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AHCA, NCAL Elect Boards and Directors at Annual Convention<p>The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) have elected AHCA’s Board of Governors and NCAL’s Board of Directors for the 2021/2022 term. Phil Fogg of Oregon was elected AHCA Chair, and Gerald Hamilton of New Mexico was elected NCAL Chair. </p><p>“We are thrilled to have Phil and Gerald as the chairs of our Boards,” said AHCA/NCAL President and Chief Executive Officer (CEO) Mark Parkinson. “They are incredible, influential leaders dedicated to seeing the industry through this challenging time, so we come out stronger, as well as providing the highest quality of care to our residents. I am confident they will do an amazing job leading our sector this next year.”</p><p>Fogg is the president and CEO of Marquis Companies in Milwaukie, Ore. As the fourth generation of a family of long term care providers, it was inevitable that Fogg would devote his life to serving seniors. His great-grandmother was one of Oregon’s pioneers in the profession, and by the age of 13, he was already working in his father’s facilities—doing laundry, washing dishes, making beds, or whatever else was needed. He previously served as Vice Chair on AHCA’s Board of Governors. </p><p>The remaining members of AHCA’s 2021-2022 board include&#58;</p><p>•&#160;Phil Scalo of Bartley Healthcare (N.J.), Vice Chair<br>•&#160;Chris Wright of iCare Health Network (Conn.), Secretary/Treasurer <br>•&#160;Debbie Meade of Health Management (Ga.), Immediate Past Chair<br>•&#160;Derek Prince of HMG Healthcare (Texas), At-large Representative <br>•&#160;Sarah Schumann of Brookside Inn (Colo.), At-large Representative <br>•&#160;Tina Sandri of Forest Hills (D.C.), At-large Representative<br>•&#160;Reginald Hartsfield of Advantage Living Centers (Mich.), At-large Representative<br>•&#160;Julianne Williams of Elevate Health Care (Calif.), At-large Representative <br>•&#160;Alex Terentev of Lilac Health Group (Fla.), At-large Representative<br>•&#160;Steve Flatt of National Healthcare Corp. (Tenn.), Multifacility Representative&#160; <br>•&#160;Randy Bury of The Evangelical Lutheran Good Samaritan Society (S.D.), Not-for-profit Representative<br>•&#160;Mark Traylor of Traylor Porter Healthcare (Ala.), Independent Owner Representative <br>•&#160;Ted LeNeave of Accura Healthcare (Iowa), Regional Multifacility Representative<br>•&#160;Gerald Hamilton of BeeHive Homes of Albuquerque (N.M.), NCAL Representative<br>•&#160;Jesse Samples of the Tennessee Health Care Association, ASHCAE Representative<br>•&#160;Betsy Rust of Plante Moran, Associate Business Member Representative</p><p>NCAL also elected its Board of Directors today, including Hamilton as its new chair. He is the co-owner of BeeHive Homes and has 35 years of experience in health care management as an assisted living facility owner/operator, licensed nursing home administrator, regional manager of multiple nursing homes, and consultant. After a successful career in nursing home administration in California, New Mexico, and Colorado, he started his own business to construct and operate assisted living communities.&#160; </p><p>The remaining members of NCAL’s Board of Directors include&#58;</p><p>•&#160;Mark Maxfield of The Cottages (Idaho), Vice Chair<br>•&#160;Sarah Silva of Avamere Health Services (Ore.), Secretary/Treasurer<br>•&#160;Helen Crunk of Pemberly Place (Neb.), Immediate Past Chair,<br>•&#160;John Bolduc of Odd Fellows’ and Rebekahs’ Home of Maine (Maine), At-large Representative<br>•&#160;Rod Burkett of Gardant Management Solutions (Ill.), At-large Representative<br>•&#160;Megan Campbell of IntegraCare Corp. (Pa.), At-large Representative<br>•&#160;Sue Coppola of Sunrise Senior Living (Va.), At-large Representative<br>•&#160;Ana de la Cerda of Aegis Living (Wash.), At-large Representative<br>•&#160;Todd Dockerty of Dockerty Health Care Services (Mich.), At-large Representative<br>•&#160;Darryl Fisher of Mission Senior Living (Nev.), At-large Representative<br>•&#160;Stacy Hejda of Assisted Living Partners (Iowa), At-large Representative&#160; <br>•&#160;Esmerelda Lee of Century Park Associates (Tenn.), At-large Representative<br>•&#160;Barbara Mitchell of Magnolia Manor (Ga.), At-large Representative<br>•&#160;Gail Sheridan of Lifespark, formerly Tealwood Senior Living (Minn.), At-large Representative<br>•&#160;Elizabeth Wheatley of Benchmark Senior Living (Mass.), At-large Representative<br>•&#160;Kristopher Woolley of Avista Senior Living (Ariz.), At-large Representative<br>•&#160;Phil Scalo of Bartley Healthcare (N.J.), AHCA Vice Chair<br>•&#160;Phil Fogg of Marquis Companies (Ore.), AHCA Chair<br>•&#160;Peter Corless of OnShift, Associate Business Member Representative <br>•&#160;Doug Farmer of Colorado Health Care Association, State Affiliate Representative<br>•&#160;David Voepel of Arizona Health Care Association, ASHCAE Vice President </p><p>“We are incredibly fortunate for this year’s Board members, and their time and contribution to assisted living,” said NCAL Executive Director LaShuan Bethea. “Now more than ever, we need their leadership to guide us during these challenging years ahead, and looking at this group of individuals I am truly excited about all they will accomplish for our profession.”