Advanced Search

MDS Alert

Medicare Part A:
Get Up to Speed on Leave of Absence (LOA) Requirements
MDS experts explain what you can include on the MDS. Don't let residents' LOAs lead your ... Read more
Compliance:
Check Out CMS' LOA Examples for EOT & COT OMRAs
"EOTOMRAExample: A resident does not receive therapy on Monday and Tuesday, and Wednesday... Read more
Compliance:
Know How the RAI Manual Defines a Leave of Absence
The RAImanual states: "A leave of Absence (LOA), which does not require completion of eith... Read more
Case Study:
Find Out How This Facility Stays on Top of MDS Assessments
The director of clinical compliance gives you the inside scoop. "With all the different M... Read more
RAI Compliance:
Beef Up Your Coding Accuracy and Care for Therapeutic Diets
Also get a tip on coding a mechanical diet. In June 2011, CMS revised the MDS 3.0 Section... Read more
Resource:
Here's a Quick Review of MDS Definitions & Coding Tips for Section K0500
The RAI User's Manual provides the following verbatim instructions for coding K0500D: THE... Read more
Coding Compliance:
Don't Overcode M1200D (Nutrition or Hydration Intervention to Manage Skin Problems)
This is a RUG driver, cautions expert. The Oct. 1 RAI manual version has new directions f... Read more
Medicare:
Tread Compliantly With Part A Rehab Therapy Co-Treatment
Be prepared to dot the I's and cross the T's. If your SNF is providing therapy co-treatme... Read more
Resource:
Looking for a Tool to Augment Your Nutrition Assessments?
This one has a handy BMI table.  ... Read more
What Do You Think?
Question: Will Part B sometimes pay for rehab therapy for a patient on hospice? Answer: "... Read more
Compliance Tips:
3 Ways to Stay Out of the Audit and Survey Fray
Is your facility using these simple practices? You can head off claims denials and F tags... Read more
Coding Quizzer:
How Would You Code These RAI Manual Examples for Transfer in Section G?
Example No. 1: "Mr. T. is in a physically debilitated state due to surgery. Two staff mem... Read more
MDS, Compliance & Clinical News To Use:
Don't Miss These New COT, EOT, and EOT-R OMRA Clarifications
A Nov. 29 CMS clarification document has a "Clarification regarding the relationship betw... Read more
SNF PPS:
Nail Down This Latest Spate of CMS Clarifications
Also: Get tips on when to combine the COT OMRA with a scheduled PPS assessment. Are you d... Read more
Medicare Part A:
Need a Quick Review of EOT and COT OMRA Definitions & Rules?
CMS provided the following information in its PowerPoint slides for the Nov. 3 national p... Read more
Management Tip:
Expert Suggests MDS Nurses Use This Approach for COT OMRAs
If they don't, this is what could happen. Marilyn Mines, BSN, RN, RAC-CT, BC, believes MD... Read more
Rehab Trends:
Follow These SNF Providers Lead to Keep Residents' Rehab Attendance on Track
Also: Watch out for this potential problem. Sunshine Terrace Rehabilitation & Skilled... Read more
What Do You Think?
Question: During the Sept. 1 SNF/LTC Open Door Forum, a caller asked how you know whether... Read more
Tool:
CMS Provides These 2 COT Evaluation Examples
Source: Slides from CMS' Nov. 3 national provider call. For an explanation of the charts,... Read more
Research Study:
Families Share Their Impressions of Hospice Care in Nursing Homes
While positive, the research findings include a caveat. In an e-mail interview with MDS A... Read more
Coding Quizzer:
How Would You Code These 2 RAI Manual Examples at J1100: Shortness of Breath (dyspnea)?
Example No. 1: "Mrs. W. has diagnoses of chronic obstructive pulmonary disease (COPD) and ... Read more
Compliance:
Cover These Bases When Hospice Is on a Case
Do you have these documents in hospice patients' medical records? When VITAS Healthcare C... Read more
MDS Coding:
Know What's Required to Code Hospice in A1800 (Entered From) and A2100 (Discharge Status)
For A1800 (Entered From): "Code 07, hospice: if the resident was admitted from a program ... Read more
Payment, Compliance & Clinical News
Some SNFs are getting MAC letters about ultra high rehab. "Highmark, the MAC for J12, has ... Read more
Clinical Tip:
Figuring Out Why This Resident Wasn't Participating in Therapy Paid Off
Rather than giving up on providing rehab, the team took a different tack. Pauline Franko,... Read more
MDS 3.0:
Check Out These RAI Manual Revisions
One of the changes is good news payment-wise. Elisa Bovee, MS, OTR/L, points to what she ... Read more
Psychosocial Assessment:
When Should You Send a Resident to the Emergency Room for Suicidality?
