Triple Check
Who monitors the daily skilled documentation for skilled residents?
Who/What is the DNS or nursing designee.
T/F To use Medicare Part A benefits in a SNF, the resident's Admitting dx must be the same condition the Hospital used for the QHS?
What is false.
Utilizing best practices, this discipline issues NOMNC & ABN's. Who is back up if this discipline is not available is?
What Social Services & BOM.
What two items are needed to support a Nursing HIPPS of Special Care low for Cerebral Palsy with a GG Function Score of 8?
What are 60 days dx signed MD orders and active dx in the 7 day lookback.
T/F The SNF QRP Threshold must be 90% or > to prevent the 2% APU reduction.
What is a true
This is the name of the standardized uniform billing form used for skilled nursing facility providers.
What is CMS-1450, UB-04 Uniform Bill.
What meeting is held weekly with IDT reviewing clinical conditions, Certs, last MD visit dates, Medicare days remaining, and plans for discharge?
What is the UR/PDPM meeting.
What notices are required if a resident has skilled benefit days remaining and elects the hospice benefit?
What is no notices are required.
T/F Input must be received across all shifts and levels of staff for nursing charting to be complete and accurate
What is true
During a standard survey, the surveyor identifies that the NAC missed coding a Stage II pressure ulcer and the related treatments on an Annual Assessment. This could result in which of the following F-tags?
What is F641 Accuracy of Assessment
Who is responsible for error-free claims that represent only medically necessary goods/services and meet all Medicare Regulations?
What Administrator and IDT working together.
What assessment changes the payment for Traditional Medicare A stays on the ARD.
What is a Interim Payment Assessment (IPA)
No specific calendar definition exists; however this form must be provided far enough in advance of delivering potentially noncovered items or services to allow for sufficient time for the beneficiary to consider all available options.
What is SNF ABN (CMS-10055).
What is Infective Isolation, tracheostomy Care, or invasive mechanical ventilation.
Which of these ICD 10 dx codes would be assigned for a resident with a dx of COPD with oxygen dependence?
a. J44.9 COPD
b. J44.89, Other specified COPD, Z99.81 02 Dependence
c. J44.9 COPD, Z99.81 02 Dependence
What is c.
If the cert/re-cert form is not completed or not signed/dated by the MD/ARNP what happens with the claim?
What is the claim is held.
Mr. Jones is enrolled in a Medicare Part C (Medicare Advantage) plan. He was receiving hospice coverage for terminal lung cancer at home before he fell and broke his hip. After a 3-day QHS, what will be Mr. Jones payer in the SNF? (note all of this occurred during the same month)
a. Part A the entire stay
b. Part C the entire stay
c. Medicare Part A until the 1st of day of the following month, then Medicare Part C
d. Medicare Part C until the 1st of day of the following month, then Medicare Part A
What is Medicare Part A until the 1st of day of the following month, then Medicare Part C
Does the NOMNC (CMS-10123) include a detailed explanation of what services are likely not covered and why?
What is false.
How often is the CMI meeting held in each facility?
What is at least weekly.
Which of the following is NOT considered a Direct Skilled nursing service.
a. Intravenous Feedings
b. Naso-pharyngeal and tracheostomy aspiration
c. Insertion, sterile irrigation, and replacement of suprapubic catheters
d. Observation and assessment of a patients condition
What is d.
Internal monitoring systems help do which of the following?
a. Build a case against terminating the NAC for inaccurate coding
b. Increase the risk for under/over coding the assessment
c. Mitigate risks associated with assessment inaccuracies, such as survey and reimbursement
d. Describe the responsibilities of the compliance and ethics committee
What is mitigate risks associated with assessment inaccuracies, such as survey and reimbursement
This assessment can be combined with the Interim Payment Assessment (IPA).
What is none.
This individual enters the date signed on the NOMNC/ABN form.
What is the resident or designee. STAFF MAY NOT ENTER THE DATE
What is the purpose of the CMI meeting?
What is managing the health care benefits of each resident to ensure optimization and furthermore, to ensure that the facility is reimbursed for care and services provided.
T/F Medicare Part A requires that the Admitting diagnosis and Primary diagnosis match on the UB-04 for the claim to pay?
What is false.