</p><p>Members of the AHCA Board of Governors are elected by the association’s governing body, the Council of States. The NCAL Board of Directors is elected by current members of the NCAL Board and by the NCAL State Leaders. Both boards hold annual elections at the AHCA/NCAL Convention &amp; Expo.<br></p>2021-10-13T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/PhilFogg.jpg" style="BORDER&#58;0px solid;" />ManagementJoanne EricksonAssociations elect annual Board line-ups during final hours of AHCA/NCAL 72nd Convention & Expo.
Bethea Shares a Passion For Advocacy as New Head of National Center for Assisted Living<p>Much has changed during the last 18 months. There’s the political dynamics on Capitol Hill, bringing new challenges to leaders in health care. On the frontlines, assisted living providers continue to battle the COVID-19 pandemic, saving lives and protecting residents from the virus’ latest iteration—the Delta variant. In Washington, there is a new face in assisted living leadership.</p><p>Being the first woman and first person of color to hold the title of executive director of the National Center for Assisted Living (NCAL), LaShuan Bethea is a force, bringing 25 years of experience as a nurse and fierce advocacy from the front lines of long term care. She most recently served as vice president of legislative affairs and reimbursement for Genesis HealthCare.</p><p>In an interview with Provider, Bethea shares her message to Washington and assisted living providers across the country, along with a sneak peak of what providers can look forward to at this year’s NCAL Day at the 72nd American Health Care Association/National Center for Assisted Living Convention &amp; Expo.<br>Provider&#58; You’ve just recently come on as NCAL’s new executive director, congratulations! What made you take this position? What challenges do you want to tackle? </p><p>Bethea&#58; I’ve been a nurse for over 25 years. I have a range of experience in a variety of different long term care settings. One of the things I’ve developed a passion about is advocacy. I’ve focused on legislation, regulation, and quality care for excellent outcomes. Having 25 years’ experience, I see this as an opportunity to expand my role for quality and great outcomes in the assisted living care setting.</p><p>Provider&#58; How can assisted living providers be successful with the Phase 4 application process with the Provider Relief Fund?<br></p><p>Bethea&#58; We’re thankful to the Biden administration for making these funds available to all providers and prioritizing the needs of those we care for in our assisted living communities. The application is open until Oct. 26, and there are webcasts that will help providers with applying. I encourage providers to complete their applications sooner rather than later so that they have enough time to get their applications in.</p><p>Provider&#58; How do you balance the needs for assisted living providers to get federal COVID relief while at the same time maintaining that assisted living remain a state-regulated area of long term care? </p><p>Bethea&#58; I think it is important that the federal government as well as state governments understand the wide variety of individuals who are providing assisted living care. We have some assisted living providers that have a social or hospitality model, and we have other assisted living providers who provide more of a medical model—they collaborate with hospitals or SNF [skilled nursing facility] settings.</p><p>Assisted living, no matter what range of the spectrum it falls in, we are not a true medical model, and we do need additional resources to make sure that we can be competitive in terms of wages and hiring caregivers to work in our settings, as well as having access to personal protective equipment, testing, and vaccines. </p><p>It’s important for the state and federal government to recognize that the government’s role in assisting providers during the pandemic should not be setting-agnostic; they should be providing assistance to those who need assistance in providing care to a vulnerable population—whether that’s in a skilled setting, a hospital, or an assisted living setting. </p><p>Provider&#58; Are there any current discussions on Capitol Hill about increased regulation or scrutiny of assisted living communities?