Talino

Talino specializes in ER CCU MICU SICU LTC/SNF.

Talino's Latest Activity

1. 

   Section B

   Talino replied to onthesunnyside's topic in MDS

   Addendum (sorry had to end prior post)... The RAI also provides a simple guide (Steps for assm't) in conducting speech, hearing and vision that can be learned by any facility staff.
2. 

   Section B

   Talino replied to onthesunnyside's topic in MDS

   CMS does not designate who may perform MDS assessments including interviews (except for an RN who has to coordinate the MDS process). It’s the facility’s responsibility to assign tasks. CMS do expect clinical competence, observational, interviewing and critical thinking skills, and assessment expertise from all disciplines. MDS Interviews do not require licensed experts. The facility simply has to prove competence that staff members (any) have the confidence and skills to complete the tasks based on an educational or training program provided by the facility. Here's a good guide for training staff (based on the MDS, app D) https://www.OK.gov/health2/documents/QM02_ER007A_12G18_MDS30_ResidentInterviewPocketGuide_4-25x5-5_20120718.pdf I would assume your interviewers are familiar of these skills and actually practice them.
3. 

   Care Plans for Covid

   Talino replied to litbitblack's topic in MDS

   Since this is a CDC mandate, the use of masks becomes a standard protocol for the facility during the period of crisis. A care plan should only be created if there is a problem or concern regarding its use. A few I could think: Non-compliance – Resident refuses to wear mask Breathing problems – Resident experiences difficulty with breathing with mask on Allergy to material or irritation to dry skin Eye problem due to exhaled air, fogging eyeglasses Communication - Inability to read lips when communicating to a deaf person; garbled speech
4. 

   Medicare Stay.

   Talino replied to Lina19's topic in MDS

   Correct, you don't get paid for the day of discharge 5/19. The day of admission 5/18 is considered a utlization day, regardless the number of hours in the SNF. In fact, if a resident is admitted @ 11 am and decides to go home @ 1 pm on the same, the day still counts as a utilization day. Medicare Claims Processing Manual Chapter 6 - SNF Inpatient Part A Billinghttps://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c06.pdf
5. 

   Medicare Stay.

   Talino replied to Lina19's topic in MDS

   Day of stay ends at 11:59 pm and begins at 12:00 am. Get paid for 5/18. Combine the 5D and DC ARD 5/19.
6. 

   Aetna MCR assessment needed

   Talino replied to MDSRN15's topic in MDS

   Correct, just the 5D.
7. 

   Dashing

   Talino replied to Lina19's topic in MDS

   Sig. change is not determined by the diagnosis alone. The criteria for 2 or more areas of change that can be irreversible/prolonged must still be met. If that’s the case all events not attained in the look back period will be excluded or dashed.
8. 

   Discharge assessment missed

   Talino replied to Lisa A's topic in MDS

   #1- If discharged return anticipated but died later while admitted in the hospital, code as such (DCRA) with the ARD 8/26/19. #2- Do Death in Facility ARD 11/19/19. Sign both today and submit. You will certainly get a warning but fortunately these type of assm’ts are only for tracking purposes. I recommend documenting the omissions and your plan to avert future mistakes.
9. 

   Activity

   Talino replied to Lina19's topic in MDS

   The nurse may conduct any and all type of interviews. As with all other interview time frames, it should be conducted on or before the ARD. During this time of difficulty, it would be wise that all interviews (pain, BIMs, PHQ-9, Act Pref) be conducted in one intercation if possible - that be by a nurse, social worker, therapists, activity staff, or even a trained CNA. Jot down interview results in paper prior to the ARD and enter them in the MDS during the completion period.
10. 

    Fall/New Admission/SCSA

    Talino replied to Lina19's topic in MDS

    In the conditions mentioned above, we are not providing skilled services for a diagnosis that is resolved but for the consequential effects of the treated condition/s. In most cases, patients experienced debility during the period of illness and recuperation while in hospital. Short term Rehab is usually recommended on discharge. SNF do not provide Rehab treaments for UTI or Pneumonia, but skilled therapies to regain physical strength. Unfortunately, therapy treatment diagnosis are not valid as primary. And there is no valid aftercare codes as in fractures. Hence, the SNF must choose the root cause for "deconditioning" which takes you back to the reason the resident was treated for in the hospital - that be UTI, PNA, or Sepsis. An example is a therapist's assm't and evaluation. Very seldomly will they identify "muscle weakness" or "need for assistance with personal care" without also mentioning the causative illness. Another example is your Physician Certification - "I certify that SNF services are required to be given on an inpatient basis because of the above named patient's need for skilled nursing care on a daily basis for the condition(s) for which he/she was receiving inpatient hospital services prior to his/her transfer to the SNF". But when in doubt, verify with you Medicare Administrative Contractor (MAC).
11. 

    Nursing CMI

    Talino replied to Lina19's topic in MDS

    The HIPPS scores are located in Chapter 6 of the RAI. IVF given in the last 7 days will yield a Special Care High nursing case mix. Open this PDPM calculator https://www.broadriverrehab.com/pdpm-calc and follow the instructions (screenshot). Notice the difference in payment (yellow highlight) when you check and uncheck K0510A. I'm also attaching a cheat sheet. Look at the applicable conditions in the last 7 days that will yield Special Care High category. Nursing and NTA Component (PDPM).pdf
12. 

    CMS

    Talino replied to Lina19's topic in MDS

    No, admission is not required but the resident must still meet the requirements for need of skilled service. The waiver does not apply to residents who have previously exhausted 100 benefit days and continues to received a skilled level of care (tube feeding, ventilator use, unhealed St IV pressure, etc.) with no 60-day wellness period.
13. 

    SNF PPS Part A Discharge

    Talino replied to Lina19's topic in MDS

    You cannot combine in this case. NPE is 3/22, DCRNA is 3/25. For 3/23 and 3/24, the resident will be liable.
14. 

    OBRA

    Talino replied to Lina19's topic in MDS

    That is correct. Item C0100 must be coded 1, Yes, and the standard “no information” code (a dash “-”) entered in the resident interview items. So C0500 = 99. Just a precaution - Staff must be able to provide the most conducive conditions to conduct interviews whenever a resident has the capacity. Being asleep at time of interview may not be a desirable reason to put the interview aside. During a 24 hour period, a nurse can perform the BIMS when the resident is awake. Since the SCSA overrides the Quarterly, your ARD may now be adjusted, provided the SCSA MDS is completed in 14 days (Z0500).
15. 

    Coding a Broda Chair

    Talino replied to litbitblack's topic in MDS

    You can not. At one SNFQRP Q&A, 2016 (?) maybe, this was CMS reply (sorry, can't find the link anymore) ... "Neither geriatric recliners nor Broda chairs, which are primarily used for those with special seating and positioning needs, are considered wheelchairs. The type of chair that should be considered when coding the wheelchair items include a typical wheelchair, either self- propelled (manual) or motorized (scooter or electric wheelchair." ...which still matches the current RAI definition ('tho Broda is not specifically mentioned)... Check G0600C, wheelchair (manual or electric): if the resident normally sits in wheelchair when moving about. Include hand-propelled, motorized, or pushed by another person. Do not include geri-chairs, reclining chairs with wheels, positioningchairs, scooters, and other types of specialty chairs.
16. 

    IPA and restorative

    Talino replied to MDSRN15's topic in MDS

    Not worth it. 'may even lower your 5day rate. There's a PDPM Calculator app for Android and iOS which can show you the rate based on your clinical conditions.