Webinar
Overview
This presentation will focus on choosing the primary diagnosis that supports the main reason the resident requires medically necessary daily skilled Medicare services. The primary diagnosis, coding on the MDS in item I0020B and on the Medicare A claim in FL67 must support that the resident requires a Medicare skilled level of care and that diagnosis must also map to payment using the CMS PDPM mapping file. Facilities must also identify the primary diagnosis for long-stay residents in many states for each OBRA MDS completed. Facility Medicare teams often struggle to identify the primary diagnosis for their new Medicare residents. The presentation will provide attendees with information regarding primary diagnosis choices from the CMS SNF PPS Final Rule of FY2019 plus the ICD-10-CM Coding Guidelines. The presentation will provide the participants clear instructions about how to use the CMS PDPM mapping file to identify whether the chosen code will map to payment for the PT/OT and/or the SLP components of PDPM.
Instructor
Carol Maher is a Board-Certified Gerontological Registered Nurse with over 30 years of experience in long-term care. Her extensive career includes roles as an MDS Coordinator, Senior Vice President of Utilization Services, and Director of Reimbursement for large, multi-facility organizations.
Carol was selected as one of the Gold Standard Nurses for MDS 3.0, contributing to the development of the Care Area Assessments (CAAs) through the RAP workgroup and serving on numerous Technical Expert Panels focused on MDS, Quality Measures, and care planning. She is a nationally recognized speaker, presenting regularly at AANAC, AHCA, and LeadingAge conferences, as well as for many state-level organizations. Her writing has appeared frequently in publications covering the RAI process and Prospective Payment System (PPS).
Carol served for nine years on the AANAC Board of Directors and currently sits on the AANAC Expert Advisory Panel. She is also an AANAC Master Teacher. As Director of Education at Hansen Hunter & Co., Carol leads MDS and Medicare training sessions nationwide, presents monthly educational webinars, and conducts compliance audits. She is the author of The Long-Term Care MDS Coordinator’s Field Guide (HCPro, 2016).
Credit Hours
- 1.5 NAB hours for Nursing Home Administrators
