on Oct. 29, although... Read more
STAFF TRAINING:
Prepare for MDS 3.0 Without Digging Into the Nitty Gritty
Here's what your facility can do now without having to backtrack later. Talk about frustr... Read more
QUALITY IMPROVEMENT:
Tales of Two Care Plans Address Falls, Fear of Letting Go of a Lap Buddy
Creativity in individualizing care -- and persistence -- can pay off. If your f... Read more
PAYMENT TRENDS:
Beware: Reports Indicate Hospitals Providing More Observation Stays
If you get a technical denial, look to Parts B and D to pay for part of the stay. Your SN... Read more
CASE STUDY:
Looking for a More Surefire Way to Keep Physician Certs/Recerts on Track?
Hint: Try hard-to-ignore hot pink binders. If your SNF uses Medicare Part A certs/ recert... Read more
WHAT DO YOU THINK? How Do Medicare Advantage Plans Handle Consolidated Billing?
Question: Do Medicare Advantage plans follow the same consolidated billing rules for a re... Read more
WHAT DO YOU THINK? Do You Code a Bath Lift at G6d (Lifted Mechanically)?
Question: A resident requires a bath lift. Would staff code that at G6d ? Answer: Lifted m... Read more
MEDICARE:
Be Certain to Meet Medicare Part A SNF Certification/Recertification Requirements
Get the required info on time and know what to do if you don't. Failure to obtain proper ... Read more
MEDICATION SAFETY:
Crosscheck Antihypertensive Meds With These Conditions
Don't let failure to check the MAR end up marring your survey record. Anytime a resident ... Read more
Medicare:
Providers Can Find No Clear Reason for Reported Uptick in Hospital Observation Days
A new legislative provision could help reduce over-use of observation stays, says one exp... Read more
MDS & CLINICAL NEWS TO USE
The quality measures posted on Nursing Home Compare now reflect an average of three quart... Read more
COMPLIANCE:
Don't Let the Newest Payment Auditors on the Block Pack a Knock-Out Punch for Your Facility
5 strategies will prepare you for the MICs (Medicaid Integrity Contractors). If you think... Read more
QUALITY OF CARE:
Enlist the MDS in the Battle Against the Bugs and F Tags
Make sure you know how to code UTI and other infections. With swine flu and a growing num... Read more
PREVENTIVE CARE:
Boost Immunization Rates and Capture Them in Section W
Protect residents against flu and pneumococcal infection, and get credit for it. Immuniza... Read more
TOOL:
Check Out the Coding for the Flu Immunization Quality Measure
Coding snafus can give a false view of your infection prevention efforts.... Read more
Quality Assurance:
Home In on a High Rate of UTIs
Here's what to do if you note a worrisome pattern. If your nursing facility's UTI QI/QM e... Read more
CARE PLANNING:
Cover These Bases When Providing Skin Care for Nursing Home Residents on Hospice
Check out these novel wound pain and odor management strategies. The regulatory pressure ... Read more
Risk Management:
Caring for a Hospice Patient With Skin Breakdown? Don't Let These Key Areas Trip Up Your Survey Record
Use this key litmus test to see if you're in compliance. Providing good skin and wound ca... Read more
MEDICAL PRIVACY:
Bearers of Paper Health Records, Beware New HIPAA Breach Notification Rules
Proactive documentation management has taken on new urgency. New HIPAA breach notificatio... Read more
WHAT DO YOU THINK? Does Addressing This Communication Barrier Count as a Restorative Program?
