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Talino specializes in ER CCU MICU SICU LTC/SNF.

don't bother, 'am boring

Talino's Latest Activity

  1. Talino

    Interrupted stay

    Do a 5D with ARD no later than 3/21.
  2. Talino

    Active diagnoses

    Diet? A diabetic diet alone may support the diagnosis. Otherwise, it’s inactive.
  3. Talino

    OBRA Assessment

    Ignore. Once the SCC is completed (accepted), the scheduler will update itself
  4. Talino

    Interview when in isolation for Covid

    CMS dose not designate interviewers. That’s left at the facility’s discretion. With adequate training and simply adhering to the guidelines and instructions, the interviews can be performed by anyone. The objective is to minimize exposure with the infected. A single direct patient care provider can be assigned to perform ALL types of interviews. The results of which becomes valid proof which can be used by the discipline to enter in his/her MDS section. Certainly, said discipline is still responsible to attest to the accuracy, not the interviewer. It’s a PHE. You simply need to show alternatives to comply with regulations.
  5. Talino


    Primary would likely be A41.9 Sepsis, unspecified organism. If organism is mentioned you can look into A40.x or A41.x. Also R65.20 without septic shock or R65.21 with septic shock. Secondary should be J69.8 Pneumonitis due to inhalation of other solids and liquids.
  6. Talino

    Morbid Obesity

    Although a physician has the ultimate authority to enter diagnosis does not mean it becomes indisputable. A physician may have copied a prior transfer medical record rather than an actual eval’n to arrive at these diagnoses while a Dietitian conducted a comprehensive nutrition assm’t. Notwithstanding a physician obtained less credit than a dietitian had about nutrition and dietetics. Albeit, the Dietitian must confer with MD for clarification and request a diagnosis entered or resolved based on his/her assessment. Both must agree!
  7. Talino

    Late Submission

    Late submission becomes a survey issue if recurrent. One or two may be negligible but always document reason and have a plan of correction in place. Dashing weight affecting payment only applies if it’s a 5-day PPS. A single occurrence is unlikely.
  8. Talino

    Indirect Skilled NURSING SERVICES

    History of fall w/o Rehab potential? Unless you can tie in other conditions (I.e. emaciation, immobility, uncontrolled DM, PVD, etc) that may lead to the deterioration of the injury without meticulous observation and management of care plan, it is unlikely it will rise to a skilled level of care but a standard nursing practice.
  9. Talino


    If admitted to a Medicare or Medicaid certified unit and discharged on the same day, the Entry and DC tracking are still required, regardless of payor.
  10. Talino

    Section B

    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.
  11. Talino

    Section B

    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.
  12. Talino

    Care Plans for Covid

    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
  13. Talino

    Medicare Stay.

    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
  14. Talino

    Medicare Stay.

    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.
  15. Talino

    Aetna MCR assessment needed

    Correct, just the 5D.
  16. Talino


    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.