Webinar
Overview
The Office of Inspector General recently released its report to Congress that reported that Falls with Major Injury were incorrectly reported on the SNF MDSs 43% of the time. This webinar will focus on the accurate coding of falls, the new definition of “fall”, the new definition of “major injury” and the new instruction about not coding pathological fractures as a major injury when the fracture occurred with a fall.
The newly updated Quality Measure will include MDS coding plus claims data. The QMs have historically been related to MDS coding alone. This is a major change and one that will be more difficult for SNFs to track because SNFs do not have access to hospital claims. The importance of person-centered care planning related to falls and fall risk will be highlighted.
The second measure that will be reviewed is the Percent of Residents who Lose too Much Weight. The coding of significant weight loss is often incorrect upon audit. The RAI User’s Manual was updated 10/1/2025 to include examples of significant weight loss and a picturegram of dates reporting which weights should be compared. The MDS coding updates will be reviewed along with what is and what is not a physician prescribed weight loss regimen, how to correctly calculate weight loss and the specific items that trigger the weight loss Quality Measure.
Both Quality Measures impact the facility’s Five Star Quality Rating and are of particular concern for surveyors. It is important for NHAs and their teams to understand the updated Quality Measures and MDS Coding updates.
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