</p><p>Bethea&#58; There is nothing specific that I’m aware of, but it’s definitely something that we’re keeping our eye on. Right now there is definitely an opportunity for Congress to continue to prioritize assisted living, including the individuals who choose to call assisted living their home as well as their caregivers. And they can do that through the Human Infrastructure Act. They can make sure that funds are allocated to cover wages. </p><p>Workforce is one of our most significant challenges. Another bill in Congress, the Care for our Seniors Act, also addresses our ongoing workforce challenge. It uses a multitiered approach to help providers not only recruit new caregivers but retain them by providing services that support them, such as affordable housing, child care, tax credits, and loan forgiveness for any new graduate who chooses to work in a care setting.</p><p>So while there is no regulation that’s looking to increase scrutiny, I think that Congress is focusing where they should be focusing right now, which is making sure that seniors and individuals living in a senior living community have the resources that they need to successfully get through this pandemic.</p><p>Provider&#58; There seems to be some movement to make assisted living care more affordable. What do you think are the prospects for more development in this area? To enhance access to assisted living for those with middle to low incomes? </p><p>Bethea&#58; With the use of home- and community-based services waivers and the funding that’s been allocated for them, I think that we should absolutely make sure that assisted living is a part of what is considered when those resources are distributed. It is a way to make sure that not only those individuals who have sufficient financial resources can afford to make assisted living their home but also individuals with a moderate or low income can use Medicaid reimbursement to select assisted living as their home. </p><p>Provider&#58; Will the vaccine mandate for health care workers cause any type of staff exodus from member facilities in the assisted living world?</p><p>Bethea&#58; There is definitely some vaccine hesitancy. One of the ways we can deal with that is while we are fully supportive of health care providers being vaccinated, I think that in order to help us deal with the vaccine hesitancy it will be important for the Biden administration to provide some type of guidance to help us manage or deal with giving additional time to unvaccinated workers.</p><p>In addition, when the mandate goes into effect, if we lose some individuals who are choosing not to get vaccinated, we believe that the administration can also assist us by providing some supplemental staffing or other resources to help us fill that gap that we may have so our staffing challenges don’t continue to get worse. </p><p>Provider&#58; Considering the post-COVID push to have elders and people with disabilities cared for more at home, how will that affect business? And will you see more of your members go into the home care space?</p><p>Bethea&#58; Assisted living is a perfect option for individuals to choose. I wouldn’t say that one is better than the other. Whether more people will stay at home or more in a facility, I think that is to be determined. Assisted living is absolutely an option for individuals whether they are people looking for a more social or hospitality environment, or whether they have additional medical needs, assisted living is an environment that has something for all those individuals. </p><p>Provider&#58; At Genesis, you were chair of the Diversity, Equity, and Inclusion Committee. As you know, more than half of the frontline workers in long term care are people of color. This is way over the national average for a workforce in any industry, but the ranks of owners, administrators, and other key leadership spots are not diversified. How is NCAL planning to support the growth in the number of people of color into management and executive positions in long term and post-acute care? </p><p>Bethea&#58; One of the ways any organization has the ability to support diversity in executive positions is making sure that when they have open positions, they interview individuals from a diverse candidate pool, and that at least one of the candidates be a diverse candidate.</p><p>I think the other option, because we know that more than 50 percent of our workforce are persons of color, is succession planning. Succession planning is another way to look at individuals in the workforce and give people a chance to move up within an organization and within a trade association. <br>It’s important to share those potential options with members and let them know what paths they can take to expand diversity within their organization, either through mentoring, succession planning, and/or ensuring diverse candidate pools with hiring and with promotion. It’s also about looking at representation within their leadership but also within their board.</p><p>Great ideas and options for opportunities come when you have diverse representation in committees and boards that are making decisions about how policy is being structured within an organization.