MDS 3.0 gold standard nurse shares her experience. Panel members participating in a CMS "... Read more
PPS Management Tip:
MDS Expert Explains Challenge to Keeping Up With Change of Therapy Observation Periods
Find out why this task isn't so simple. Rena Shephard, MHA, RN, RAC-MT, C-NE, notes that t... Read more
Rehabilitation Therapy:
Consider This Creative Approach for Group Therapy
Therapy expert shares ideas for a weekend 'power group'. "Group therapy can be an avenue ... Read more
What Do You Think?:
CMS Rep Answers Caller's Questions About Group Therapy
In an Aug. 23 training session, CMS' Penny Gershman answered a caller's questions about gr... Read more
SNF PPS:
Be Aware of This Clarification on Setting the ARD
The rule differs for these assessments, according to CMS memo. Consultant Judy Wilhide Br... Read more
Quality of Care:
Assess Residents for Mood and Other Clinical Issues on an Ongoing Basis.
Also ask yourself this question, advises nurse expert. The MDS 3.0 can help identify resid... Read more
Resource:
Review the Instructions for the Change of Therapy (COT) OMRA
See if you're up to speed on this new required PPS assessment. The RAI manual states that ... Read more
MDS 3.0 Coding Quizzer:
How Would You Code This RAI Manual Example at K0300 (Weight Loss)?
Has the resident lost enough weight to code a weight loss? "Mrs. J has been on a physician... Read more
Coding, Survey & Research News
The new ICD-9 codes for Oct. 1 include "two new ones for dementia: 294.20 (Dementia unspec... Read more
Medicare Part A:
CMS Targets Rehab Reimbursement
Check out the Oct. 1 Part A payment change. In the SNF PPS final rule, CMS says it projec... Read more
Medicare:
Wondering What Your RUG Revenues Will Be?
Follow these steps to find out. To project your revenues for FY 2012, "obtain a report li... Read more
CMS Explains the Math for the $3.87 Billion SNF Part A Reduction for FY 2012
'Believe it or not, it could have been worse,' says SNF PPS expert. CMS noted in a press ... Read more
Research:
Beware These Shortfalls in UTI Management
Study author shares concerns about research findings. Recent research results proved to b... Read more
MDS 3.0 Coding:
Keep an Eye on UTI in Section I
Get advice on coding this condition on the MDS and doing quality assurance. When an asses... Read more
Clinical practice:
Fine-Tune Your SNF's UTI Assessment, Treatment & Prevention
These strategies can halt a resident's recurrent UTIs. As a first step toward avoiding unn... Read more
F315 Survey Guidance Incorporates McGeer Criteria
"Indications to Treat a UTI Because many residents have chronic bacteriuria, the research-... Read more
Risk Management:
HEAT Training Session Offers Pointers for Self-Disclosing Payment Issues
The OIG has some advice for you on this compliance topic. Heads up: The "OIG has long bel... Read more
Quality of Care:
When a Pressure Ulcer Doesn't Seem to Be Healing, Look for These Key Reasons
Know what to consider if you see this when wound bed slough clears, advises expert. First... Read more
Centers for Medicare & Medicaid Services Memorandum
"Transition for Implementation of FY 2012 SNF PPS Policies Change of Therapy (COT) Other ... Read more
Medication Safety:
Are Your Residents Taking Any of These Drug Combos?
Expert warns about drug-drug interactions that can cause negative outcomes. Suppose a pat... Read more
MDS, Research & Payment News
Don't miss the July 13 RAI manual update. On its MDS 3.0 website, CMS notes that it has u... Read more
Pain Assessment:
Refrain From Over-Relying on a 'No' for Pain Presence at J0300
These strategies will help you cover the pain assessment and care planning bases. Problem... Read more
MDS 3.0:
Assess and Code Pain Presence Correctly at J0300
"Steps for Assessment 1. Ask the resident: "Have you had pain or hurting at any time in th... Read more
Resource:
Video on Interviewing Vulnerable Elders (VIVE) for Pain Demonstrates Helpful Technique
The interviewer doesn't let the resident's comment go unaddressed. The MDS 3.0 VIVE (Vide... Read more
MDS Coding:
Don't Let Dashes Derail Your RAI Compliance Track Record
Know what to do when an unplanned discharge prevents you from conducting any of these 3 in... Read more
Compliance:
CMS Memo Provides Existing RAI Manual Excerpts on Dashes
Ready for a quick review? CMS' recent memo, "The Use of Dashes in Completing the MDS 3.0 ... Read more
Compliance:
HEAT Training Session Homes in on These Key Medical Record Compliance Issues
Be aware of a crackdown in this area, says OIG official. In a recent HEAT training sessio... Read more
ICD-10:
Not Planning to Transition to ICD-10 as of Oct. 1, 2013? You Might Be Liable for Fines, CMS Reps Say
Plus: CMS officials are considering how to handle dates of service that span the pre- and... Read more
Payment:
Nail Down These 2 SNF Billing Clarifications
Know what counts as a unit of rehab therapy. SNFs will likely be more on the same page wi... Read more
HIPAA Compliance:
What Do You Think?