Question: Can a restorative program (P3j) be coded when the deficit is a language barrier... Read more
MEDICARE PAYMENT:
Final SNF PPS Rule Provides Leeway for Capturing Rehab for Short-Stay Patients
You can't project therapy minutes under RUG-IV, but you can do this ... If you're still r... Read more
BEHAVIORAL MANAGEMENT:
If the Resident Has Behavioral Sx, Consider Using This ABC Assessment Format
This approach works whether residents are cognitively impaired or not. What might screami... Read more
MEDICARE NEWS
Double check whether a Part A resident has had a bona fide three overnight inpatient stay... Read more
MEDICARE:
RUG-IV Reshuffles Nursing RUG Placement -- Here's What to Expect
It definitely won't be business as usual come Oct. 1, 2010. When RUG-IV rolls out, your S... Read more
REHABILITATION THERAPY:
Limits on Concurrent Rehab Therapy Create an Undercurrent of Uncertainty and Concern
CMS puts its foot down on this popular form of rehab delivery. The final SNF PPS rule gav... Read more
RISK MANAGEMENT:
Watch Out for New False Claims Rules
A law cracking down on financial fraud can backfire for nursing homes. If you're wonderin... Read more
Medicare:
OMRA to Become a Give-and-Take Proposition Under RUG-IV
Check out a major change to this often overlooked MDS assessment. Have you every wished y... Read more
DIAGNOSIS CODING:
Know the Ropes for Selecting a Principal Diagnosis for a Rehab Patient
Find out the secret to navigating the murkier scenarios. Your SNF has admitted a Medicare... Read more
SKIN CARE:
3 Ways to Head Off Hospital-Acquired Pressure Ulcers
Synching with the hospital helps keep residents' skin in the clear. Cooperation is the na... Read more
TOOL:
Transfer Communications Guidelines: Pressure Ulcers
Skilled Nursing Facility to Northwest Hospital... Read more
QUALITY ASSURANCE:
Follow This Facility's Path Away From Physical Restraint Use
Find out why taking it slow and including this key discipline pays off. Are you looking t... Read more
CODING QUIZZER:
Code P5 (Hospital Stays) for This Resident
Mrs. D, an insulin-dependent diabetic, was admitted to the nursing facility yesterday from... Read more
COMPLIANCE:
4 Mistakes You Don't Want to Make With the OMRA
Keep your payment and compliance humming along. The Other Medicare Required Assessment or... Read more
MEDICARE & MDS NEWS
For those who hoped the final SNF PPS rule might soften proposed payment cuts to SNFs&nbs... Read more
YOU BE THE CODER:
How Would You Code This Real-Life Scenario?
The scenario: A resident with severe type 1 diabetes underwent an amputation and was set ... Read more
QUALITY OF CARE:
Ready, Set: Detect, Address, Prevent Delirium
This care map can help keep residents off a dangerous clinical path. Delirium is definite... Read more
RAI COMPLIANCE:
Navigate Significant Change in Status Assessments to Improve Your Facility's Survey and Payment Status
Defuse the confusion about this OBRA-required MDS assessment. True or false? You should d... Read more
QUALITY OF CARE:
5 Tips Ensure Your Restorative Program Meets RAI Manual Requirements
If you want to get paid, follow these key strategies. Providing restorative is one thing,... Read more
MDS AUDIT:
If Sections F and E Don't Jibe,You May End Up With an F Tag
Comparing notes can tell you that trouble may be brewing for a resident. The MDS should p... Read more
Time Management Tip:
Don't Get Too Wrapped Up in RAPs When Doing an SCSA
Work smart when doing this comprehensive assessment. Some MDS teams disdain doing signifi... Read more
SURVEY MANAGEMENT:
MDS 3.0 Delirium Assessment Trumps MDS 2.0
The new instrument does a better job detecting this potentially lethal problem. The last ... Read more
ASSESSMENT:
These Examples of Decline Could Herald a Sig Change
The RAI User's Manual provides these coding examples. Look for decline in two or more of ... Read more
PHARMACOTHERAPY:
Help Keep Residents Delirium-Free With These 3 Key Strategies
Doing a little homework will earn you high marks with surveyors in this area of preventiv... Read more
CARE PLANNING:
Cover These Care Plan Bases to Keep Surveyors Off Your Case
3 ways to tell if you're wide open for F tags. A few common shortfalls in your care plann... Read more
Patient Safety Tip:
Resident Opioid Naïve? Beware This Drug
Prevent falls, oversedation. Doing a medication history can pay off by identifying reside... Read more
CODING QUIZZER:
Have These Residents Undergone a Change in Their Cognitive Status?