&#160; </p><p>Provider&#58; This month is the largest gathering of your members of the year, and the first since the start of the COVID-19 pandemic. What can your members expect from NCAL Day? </p><p>Bethea&#58; I’m extremely excited about our fifth annual NCAL Day on Oct. 10. It’s a great opportunity where like-minded assisted living providers can join together to enjoy thought-provoking education that is tailored to the assisted living sector.</p><p>We have lots of great educational opportunities, including one provided by the Ritz Carlton leadership center. They will conduct a presentation that is going to walk through how to foster a culture of personalized service in genuine care. Attendees will hear a national update from NCAL leadership, they will hear more about how the federal government will potentially impact the assisted living profession, and how NCAL is working on their behalf.</p><p>One of the other benefits, especially after 18 months of working remotely and having video conference calls, is that this is an opportunity to safely network, meet new people, share ideas, and innovate with your fellow assisted living professionals as well as discuss some best practices and some of the experiences that individuals have had within the last 18 months. </p>2021-10-08T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/LaShuanBethea.jpg" style="BORDER&#58;0px solid;" />ManagementAmy MendozaRight now Congress has an opportunity to continue to prioritize assisted living along with skilled nursing.
Mark Parkinson Talks Relief Funds, Vaccine Mandate, Politics<p>In the midst of the second fall season in the COVID-19 pandemic, much is on table for skilled nursing providers and the residents and patients they care for. With the Delta variant top of mind and providers working harder than ever to save lives, opportunities with the latest round of provider relief funds are at hand, mixed with new staffing challenges and occupancy ebbs and flows.</p><p>In an interview with Provider, American Health Care Association/National Center for Assisted Living President and Chief Executive Officer Mark Parkinson outlines the current political dynamics in Washington, D.C., how vaccine mandates are affecting long term care, what providers should focus on with relief funds, and what attendees can expect at the 72nd AHCA/NCAL Convention &amp; Expo.</p><p>Provider&#58; This month your members are coming together at the 2021 AHCA/NCAL National Convention &amp; Expo. It’s the first time since the start of COVID that you’ve held this event at a physical site. What can attendees expect?</p><p>Parkinson&#58; We are really thrilled to be able to get back together in person with everyone. Our hope is the conference will be a time where people can refresh, get reinvigorated, share experiences, and prepare for the recovery of the future. The conference will be focused on really educating people, but also the theme of inspiring people will run through the conference. There will be a lot of inspirational sessions. </p><p>Provider&#58; How can nursing homes be successful in applying for the latest round of provider relief funds? Is it enough aid for the sector? </p><p>Parkinson&#58; The most important thing at this point is that people get applications in well before the deadline on Oct. 26, 2021. We don’t believe that CMS [Centers for Medicare and Medicaid Services] will grant an extension for applications on this phase. Everyone should have everything filed at least a week before the deadline. HRSA [Health Resources &amp; Services Administration] has had some webinars on how to properly apply, and we encourage everyone to review those webinars, as well as additional materials we’re putting out. </p><p>Unfortunately, even with this additional funding, it won’t be enough. The Delta variant has caused a pause in the financial recovery of the sector. Combined with increasing staffing costs that we were already experiencing, we’re going to need continued help from both the federal and state governments. </p><p>Provider&#58; Workforce is the current major issue it seems. Is there any legislation that you would like to see passed in Congress to help make it easier to find and retain workers for long term care? </p><p>Parkinson&#58; There are two things the federal government can do right now to help us with our workforce shortage. First is to test incentives for workers to stay in our workforce in the reconciliation bill. We are advocating for some funding increases to SNFs [skilled nursing facilities] that would be passed through in the form of wage increases. That’s the first thing that Congress can do.