Question: Who's authorized to make a request to review a resident's medical record? Can a... Read more
Coding Quizzer:
Would You Code Both of These Eating Examples as Total Dependence in Section G?
Try your hand at coding these two RAI User's Manual examples: 1. "Mrs. U. is severely cogn... Read more
Care Planning Tip:
Is the Resident With Behavioral Sx Taking Any of These Meds?
These drugs can cause socially inappropriate behaviors, agitation, paranoid delusions. Th... Read more
Compliance & Payment News
While CMS hadn't at press time released its final SNF PPS rule, you might want to take a ... Read more
MDS 3.0:
Don't Delay: Nailing Down the Latest RAI Manual Revisions Will Pay
Make sure you're using these instructions now. Wondering if you can code ADL help provide... Read more
Clip 'N Save:
CMS Pumps Up Instructions for Coding Isolation for Infection
You can still code isolation if the resident goes offsite for these reasons. The revised R... Read more
MDS ComplianceL:
Sidestep Unnecessary Dashes on the MDS
Overuse has raised a flag for CMS, says agency official. A CMS official recently gave nur... Read more
SNF Prospective Payment System:
CMS' PPS Proposal Targets Rehab With These Key Measures
The Change of Therapy OMRA could rock the payment boat. Beware: You could soon have some ... Read more
Quality Improvement Trends:
Follow These Facilities' Lead to Take the MDS 3.0 and Care to a New Level
Including mood items on the daily CNA documentation form helped this care team assist a re... Read more
WHAT DO YOU THINK?
Should a Facility Code Pain Education as a Non-pharmacological Pain Remedy at J0100C? Ans... Read more
Prospective Payment System:
Brace for Briefer ARD Windows: Expert Provides Tips for Managing the Potential Change
This aspect would remain the same, says CMS official. The FY 2012 proposed SNF PPS rule s... Read more
Tool:
Nursing Facility Highlights Must-Dos for Shift Report
Spelling out the process helps staff know what to report. MaineGeneral Rehabilitation &... Read more
MDS, Compliance & Clinical News
Your facility's HIPAA disclosure obligations could soon increase. A proposed Health &... Read more
MDS 3.0 Coding
Review the Staff Assessment for Pain J0800. Indicators of Pain or Possible Pain in the las... Read more
Quality of Care:
Help Your Physicians Tap MDS 3.0 Scores to Improve Resident Care
These tips can help attendings quickly home in on what they need to know. If physicians a... Read more
Test Yourself:
Can You Administer the BIMS in Writing if the Resident Requests It?
Suppose a resident prefers to do the Brief Interview for Mental Status in writing. Will t... Read more
Medicare Part A:
Upgrade Your Skilled Care Documentation to Stave Off Payment Recoupments
If you use daily check-off sheets for Medicare documentation, make sure to do this. Is yo... Read more
Risk Management:
All May Not Be Lost If Medical Record Documentation Doesn't Back You Up
There are other ways you can prove the facility didn't violate the regs. Taking a closer ... Read more
Quality Improvement:
Don't Undermine Wound Care Outcomes: Use These Topnotch Tracking Strategies
Find out how this nursing home organization keeps a careful watch on pressure ulcer progr... Read more
CODING QUIZZER:
How Would You Code Two Decubs That Have Merged Into One?