Try your hand at coding B6. How would you code the following case examples at B6? The cod... Read more
MDS & MEDICAID UPDATE
Good news: The MDS 3.0 may not impact Medicaid case-mix states as much as predicted. Stat... Read more
MDS 3.0 :
Be Aware of CATs and Other Changes for Care Planning Afoot Under MDS 3.0
CMS plans to put the CATs analysis more in facilities' court. Once the MDS 3.0 goes into ... Read more
Check Out the CATs
The draft MDS 3.0 includes these Care Area Triggers: Delirium Cognitive Loss/Dementia Visu... Read more
QUALITY ASSURANCE :
Use This Model to Target Restorative Nursing and Watch Your QIs/QMs Fall Into Place
Nip problems before they morph into F tags. Think of the facility's quality indicators/me... Read more
TRENDS :
Providers Challenge RUG-IV on Multiple Points
CMS rep addresses concerns about Rehab plus Extensive Services. As industry experts diges... Read more
DIAGNOSIS CODING :
Get Ready for 141 New ICD-9 Codes Effective Oct. 1
Some of the new codes may help you with ICD-10. The MDS 3.0, RUG-IV, and ICD-10 may be lo... Read more
Coding 202 :
1 2, 3 … Keep Your ICD-9 Coding More Error Free
A little extra effort can clean up your claims. Ready to give your ICD-9 coding and billi... Read more
DIAGNOSIS CODING :
Get the Latest Scoop From CMS on ICD-10
Don't count on much wiggle room on the implementation deadline. Although confusion about ... Read more
Compliance :
Stay a Step Ahead of the RACsWith 2 Strategies
How to keep claims out of RACs' hands. Giving your claims a clean bill of health may be t... Read more
QUALITY ASSURANCE :
Let the MDS Be Your Guide in Keeping Diabetes Care and Outcomes on a Positive Course
Find out if you're coding and addressing everything you should be. Imagine a good plainti... Read more
SURVEY MANAGEMENT :
Afraid Your Activities Program Isn't Making the Grade? Conduct a RAID
A mock inspection in time can stave off F248 and other tags. Surveyors increasingly have ... Read more
ACTIVITIES :
Do Your Facility's Activities Include These Key Therapeutic Design Elements?
This quick 8-point checklist can keep your programming on the mark. Activities should mee... Read more
CLINICAL TIP :
Identify ResidentsWith Prediabetes to Get the Care Plan Rolling
A 3-prong approach can improve care for this common condition. You can't address what you... Read more
CODING QUIZZER :
To Code or Not to Code E4e if a Resident Refuses Care
The answer hinges on this key consideration. Question: Should you code E4e that a residen... Read more
MDS & CLINICAL NEWS TO USE
Screening patients with heart disease carefully for depression symptoms might be a good i... Read more
MEDICARE :
CMS Rolls Out New RUGs With Significant Changes
Extensive Services to include only vents, trachs, isolation for active infection. The pro... Read more
PPS Analysis :
Industry Insiders Highlight the Good, Bad and Unknowns to the Proposed RUG-IV
The ADL index range change could be a boon. Industry leaders view the proposed RUG-IV as ... Read more
Brace for a Part A Payment Cut on Oct. 1
The case-mix adjustment recalibration is back. If you hoped the Centers for Medicare &... Read more
MEDICARE :
Take a Look at Part A Current Concurrent Therapy Now
The handwriting appears to be on the wall for this modality. When CMS expresses concerns ... Read more
RESOURCE :
Find Out How the New RUGs Break Out
Chart shows RUG-IV categories and ADL splits.... Read more
MDS 3.0 :
CMS Unveils a New Draft MDS 3.0 Data Item SetWith ADL Changes and CATs
Find out 2 key differences in this latest version. The month of May proved to be a fruitf... Read more
RAI COMPLIANCE :
Get the Inside Skinny on Coding Skin Ulcers on the MDS
Follow these inside tips to boost accuracy. Painting an inaccurate picture of residents' ... Read more
PAYMENT TIP :
Is Your SNF Missing Out on RUG Payment forWounds or Rx?
