Nutrition: Swallowing Problems, Weight Loss, Diets, IV Fluids, Feeding Tubes

December 22, 2023


The MDS Section K, Nutrition information includes many Medicare payment items and Quality Measure triggers. The information coded on MDS assessment has often found to be inaccurate when submitted for a compliance review. Dietitians and Dietary Managers have historically coded this section without strong understanding of MDS coding instructions or the importance of the Assessment Reference Date (ARD) and 7-day look-back. The requirement to base MDS coding on the 7-day look-back from the ARD has often been ignored due to lack of knowledge. PDPM payment is increased when a resident has had a swallowing problem during the look-back or received a mechanically altered diet. Significant weight loss is a Medicare Nursing component qualifying item and a clinical issue that triggers the MDS 3.0 Quality Measures.

This webinar will focus on the payment and important clinical items that must be accurately assessed and care planned. The NHA and Clinical on team must ensure that the residents’ statuses are accurately reported so that residents are safe, care plans are accurate, interventions are put into place when appropriate, and that payment is correctly received.

Learning Objectives:
1. Name one swallowing problem that will impact payment.
2. State the percentage of calories a resident receives through a feeding tube that will qualify the resident for a Medicare skilled level of care.
3. Report one Section K item from a hospital stay “while not a resident” that should be strongly considered when setting the ARD for the 5-day PPS MDS.
4. Explain how to calculate significant weight loss in the one month and 6 month timeframes.



Carol Maher is a Board Certified Gerontological Registered Nurse with over 30 years of long term care experience and has worked in long term care in many roles. She worked as the MDS Coordinator in a 300 bed SNF in Pennsylvania for 8 years before moving to CA to become the MDS Coordinator/Director for a 1200 bed SNF in San Francisco. She has also worked as the MDS Coordinator in a SNF that typically had 60-75 residents on Medicare in addition to 160 long-term care residents. Most recently she was the Senior VP of Utilization Services and Director of Reimbursement for large multi-facility organizations.

Carol has worked as one of the Gold Standard nurses for MDS 3.0, serving on the RAP workgroup to prepare the way for the CAAs for MDS 3.0, and participating on a number of Technical Expert Panels related to MDS, Quality Measures and care planning. A sought-after speaker, she has given presentations at AANAC, AHCA and Leading Age national conferences as well as many state organization presentations. She is also a frequent author of articles related to the RAI process and PPS. Carol served as a member of the AANAC Board of Directors for 9 years. She is presently serving as the chair of the AANAC Expert Advisory Panel and as an AANAC Master Teacher of the RAC-CT and RAC-CTA certification courses. Ms. Maher is the Director of Education for Hansen Hunter, providing MDS and Medicare classes across the country, presenting monthly educational webinars and completing compliance audits. She is the author of Long-Term Care MDS Coordinator’s Field Guide (HCPRO 2016).

Credit Hours

  • 1.5 hours for Licensed Nurses
  • 1.25 NAB hours for Nursing Home Adminstrators

This pre-recorded webinar expires on January 25, 2025.


Hansen Hunter & Co. P.C. clients are invited to access any of our webinars for free by contacting Allison Johnson at our office at 503.244.2134 to receive your free registration code.


  • This nursing continuing professional development activity was approved by Montana Nurses Association, an accredited approver with distinction by the American Nurses Credentialing Center’s Commission on Accreditation.
  • Enduring material: To meet the requirements for these contact hours, you must watch the entire recorded presentation as well as answer and submit the post-test evaluation that is provided as a link along with the link to your webinar which you will receive via email after completing your purchase.