</p><p>The second thing is that the administration can do some things to make immigration easier. We don’t expect a broad immigration bill to pass on the Hill, but there are some administrative changes that the Biden administration can make that would increase the ability for nurses to come to the United States, and that’s what we’d like to see happen. <br>Provider&#58; What are the current political dynamics in Washington, and how does long term care fit in? </p><p>Parkinson&#58; Washington continues to be very partisan and quite divided, and as long as that remains the case, it’s difficult for bills to pass Congress. What that means for long term care is that, for us to achieve our objectives, a lot of work has to be done with the administration on actions that do not require Congressional approval.&#160; </p><p>The good news for the sector is that, because of the hard work of providers, we have broad support from both parties—Republicans and Democrats, leadership and rank and file members—from the efforts that providers have undertaken, particularly the work that they’ve done during the pandemic.</p><p>After the pandemic occurred, I was concerned that the attitude on the Hill and in the general public would be to blame nursing homes for what happened. Initially there was a lot of blame out there. But as time has passed, politicians and the general public have really begun to understand that this pandemic was a once in a hundred-year event, and the virus was so contagious that there was nothing that long term care providers could do. The work that was done saved tens of thousands of lives in the buildings.</p><p>So the overall attitude about long term care on the Hill is positive, but they still have a hard time helping us because they can’t pass any bills. They are that divided. </p><p>Provider&#58; What will be the effect of the administration’s vaccine mandate for health care workers on skilled nursing and assisted living staff? </p><p>Parkinson&#58; It’s too early to tell right now because the administration has announced the vaccine mandate, but they have not enacted the mandate yet. Until we get to the point where either workers have to be vaccinated or they will be terminated, we’re not going to know what the impact of the mandate is.</p><p>It’s very clear to me that there are parts of the country where there is so much vaccine hesitancy, that if there isn’t some alternative to the vaccine, assisted living centers and skilled nursing facilities are going to lose a lot of employees. We encourage the administration to provide some exceptions or alternatives in those cases or we believe they are going to exacerbate the already challenging staffing situation. </p><p>Provider&#58; Do you see further specialization by providers to diversify their care settings? For example, are memory care and non-skilled settings still booming?</p><p>Parkinson&#58; Successful providers are branching off into all sorts of different areas beyond the core work of long term care. We have seen great success of providers going into memory care but also the ancillary businesses, like creating their own pharmacies, their own hospices, their own rehab companies, their own institutional special needs plans. </p><p>The financial lessons of the last 10 to 15 years has been that if all you have is the core business of long term care, you’re going to have a hard time surviving financially, particularly in the vast majority of states that underpay for Medicaid. And so the successful providers now and into the future will be those that take part in ancillary businesses that surround the basic long term care work that we do.</p><p>Provider&#58; Considering the post-COVID push to have elders and people with disabilities cared for more at home, how will that affect business? And will you see more of your members go into the home care space?</p><p>Parkinson&#58; The major misunderstanding of many home care advocates is their belief that there are many residents who can be taken care of at home. And that simply is not true. The average resident of a SNF or assisted living building is typically in their 80s and needs help with multiple activities of daily living. It’s just not possible for these people to be taken care of at home. Many states that have attempted to provide home care services and move people from nursing homes into home residences have found it doesn’t work out. </p><p>There are some people who are at home who do need additional home care services, and that’s why we support the efforts of the administration to expand home- and community-based services for those people. Those are important services for those people, but it will not dimmish the number of people who still do need skilled nursing and assisted living care.<br>Because of the caregiving work that all skilled nursing and assisted living providers perform, many of them also provide home care services. If that funding is expanded, as the Biden administration would like to have happen, I think you’ll see more long term care operators expand into home care as well.