If you don't code certain wounds or treatments, your payment may suffer. Your facility ma... Read more
DIAGNOSIS CODING :
Know How to Code Non-Pressure Type Ulcers in Section I3
Get it right with these key ICD-9 coding principles. Sometimes you have to think outside ... Read more
PAIN MANAGEMENT :
Meet and Exceed Residents' Pain Management Expectations
A 3-step approach will improve care and rein in your pain QMs. A cognitively intact resid... Read more
MDS ACCURACY :
KnowWhen You've Entered the No-Code Zone
Master this short list to keep your RUG-III scores on the up and up. Is your team aware o... Read more
Proposed RUG-IV System :
Check Out Proposed RUG-IV Drivers for Special Care High and Low, and Clinically Complex
Special Care High includes residents with an ADL score greater than or equal to 2 with an... Read more
READER QUESTIONS :
To Give an ABN or Not for a Part B Resident Who's Exhausted the Therapy Cap
Question: Should our facility give a beneficiary the CMS-R-131 when the resident has exha... Read more
READER QUESTIONS :
How to Code the Number of Meds at O1 Accurately
Question: What are the key mistakes facilities make in coding the number of medications a... Read more
WOUND ASSESSMENT:
TheWrong Dx Can Hurt Residents and Your Survey Record
3 principles keep your quality reporting and wound care plans on the mark. Leg ulcers may... Read more
MEDICAID:
Don't Ding Your NF's Bottom Line: Ring Up Fair Medicaid Case-Mix Payment
Put your RAI compliance and reimbursement on the high road. Nursing facilities in states ... Read more
Quality Improvement:
Jazz Up Restorative With These Programs
If you're wondering how a ball or ring toss or rhythm band might qualify as restorative n... Read more
WOUND CARE:
Put Your Best Effort Forward in Diabetic Ulcer Identification and Prevention
Get the upper hand with these difficult wounds. Recognizing and preventing diabetic ulcer... Read more
MEDICATION REVIEW:
Keep Your Eye on This QI: Residents Taking 9 or More Meds
4 ways to keep adverse drug reactions at bay. Ensuring medications help rather than cause... Read more
MDS COMPLIANCE TIP:
Identify This Discrepancy in a Resident's Goal-Setting Ability Before Surveyors Do
Beware this roadmap to F tags. If the MDS shows a resident has the cognitive where-with-a... Read more
CODING QUIZZER:
How Would You Code O3 (Injections) and O1(Number of Meds) for These Residents?
The correct answer lies in the RAI User's Manual instructions. 1. During the last seven d... Read more
SURVEY MANAGEMENT:
Use This Quality Indicator Survey Form to Sidestep Citations for Unnecessary Meds
Track your compliance with F329 requirements.... Read more
TOOL:
Check Out the PsychosocialWell-Being RAP Triggers
Help the resident support 2 care-plan related strengths that trigger this RAP. TRIGGERS A... Read more
PATIENT SAFETY:
Standardize a Risk Assessment Checklist for Residents Receiving MRI
Asking the right questions in time can head off serious harm. For certain residents, magn... Read more
MDS & BILLING NEWS
MDS 3.0 preparation will be heating up again in October, if the revised timeline stays on... Read more
READER QUESTIONS:
Stay on Top of Self-Administered OTC and Herbal Medications
Question: Our nursing staff has found numerous occasions where residents are taking their... Read more
READER QUESTIONS:
To Code or Not to Code Recent Weight Loss at K3
Question: When evaluating residents'weight change for coding the MDS,should we look back ... Read more
QUALITY IMPROVEMENT:
Stay Out of a Survey Bind: Tighten Up Pain Assessment
4 strategies lay the groundwork for staying a step ahead of F309 tags. With tougher F309 g... Read more
CARE PLANNING :
Tap the MDS and Survey Guidance to Create a Pain RAP
Standardize and individualize care planning with this approach. The lack of a pain RAP can... Read more
MDS 3.0:
It's Official: CMS Pushes Back MDS 3.0 Rollout
Find out what to expect with this major delay. With rumors of an MDS 3.0 delay in play for... Read more
RAI Compliance :
Get Your SNF on Top of These 2 RAI Manual Changes
CMS posted the update in February with a December 2008 implementation. The latest RAI User... Read more
Medicare:
Preempt Payment Recoupments and Worse With This RAC Risk Management Plan
Your SNF could be more vulnerable than you think. The Recovery Audit Contractors have been... Read more
If RAC Auditors Come Knocking, Stand Your Ground
Don't be waylaid by demands for records. You come in Monday morning and find RAC auditors... Read more
MEDICARE:
Keep Your Payment and Compliance on Track With Your New MAC
Use this handy checklist to ensure a smooth changeover. The transition to MACs doesn'thav... Read more
WHAT DO YOU THINK? When Do You Include a Pneumonia Diagnosis on a Claim for a Rehab Patient?
