Cecilianurse

The sacral wound just reduced in size and still present when discharged to hospital. Does this mean she cannot be covered under Med A?

Experts, I have LTC resident that was skilled for a Stage 4 sacral wound for the her Med A - using all 100 days. Had a 60 day wellness then went out again for dx of UTI with PO/ABT/10days. All within this year. I have her on MED A right now, but my question is - Can I skill her again for the same sacral wound? It was a deep wound and hasn't fully healed. Current measurement 3x2.8x1cm. If I cannot use the wound, I plan to skill her under Med A for at least 10 days since ABT is only PO. Or any suggestion would help. Thank you!!!

THANK YOU !!!!

CMS is more confusing that ever. I will continue to complete assessments for billing and see how I can contact the MAO or if I can.

If they do not complete the 8 days, I always complete a 5 day without submitting to CMS, so billing can use the RUGS. This will satisfy billing, but with regards to requirements will this do?

I got this memo from CMS. See below. Does it mean I have to submit 14D, 30D even if they are HMO? Right now I create one, but do not submit. CMS MEMO As noted in the November 4, 2013 HPMS memo, "Encounter Data Submission of HIPPS Codes," the disposition for the HIPPS codes edits will be changed from 'Informational' to 'Reject' effective with July 1, 2014 dates of service (DOS) for any Skilled Nursing Facility (SNF) and Home Health Agency (HHA) encounters submitted without HIPPS codes. The purpose of this memo is to provide additional details about this requirement, and encourage MAOs and other entities to continue to work with SNF and HHA providers to meet this requirement. I. HIPPS Codes for SNF Encounters Starting with July 1, 2014 Dates of Service CMS is clarifying that for 2014 DOS beginning on or after July 1st, MAOs must submit a HIPPS code on a SNF encounter that comes from the initial OBRA-required comprehensive assessment (Admission Assessment). Specifically, SNF encounters with "from" dates July 1, 2014 or after that are submitted without a HIPPS code will be rejected. The OBRA-required tracking records and assessments are federally mandated for all residents of Medicare and/or Medicaid certified SNFs and nursing facilities. For 2014 encounter data submissions, CMS will not require MAOs to submit HIPPS codes from any other OBRA-required comprehensive or non-comprehensive assessments; we also will not require submission of HIPPS codes for any scheduled or unscheduled SNF Prospective Payment System (PPS) assessments. Nevertheless, we do encourage you to submit the HIPPS codes both from other OBRA assessments and from PPS assessments when available from the providers. We especially encourage submission of the HIPPS code based on the Discharge Assessment, which is based on a OBRA-required assessment.

Experts, I have a resident in sub-acute unit, on med A and undergoing chemo on admission 5/7. Now, she has declined significantly extensive to total. Do I have to do a sig. change? Thank you!

I will only complete the 5D, 14D, 30D...not transmitting. With regard to the quarterly, there is no need for it. IV was only done in hospital and CHF dx is not new. Thank you!!!!

Experts, I have a long term resident that went out to hospital and his Horizon plan kicked in(dx of CHF, had IV in hosp). Our billers said they need RUGS to get paid. Last assessment of Q2 on 4/18. I am following the PPS schedule, but for the 5D - I will do a Q3 ----- THIS IS MY QUESTION. CAN I DO THIS? 14D - 14D 30D - 30D - both will not be submitted to CMS, but will give me the RUG. THANK YOU VERY MUCH!

To all EXPERTS, I have a resident that had a fx of the left humerus with a soft cast on 2/11. No changes in ADL despite the fx, she is a 3--2 in most adls. I opened a quarterly on 3/13 and the nurse who completed it, did not add the fx in Section I. Question: 1. Since, there was no adl change, but there was a fx, should I have opened a sig change instead? 2. Do I ALWAYS have to do a sig. change for ANY fracture to be on the safe side? THANK YOU!!!

To all experts, :-) PLEASE HELP! I have a resident on existing MED A then on his 57 day he went to hospital for a scheduled Kyphoplasty of T12 and stayed one night for observation. Last assessment done was a 60D/Q on 2/17 then SX on 2/18, also had 3 COTs and 90D completed for him. 1. Do I inactivate the 60D/Q on 2/17? 2. Complete the DC for 2/18? 3. Do a re-entry for 2/19? 4. Complete a readmission/Q for 2/26? Then whatever COT needed. Please confirm if these steps are correct. All assessments will be late. FYI, this is was just discoved by the SS yesterday. THANK YOU!!!

Do I do a significant change for an arm fx with a cast for 6-8 weeks?

Resident was DC to hospital that is why this type of situation occured.

Need an RN license.

Thanks, so glad I have someone to ask for info.