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Ask the expert: Medicare Part A coverage for a PEG tube

Q: I have a patient that has 100 days of Medicare Part A and a percutaneous endoscopic gastrostomy (PEG) tube—the primary source of nutrition—in place since 2008 due to laryngeal cancer. All rehab therapy is discontinuing in three days. Can I continue Medicare Part A, related to the PEG tube? A: As long as 26% […]

Qualifiers for ICD-10 Diagnosis Codes on Electronic Claims

As you submit electronic claims for services, it is important for you to remember that: Claims with ICD-10 diagnosis codes must use ICD-10 qualifiers; all claims for services on or after October 1, 2015, must use ICD-10 Claims with ICD-9 diagnosis codes must use ICD-9 qualifiers; only claims for services before October 1, 2015, can […]

CMS releases Five Star Quality Rating updates and FAQ for SNFs

In the midst of the coronavirus pandemic, CMS has updated the Nursing Home Compare site with updates for SNFs. The updates, announced in an April 24 memo, include: Nursing Home Compare website & Nursing Home Five Star Quality Rating System: The inspection domain will be held constant temporarily due to the prioritization and suspension of […]

What you need to know about the updated MDS items sets for 2019

Source: The Bottom Line CMS posted a new DRAFT version of the 2019 MDS item sets (v1.17.0) last week. This version is scheduled to become effective October 1, 2019, giving facilities until then to update their software with the new MDS questions and answers. Downloadable files can be accessed here: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIMDS30TechnicalInformation.html HCPro’s post-acute regulatory specialist […]

Care area triggers, the CAA process, and how they help the IDT

Editorial Note: This post has been adapted from HCPro’s popular title Long-Term Care MDS Coordinator’s Field Guide by Carol Maher, RN-BC, RAC-CT. For content details and ordering information, visit our Marketplace! What is a care area trigger? Certain single MDS items can trigger a care area. Some care areas are triggered by comparing responses entered […]

Post-Acute Wound Management and Patient-Derived Reimbursement Models

By: Roger B. Schechter, MD, Fellow of American College of Wound Specialists; Chief Medical Officer, Synergy Wound Technology Wound care has always been a considerable challenge in the post-acute setting. Patients with skin breakdown usually have a plethora of chronic comorbid conditions. Chronic wounds themselves, including pressure injuries, diabetic foot ulcers, venous leg ulcers, severe […]

CMS releases interpretive guidelines, F-Tags for new survey process and penalty updates

The Centers for Medicare & Medicaid Services (CMS) has released revised interpretive guidelines to clarify existing requirements and provide guidance for Phase 2 of the new survey process, which includes requirements such as antibiotic stewardship, facility assessment, and QAPI. Along with a revised Appendix PP, CMS also published two documents to help providers understand revisions […]

Four basic leadership styles every long-term care manager should follow

This is an excerpt from The Long-Term Care Director of Nursing Field Guide, Third Edition, written by Barbara Acello, MS, RN. For a long time, people thought there were only two leadership styles—autocratic and democratic. In fact, people used to shout at each other from these two extremes, insisting that one style was better than […]

Ask the expert: Death in the facility assessments

Q: If a resident was discharged to the hospital and died within 24 hrs in the hospital, do we need to do a discharge assessment or death in the facility assessment? I read an article claiming that it should be a death in the facility since the resident was not admitted in the hospital, but I […]