Question: When should the SNF claim include an ICD-9-CM code for pneumonia for a rehabili... Read more
Test Yourself (Answer) Where Do You Capture Restorative Nursing on the MDS?
The answer is option 3. Code restorative nursing in Section P3 and H3a or H3b, according ... Read more
TOOL:
Give Your Staff's Pain Assessment Prowess a Check-Up
Consider using these vignettes to generate discussion about pain. Would these scenarios t... Read more
CODING QUIZZER:
Get in the Groove for Coding Mood (E1)
How would you code Mr. F's verbal and other expressions below in E1? He is a new admissio... Read more
MEDICARE NEWS
Keep your Part B therapy cap payments flowing smoothly. The outpatient therapy cap is $1,... Read more
REIMBURSEMENT:
Nurses Providing Respiratory Therapy? Don't Lose Out on Available Reimbursement
You can capture RT if you meet the RAI User's Manual guidelines. Your MDS team wouldn't d... Read more
COMPLIANCE:
Forewarned is Forearmed: 4Ways to Stay a Step Ahead of the RACs
You can bank on the RACs having the scoop on you -- here's what you need to know and... Read more
IN THE SPOTLIGHT:
Rein in Pain Rates and Other Negative Outcomes
Don't reinvent the wheel: Lessons learned help you move forward quickly. Saint Elizabeth ... Read more
QUIZZER:
Would You Code This Resident at E3 as Having a Mood Change? (Answer on Page 48)
Mrs. Y has bipolar disorder. Historically, she has responded well to lithium and her mood... Read more
CARE PLANNING:
Take Care of Common Problems That Jeopardize Care Plan Success
Shore up these key areas and watch your outcomes soar. The best laid care plans sometimes... Read more
MEDICATION MANAGEMENT:
Beware: These 2 Types of Meds Heighten Pneumonia Risk
If the resident has COPD coded in Section I, or antipsychotic use in O4, take a closer lo... Read more
SURVEY PREPARATION:
Could You Find the Answers to These Questions and Ante Up the Documentation?
The QIS staff interview questions can help with QI and survey preparation. Practice makes... Read more
MDS, CODING AND SURVEY NEWS
Despite rumors to the contrary, the MDS 3.0 is on track for an October 2009 rollout. That... Read more
MEDICARE:
5Ways to Keep Your Short-Stay Rehab Program From Falling Short
Put your post-acute rehab on sure footing in the clinical, fiscal, and compliance realms.... Read more
QUALITY OF CARE:
Tap This 3-Pronged Pneumonia Prevention Plan
Stave off this potentially lethal condition with the right clinical know-how. Nursing hom... Read more
PREVENTIVE CARE:
Boost Your Pneumococcal Immunization Compliance: Know Who to Vaccinate and When
A few key principles keep you on the right track. All adults 65 years of age or older sho... Read more
ADL CODING:
Don't Let Missing ADL Points Dock Your RUG Scores
Make sure these common examples stay on the RAI radar screen. Certain types of ADL help c... Read more
CODING TIPSTER:
Simple StrategiesWill Make Your Bathing Coding Pristine
Sidestep common reasons for miscoding bathing and related ADLs. Bathing is one area where... Read more
QUIZZER:
How Would You Code Bathing for These Resident Scenarios?
Hint: Focus on the different rules for coding self-performance. Example No. 1: The reside... Read more
RISK MANAGEMENT:
Outcomes Not Improving? Get in a New QA Groove
Master the simple inside secret to implementing lasting changes. If your quality assuranc... Read more
MDS 3.0 UPDATE:
Beware Medicaid System Changes, Software Ramp Up as October Rollout Looms
Case-mix jump, magnitude of software changes among top concerns. The MDS not only drives ... Read more
MDS & CODING NEWS:
Is your SNF on top of these errors in the 2009 ICD-9 Manual?
