This presentation will assist the SNF Medicare team to understand the requirements that must be met in order to code the Section GG functional assessment “usual” functional performances of residents during the 3-day MDS look-back for the 5-day PPS MDS for Medicare and Medicare Advantage residents, the 3-day look-back for the Part A PPS Discharge MDS for Medicare residents and for each OBRA MDS in states that require PDPM HIPPS codes be calculated on OBRA assessments.
The assessments should be completed by a multidisciplinary team of qualified clinicians in order to determine the residents’ “usual” performance for each MDS assessment. Medicare A reimbursement and payment for most Medicare Advantage plans use the Section GG functional assessment coding to inform the PDPM payment for the therapy and nursing components. Determining the “usual” performance will require interdisciplinary collaboration. The SNF leaders must work to ensure that the therapy and nursing teams are collaborating to determine the residents’ performances on each MDS. There must be documentation that supports that the collaboration occurred and why the team decided on the final MDS coding. Negative findings on Medicare reviews are seen when no documentation is seen to support that collaboration occurred when nursing and therapy assessments recorded different coding.
- List at least one method of collaboration used to ensure that the resident’s “usual” performance is coded.
- List 5 of the Section GG items that impact Medicare payment.
- Report the timeframe for completing GG assessments for the 5-day PPS MDS.
- Explain how the GG functional score impacts the PT/OT and nursing components of PDPM.
Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC
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 & Co. P.C., 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).
- 1.5 credit hours for RNs
- 1.5 credit hours for NABs
This pre-recorded webinar expires on June 25, 2023.