"On admission, the resident has three small Stage 2 pressure ulcers on her coccyx. Two we... Read more
Tool:
Check Out the Nursing Documentation Core Components for CVA
Daily skilled nursing notes should include these elements, according to tool.... Read more
Quality Assurance:
Weigh the Pros and Cons of Wound Photodocumentation
Here are the various views on this method of chronicling wound healing. Using pictures to... Read more
Survey Management:
Physician Dx Helps Facility Successfully Challenge IJ Citation for Pressure Ulcers
Make sure to include physicians in your wound-care efforts. Having your physicians involv... Read more
Compliance:
Don't Let Auditors Yank the Rehab RUGs Out From Under Your Bottom Line
Making this simple check can keep you from holding the bag for rehab services. Your RUG p... Read more
WHAT DO YOU THINK?:
Know How to Code Pain Meds at J0100A and J0100B
Can you code PRN meds if the resident refused them? Question: How should we code a resid... Read more
Clinical Tip:
Does the Resident Really Need Thickened Liquids?
These strategies may allow some residents to safely drink regular liquids. Thickened liqu... Read more
HIPAA, Billing & Survey News to Use 
Beware delays in responding to authorized requests for a resident's medical records. A cl... Read more
MDS 3.0 Quality Improvement:
From Interview QA to Achieving Fair Payment, Experts Have Suggestions for You
Hold onto this practice from the MDS 2.0 days. While MDS 3.0 mastery remains a work in pro... Read more
MDS 3.0 Coding Update:
CMS Addresses How to Code Isolation in Section O of the MDS 3.0
Facilities should check their MDSs to see if they are coding correctly, says official. If ... Read more
Medicare:
2 Pointers Help You Steer Clear of Problems With the SOT OMRA
The first strategy will help prevent confusion about what rules apply when. If the Start ... Read more
Quality Reporting:
National Quality Forum-Endorsed Quality Measures Include Customer Satisfaction Surveys
Whether the entire list will fly with CMS remains to be seen, says expert. The National Q... Read more
Check Out the NQF-Endorsed Quality Measures for Nursing Facilities
Physical therapy or nursing rehabilitation/restorative care for long-stay patients with ... Read more
Privacy Compliance:
Take a Hard Look at Whether Your Facility Is Vulnerable to This HIPAA Violation
If your staff ever carries paper PHI offsite, implement these proactive strategies. HIPAA... Read more
What Do You Think?:
Know the Ropes for These Assessments and Tracking Records
Question: Can you walk us through admission assessments and tracking requirements under M... Read more
Clinical Care:
Resident Not Eating Enough? Here's How to Get Intake Back on Track
The remedy may be simpler than you think, says expert. You don't want the first indicatio... Read more
CODING QUIZZER
Question: How Would You Code Transfer in Section G for This Resident With Parkinson's Dise... Read more
Tool:
Simplify RAI Compliance With This Handy Algorithm
Source: Provided courtesy of Judy Wilhide Brandt, RN, RAC-MT, C-NE, principal of Judy Wil... Read more
Consider These Parameters When the Resident Isn't Eating Well
The Nutritional Status Care Area Assessment Resource spells out the following things to c... Read more
Compliance & Coding News
Get up to speed on Medicaid audits, which experts say are coming your way. For one, "the ... Read more
MDS Management:
Home In On These 3 Problem Areas of the MDS 3.0
Clarity of Section O instructions for coding isolation is on the list. Facilities and res... Read more
Coding Instructions for Isolation at O0100M
Here's what CMS says to do. The RAI User's Manual provides the following instructions for... Read more
MDS Assessments:
Efficiency Is Key When Dealing With Discharge Assessments
Make sure you're not doing more than required. Most people agree that discharge assessmen... Read more
Quality of Care:
Preempt Aspiration With This Admission Checklist
There are more ways to detect swallowing problems than included in Section K. Completing ... Read more
Clinical Care:
Incorporate Speech Therapy Interventions and Recommendations in the Care Plan
Expert shares strategy for providing feeding and swallowing instructions in the dining roo... Read more
CODING QUIZZER:
How would you code the following scenario from the RAI User's Manual?
Calculation for Average Daily Fluid Intake Mrs. G. received 1 liter of IV fluids during t... Read more
WHAT DO YOU THINK?:
When Would the RUG Rate Change in This Scenario?
Question: When you combine a 5-day assessment with a significant change in status assessm... Read more
WHAT DO YOU THINK?:
What Kind of Support Documentation Do You Need for This Service Coded on the MDS?
Question: When we have a resident who receives IV fluids to prevent dehydration in the nu... Read more
WHAT DO YOU THINK?