</p><p>Provider&#58; On occupancy, did we bottom out months ago as some expected, or have we still not hit the bottom? What are the prospects in the coming months and in 2022? </p><p>Parkinson&#58; I think we hit the bottom in January. We had a huge wave of COVID in November and December in the U.S., and the country-wide occupancy hit a low of 67 percent. We are now at 72 percent. We were at 80 percent before the pandemic. We’ve had a pause in the census recovery during the time of the Delta variant, but as the variant recedes, our hope is the pause turns into a slow and steady increase in occupancy through the end of the year, and then we can fully recover in 2022.</p><p>Provider&#58; You’ve been at this for a number of years. Do you still find the challenges exhilarating? What have you learned from heading AHCA/NCAL? </p><p>Parkinson&#58; The last two years have been the most important work that I’ve been able to do at any point in my career. Our mission statement at AHCA/NCAL is to improve lives by delivering solutions for quality care. We feel like the work that we’ve been able to do both at AHCA and more importantly for our members in their buildings hasn’t been just to improve lives but to actually save lives. And I believe that our work and our members’ work have saved tens of thousands of lives over the past 10 years. And so yes, that’s been exhilarating.</p><p>On the other hand, all of us at AHCA/NCAL have been working hard every day for the past year and a half, and we haven’t been working as hard as our members have. It’s been tiring at times, and it’s been exhilarating at times, but it’s been the most important part of my career.<br></p>2021-10-07T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/1120MarkParkinson.jpg" style="BORDER&#58;0px solid;" />ManagementAmy MendozaSuccessful providers are branching off into all sorts of different areas beyond the core work of long term care.
Common PDPM Missteps and How to Avoid Them<p><img src="/Monthly-Issue/2021/October/PublishingImages/JenniferLaBay.jpg" alt="Jennifer LaBay" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;145px;height&#58;186px;" />In October 2019, the Patient-Driven Payment Model (PDPM) became the new payment methodology for Medicare Part A residents in skilled nursing facilities (SNFs). Although PDPM has been in effect for two years, the public health emergency may have temporarily shifted priorities for some facilities.<br></p><p>This temporary shift, combined with PDPM’s relative newness and recent staff turnover, may have significantly affected Medicare revenue over the past 18 months.<br></p><p>Here are three common missteps that may be impacting a facility’s Medicare reimbursement.<br><br><em>1. Managing the Assessment Reference Date (ARD)</em><br>The Medicare 5-Day assessment has an ARD range of Days 1-8 of the SNF Part A-covered stay. Nurse assessment coordinators (NACs) who insist on using Day 8 as the ARD for all 5-Day assessments may not capture all the services or conditions that impact Medicare revenue.<br></p><p>Since payment is no longer based on therapy minutes, facilities may benefit from finessing their ARDs to ensure documentation is in place to capture key services and diagnoses. The ARD for the 5-Day assessment must be set on a Minimum Data Set (MDS) form or in the MDS software no later than 11&#58;59 p.m. on Day 8 of the Medicare stay. Once that time and date passes, the ARD cannot be changed, but until that point, it can be adjusted.<br></p><p>Ideally, on Day 8, the NAC should be completing a full chart review, including preadmission records, to determine the care and services that were provided. Using the calculation worksheets in chapter 6 of the “Long-Term Care Facility Resident Assessment Instrument (RAI) 3.0 User’s Manual,” the NAC can determine the optimal ARD to capture the care and services, which will result in the best PDPM case-mix groups (CMGs).<br></p><p>Choosing Day 8 as the ARD instead of Day 2 could make a difference of hundreds of dollars per day, depending on what services were delivered and diagnoses assigned during the observation period.<br></p><p>Some examples of missed opportunities related to improper ARD selection include&#58;<br></p><ul><li>Not capturing cognitive impairment under the Speech-Language Pathology (SLP) component can occur when the Brief Interview for Mental Status (BIMS) is not conducted during the look-back period. If BIMS was completed on Day 1 of the stay and the ARD selected is Day 8, the BIMS is outside of the range for inclusion on the MDS.</li></ul><p>Per RAI manual instructions, page C-2, “Item C0100 must be coded 1, Yes, and the standard ‘no information’ code (a dash ‘-’) entered in the resident interview items. Do not complete the Staff Assessment for Mental Status items (C0700-C1000) if the resident interview should have been conducted but was not done.”<br></p><p>Preferably, the BIMS should be completed on the day of or the day before the ARD. Staff must be aware of all services that have been provided each day so that an ARD can be selected for a timely completion of the interview.