April 2021 - Functional Pathways

April 2021

We are committed to keeping our clients up to date on the latest news and regulations in the post-acute
environment. We strive to create a valuable and lasting partnership through information sharing, education, and
expertise in therapy service delivery. We focus on evidence-based clinical outcomes and accurate reimbursement
that reflects all the care provided. Enjoy!

MDS 101
Consider developing a toileting program to increase the success of continence in your building.

A resident will trigger on the quality measures if the most recent MDS indicates “frequently or always incontinent of bowel or
bladder.” All long-stay residents coded with frequently or always incontinent of B & B count, unless they are excluded
because of being totally dependent in bed mobility, transfer, locomotion on unit, or severe cognitive impairment. Here is
where we ask the question, “what do we do?”
First, determine the percent of low-risk residents with loss of bowel or bladder continence by auditing The Resident Level
Report.
Next, develop a Performance Improvement Plan (PIP) to impact the residents listed on The Resident Level Report.
 Ask your team these questions:
     • What environmental conditions could be contributing to their incontinence?
     • What specific medications could be contributing to their incontinence?
     • What physical conditions could be contributing, such as Diabetes, Cancer, Stroke, Cognitive and Mobility impairment,
         Chronic Diarrhea or Constipation, Inadequate fiber or water intake, and Psychiatric conditions.
     • What type of incontinence is the resident experiencing? Stress, Urge, Mixed, or Overflow?
 Complete a toileting diary for each resident identified on The Resident Level Report, to identify the pattern of
     incontinence or continence and incorporate this patterning into the continence program.
 Educate all staff on providing the appropriate toileting program for each resident.
 Include a document tool to record each time the program is provided.
 Update the resident care plan with the individual interventions for this program.
 Implement the toileting program for the residents.
 Audit the program monthly.
 Document the results of the individual objectives and interventions of the program.
 Review your PIP in QAPI and add any changes to improve efficacy.

SNF Quality Reporting Program (QRP)

 The 13 QRP measurement data will be unfrozen in January 2022. CMS is gathering data now, so ensuring you are submitting
at least 80% of your MDS data is required to avoid a 2% reduction in your Medicare rate! For details on the QRP program –
join our Advanced Clinical Reimbursement Series starting the week of April 26th! You can also access the CMS data at

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-
Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Measures-and-Technical-Information

April is the month of the Squirrel!
                                                                     Chronic Kidney Disease coding is based on the
                                                                     severity of stages 1 – 5 the physician assigns.
                                                                     Stage 2 is mild using the code N18.2; Stage 3 is
                                                                     moderate using codes N18.30 – N18.32; Stage 4 is
                                                                     severe using N18.4 when coding stage 5 for
                                                                     Endstage renal disease (ESRD) code N18.6.
                                                                     Sometimes residents suffer from other serious
                                                                     conditions along with their Chronic Kidney
                                                                     Disease. Conditions such as Diabetes Mellitus and
It’s all fun and fools until someone eats the ears off your          Hypertension. The Chronic Kidney Disease code's
chocolate bunny while standing in the rain, looking at the           sequencing with codes for these other conditions
meteor showers in the night sky with April’s pink moon, and          is based on the Tabular List's specifics in your ICD-
your seasonal allergies kick in!                                     10 coding book. An example would be coding
                                                                     E10.22 – Type I Diabetes mellitus with Diabetic
March might be the month that comes in like a lion and out           Chronic Kidney Disease with the ICD-10 manual
like a lamb, but April is allergy month: First we see signs of       giving you further instructions for coding an
warm weather to come, then bam! A frost.                             additional code to identify the stage of the Chronic
                                                                     Kidney Disease (N18.1 – N18.6).
There is enough pollen to make you cough up a whole pine
cone when it’s not raining, but it’s usually raining. It rains for
days and just when you are about to start building a boat, the
sun comes out and flowers bloom and its beautiful and
magical…and then you sneeze.                                         The Client Portal

                                                                     Functional Pathways has a wonderful
                                                                     resource called the Client Portal. This is
                                                                     where we house all our client education
                                                                     resources, recordings, webinars, forms,
                                                                     latest updates and so much more.
                                                                     Log in and see for yourself.

                                                                     https://fprehab.com/fp-academy/

                                                                     password: academypath

April is OT Month!!!
                                                         FY 2022 SNF PPS Proposed Rule Puts the
As we celebrate Occupational Therapy month in
April 2021, we have an opportunity to reflect on         Spotlight on Quality Measures
the past year. A worldwide pandemic filled our
professional and personal lives with                     On April 8, the Centers for Medicare & Medicaid Services (CMS)
unprecedented chaos, fear, and loss. Even                released for public inspection the Fiscal Year (FY) 2022 Proposed Rule
through this challenging time – Functional               for the Skilled Nursing Facility Prospective Payment System (SNF PPS)
Pathways continues to provide therapy services           and Consolidated Billing, and Updates to the Quality Reporting
that exceeded expectations. Resident                     Program and Value-Based Purchasing Program (CMS-1746-P) as
identification and treatment remains imperative          required by law. The agency will accept comments, which may be
now as individuals were confined with less               made electronically, through June 7.
visibility to staff and limited contact with family
and friends.                                             See CMS website for the full proposal rule.

Occupational therapy emerged as a profession in          Also make sure you attend the 4th training of the Functional Pathways
1917 in the United States of America when the            Advanced Clinical Reimbursement Series to get all the latest on
National Society for Promotion of Occupational           Quality measure, Value Based Purchasing, and the Quality Reporting
Therapy was created. This later evolved into the         Program!!
American Occupational Therapy Association
(AOTA). This association was established with
the belief in remedial properties of human            $$$ On the Table
occupation. This therapy played a vital role in
the treatment of patients suffering with AIDS,        IPAs - To do or not to do that is the question!
polio, tuberculosis, and other illnesses. OT          Interim Payment Assessments are an optional assessment designed to allow
serves as a holistic approach to rehabilitation       facilities to capture a higher reimbursement if the resident’s condition
incorporating both psychiatric and physical           changes to the point that additional care is required.
dysfunction components. How ironic that 104            Do you have a way of tracking IPAs? A log or list that you place residents
years later, the world would be thrown into a         on at the first sign of a clinical change?
COVID-19 pandemic. The role of OT continues to
be multi-dimensional as we face a world of social      Do you review that resident’s chart to see if there are additional
distancing and isolation.                             physician notes, orders, medications, supplement, consults, labs, or other
                                                      documentation that indicate or support a change?
Functional Pathways celebrates our Occupational
Therapy practitioners as an essential part of the      Do you follow that resident closely for the next few days using an early
rehabilitation team. The framework of OT              warning sign system such as stop and watch?
practice is based on both the psychosocial and
                                                       Do you use a daily rate calculation tool to determine if the change of
physical needs of the individual. This allows a
unique approach to rehabilitation especially in       condition would result in higher payment?
light of the mental and functional impacts of an      If you don’t have an IPA policy and a way of tracking them, then you may be
international pandemic.                               leaving money on the table!