Question: What support documentation would a nursing facility need to code IV fluids prov... Read more
Case Study:
Bringing On an MD + NP Hospitalist Team Proves to Be a Smart Move for This SNF Provider
The approach achieved several goals at once, including reducing rehospitalization. SNFs l... Read more
Diagnosis Coding:
Most Organizations 'Surprised' By How All-Encompassing ICD-10 Transition Is
Best bet: Establish your initial plan for conversion immediately so you can project your ... Read more
Tool:
Use This Form to Stay on Top of Community Referrals for Section Q
This way you can track where each resident is with the process.  ... Read more
Billing & Survey News to Use
SNFs will have their Part A claims readjusted but not by much. CMS recently reported in a... Read more
Care Planning:
Revamp Risk Management for These 4 MDS 3.0 Areas
On the list: anticoagulant therapy and another med now coded in Section N. The MDS 3.0 cap... Read more
MDS 3.0 Trends:
CMS to Take a Close Look at Burden Imposed by Discharge Assessments
But the agency wants the nursing facility community to identify some of the root causes o... Read more
Payment & Compliance:
Take Your Medicare Meeting Productivity to a New Level
Tip: Make sure someone at the meeting knows if the resident has a clinical need for skill... Read more
Tool:
Template for Medicare Meetings Helps You Keep Info in a Row
Check out this tool for staying on top of what you need to know.... Read more
Assessment and Coding:
Stage Pressure Ulcers Correctly on the MDS 3.0 With These Key Strategies
Be aware of this difference between a stage 2 and stage 3. Staging pressure ulcers accura... Read more
Risk Assessment:
Some SNFs Are Tapping Ultrasound Technology to Enhance Skin Assessment
The approach jumpstarts care plan interventions. Wesley Healthcare Center uses ultrasound ... Read more
Compliance:
Make Sure These Documents Jibe for Rehab Residents
This documentation shortcut can cause ADL undercoding. Medical reviewers will likely look... Read more
Quality of Care:
Hone Your Behavioral Care Plan With a 'Scatter Plot'
This simple approach can provide the answer to why a resident is behaving aggressively. I... Read more
Coding Quizzer:
Select the Right Option for This Scenario
Try your hand at coding these two RAI User's Manual examples below: Scenario No. 1: "A re... Read more
WHAT DO YOU THINK?:
Can You Count Therapy Assistance When Coding ADLs?
Question: Can a facility count ADL assistance provided by rehab therapists in the facilit... Read more
Compliance Trends:
Beware RAC Scrutiny of These 2 Rehab-Related Areas in SNFs
Put this HHS OIG report on your radar screen. If you've been hoping that the Recovery Aud... Read more
MDS & Billing News
Have you incorporated this billing change? Effective for services with dates on or after ... Read more
MDS 3.0 Coding:
Keep Coding and Care Woes Off the Table for Section K (Swallowing/Nutritional Status)
Don't make this mistake in coding K0700. Laying an accurate assessment foundation for Sec... Read more
Coding Tips:
Follow These Instructions for Coding Each Item at K0100 (Swallowing Disorder)
Look for this frequent complaint as a red flag. The RAI User's Manual directs you to chec... Read more
Care Area Assessments:
CMS Official Dishes on Documenting Nutritional-Related Issues for CAAs
The RD's note should explain this critical information. If your dietitians are looking fo... Read more
Rehab Therapy:
Make the Most of the Start of Therapy OMRA
Obtain the fairest reimbursement and sidestep unnecessary assessments. The Start of Thera... Read more
Compliance:
Don't Let Your Therapy Documentation Undercut Rehab RUG Payment
Shortfalls in documenting previous functional status can be a ticket to claims denials. F... Read more
Nursing Documentation:
Make Sure Nursing Notes Address Rehab Residents' Progress, Functional Goals
These 2 documentation examples can sink claims. Therapy documentation may fly with audito... Read more
Medicare Payment:
Know When Residents Qualify for Both Hospice and Part A SNF Care
Apply this key litmus test to see if residents qualify for dual coverage. A Medicare pati... Read more
WHAT DO YOU THINK?:
Should You Always Do a Significant Change in Status Assessment for SNF Readmissions from the Hospital?
Question: Should our facility always do an SCSA combined with a readmission assessment fo... Read more
Test Yourself:
What Does the F325 Surveyor Guidance Say About Swallowing Disorders?
See if you're up to speed on what surveyors will consider. Which of the following accurat... Read more
Medicare, Clinical & Research News
Legislation has put an end to the RUG-II hybrid. In December, lawmakers passed the Medica... Read more
WHAT DO YOU THINK?:
Are You Required to Do SCSAs for Residents Who Go On a Palliative Care Program?
Question: Our facility is starting a palliative care program. Should the MDS team do a sig... Read more
Available Years:  2011  2010  2009  2008  2007  2006  2005  2004  2003