Falls with Major Injury: New CMS Guidance, Coding Clarity, and QAPI Strategies for SNFs

In this LTC NAC Chat podcast episode, Sarah Becker, RN, Director of Clinical Reimbursement for Proactive LTC Consulting, and Christine Twombly, RN, RAC-MT, RAC-MTA, CQP, CRC, break down the updated CMS guidance on Falls with Major Injury and what it means for MDS coding, Quality Measures, survey outcomes, and resident safety. Together, they simplify complex regulatory changes, clarify key definitions — including intercepted falls and pathological versus traumatic fractures — and walk through real-world examples to support accurate coding and interdisciplinary collaboration. The discussion also highlights the impact of these changes on Quality Measures and recent OIG findings on underreporting, along with practical strategies for improving compliance and reducing risk. To close, the team shares how strong QAPI processes can transform fall prevention efforts through trend analysis, individualized care planning, and system-wide improvement.