<br></p><ul><li>Not capturing IV fluids or parenteral feeding from the hospital will impact the Nursing component of PDPM. Calculation for the Special Care High CMG comes from a 7-day look-back for both while a resident and while not a resident. If these services were received in the hospital, it may be beneficial to choose an earlier ARD to capture the IV or parenteral feeding.<br></li></ul><p><em>2. Assigning Primary Diagnosis Codes</em><br>Part of PDPM accuracy is ensuring the appropriate primary diagnosis is selected in section I0020B of the MDS. Some common diagnoses that have historically been used as a primary reason for admission to a SNF that, per the Centers for Medicare and Medicaid Services, will not map to a billable clinical category include weakness, failure to thrive, falls, and altered mental status. All of these calculate as return to provider (RTP) diagnoses in the PDPM ICD-10-CM mapping tool.<br></p><p>RTP diagnoses do not reflect care and services that would meet the skilled coverage criteria outlined in chapter 8 of the “Medicare Benefit Policy Manual” and will not generate a CMG. This may lead to payment at the default rate or, worse, provider liability. When this occurs, facilities need to dig deeper and query the physician or non-physician providers (NPP) about the cause of these conditions. <br></p><p>The better clinicians understand the nature of the problem, the better resident care will be, and the more accurate the payment category. It is important for the SNF team to discuss as a group before and after admission to ensure the medical record and MDS reflect the true reason for all skilled care. If there is no underlying cause found, the resident may not meet Medicare skilled coverage criteria. <br><br><em>3. Assigning Additional Diagnosis Codes</em><br>In addition to the Primary Diagnosis at I0020B, which affects the Physical Therapy (PT), Occupational Therapy (OT), and SLP components, the additional diagnoses in section I of the MDS may impact the SLP, Nursing, and Non-Therapy Ancillary (NTA) components as well. Unlike I0020B, diagnoses coded in sections I0100 – I8000 do not have to follow the clinical category map with the RTP restriction.<br></p><p>However, facilities do still need to use the ICD-10-CM map. SLP and NTA comorbidities captured in I8000 must be cross-referenced with the corresponding tabs in the ICD-10-CM mapping tool to determine if the criteria have been met for capturing the comorbidity in the PDPM CMG.<br></p><p>Another requirement for capturing the diagnosis in section I of the MDS is that the diagnosis must be documented in the medical record by the physician or NPP within 60 days of the ARD and must be active in the 7-day look-back period (excluding UTI, which must be active in the last 30 days).<br></p><p>If the medical record suggests a historical diagnosis, but there is not proper documentation from the provider during the look-back period, it is beneficial to use a later ARD to allow time for the provider to include this documentation in the medical record. <br></p><p>Some common PDPM missteps related to ICD-10-CM coding include&#58;<br></p><ul><li>Assigning a primary diagnosis that affects only one discipline instead of the overall skilled needs of the resident. For example, PT, OT, and nursing are treating removal (explantation) of hip joint, which maps to Orthopedic Surgery, while nursing is treating complication of infected hip joint, which maps to Acute Infections. Because most of the skilled care is provided to treat the explantation of the hip, that should be captured as the primary diagnosis.</li><li>Not capturing a diagnosis such as septicemia that is active at the beginning of the Medicare stay. An earlier ARD could allow capture of an active diagnosis from the hospital.</li><li>Not querying the physician or NPP for diagnosis clarification when the diagnosis is only listed in past medical history. For example, a history of cerebrovascular accident (CVA) with no residual deficits identified may miss clinically present sequelae (neurologic deficits).</li><li>Not capturing section I diagnoses correctly. Some NTA comorbidity points are assigned by section I0100 - I7900 checkboxes and others by I8000 ICD-10-CM codes. For example, coding Diabetes Type 2, E11.9, in I8000, will not accrue NTA points. MDS item I2900 for diabetes must be checked.</li></ul><p>NACs must diligently apply all the rules of PDPM, MDS, and ICD-10-CM coding. Understanding the “RAI User’s Manual” instructions and ICD-10-CM coding guidelines is essential to PDPM accuracy and success. <br><br><em><a href="mailto&#58;jlabay@AAPACN.org" target="_blank">Jennifer LaBay,</a> RN, RAC-MT, RAC-MTA, CRC, is curriculum development specialist for the American Association of Post-Acute Care Nursing (AAPACN). </em><br>​</p>2021-10-01T04:00:00Z<img alt="" src="/Monthly-Issue/2021/October/PublishingImages/1021_mgmt.jpg" style="BORDER&#58;0px solid;" />ManagementJennifer LaBayNurse assessment coordinators must assign each patient’s assessment reference date to capture key diagnoses that impact Medicare revenue.