The American Medical Association recently identified several corrections to its 2009 ICD-... Read more
READER QUESTION:
How Do Mandatory Patient Lifting Requirements Affect ADL Coding?
Question: Our facility is thinking about implementing ergonomic-related safety requiremen... Read more
Medicare:
Leaving These Key RUG Drivers Behind Could Put Your SNF in a Fiscal or Survey Bind
Most SNFs home in on the IV fluids and IV meds in the hospital lookback. But failing to c... Read more
RUG Calculation:
Will the Resident Go Into SE1, SE2 or SE3?
Find out how the points add up If the resident is coded for receiving one or more of the ... Read more
Risk Management:
Shore Up Pressure Ulcer Care With 'Lessons Learned' From This Real-Life Scenario
Find out if your facility is wide open to a similar disaster A few common missteps in ass... Read more
Quizzer (Answer page 23):
Cut Through the Confusion for Assessing, Coding Delirium
How would you code this resident's behavior at B5 (Indicators of Delirium -- Periodi... Read more
Quality Improvement:
Solid Case Management Can Move Your Rehab Program to the Head of the Class
These fail-proof strategies address what ails many rehab programs -- and will get yo... Read more
Resident Assessment:
This resident developed a Stage 4 decub.
A resident with a reddened area developed a Stage 4 pressure ulcer (see the case study on... Read more
ADL Assistance:
Turn Bath Time Into Quality-of-Life and Care Time
A combo of strategies can make a big difference in resident behavioral and satisfaction o... Read more
Tool:
Check Out This Pressure Ulcer Risk Assessment
Determining a patient's pressure ulcer risk can start with a solid assessment form, altho... Read more
Coding Tipster:
3 Strategies Help Error-Proof Pressure Ulcer Dx, Coding
Ease the pressure for getting it right. Accurately coding pressure ulcers in Section M is... Read more
Coding Quizzer Answer :
Cut Through the Confusion for Assessing, Coding Delirium
Answer: a. Easily distracted: 2 (present, new) b. Periods of altered perception or aware... Read more
MDS & Coding NEWS
Prepare for ICD-10 now to get a step ahead of the learning and software curve -- esp... Read more
READER QUESTION:
Can SNFs Still Count Rehab Provided by Therapy Aides?
Question: Our facility has heard rumors that changes in therapist assistant requirements ... Read more
Medicare Payment:
To Keep the Coffers Filled, Hone Your ARD-Setting Skills.
How would you manage these 3 scenarios? All RUGs are not created equal in terms of provid... Read more
RAI Compliance:
Nail Down ADL Assistance Provided in the Hospital.
Simple tips help back up your coding. Knowing a resident received a certain level of ADL ... Read more
Documentation:
Tackle 2 Tasks When Reviewing Clinical Records for MDS Assessments
Here's how to create another layer of safety to catch cracks in the system before it's to... Read more
Coding Quizzer:
Would You Code These Residents
The answer isn't always as straightforward as you might think. Which of the following res... Read more
Payment Compliance:
Restorative, Rehab Or Both? This Decision-Making Tree Will Help Keep You Worry Free
5 quick questions will put your care and payment on the right track. You may get kudos fr... Read more
Resident Assessment:
When Evaluating ADL Decline, Don't Overlook This Potential Culprit
If you don't catch this medication issue, surveyors probably will. The reason for a resid... Read more
Coding and Compliance:
Give Your Flu Immunization Compliance, Coding a Booster
2 tips will sharpen your compliance in this vital area. Managing flu immunizations includ... Read more
Risk Management:
The OIG Has a Plan for 2009. Does Your Nursing Facility?
The time to shore up compliance is now. If staff read and stash the OIG work plan each ye... Read more
MDS News To Use:
MDS News To Use:
Have you seen the latest version of the MDS 3.0? In October, the Centers for Medicare &am... Read more
Reader Question:
Know Who Can Sign at R2 and What Signing Means
Question: What legally speaking is the nurse who signs at R2a (signature of person coordi... Read more
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