News / Blog
Need to brush up on the latest industry news? Look no further! Proactive Medical Review consultants provide up-to-date blog postings to keep you in the know.
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F605 Gradual Dose Reduction Updates for Nursing Homes
F605 Gradual Dose Reduction Updates for Nursing Homes Earlier this year, the Centers for Medicare & Medicaid Services (CMS) issued revised guidance under F605, sharpening its focus on the misuse of psychotropic medications as chemical restraints and...
Home Health News: Understanding Medicare Secondary Payer (MSP)
Understanding Medicare Secondary Payer (MSP) in Home Health For home health agencies, accurate billing is critical, especially when Medicare is not the primary payor. Understanding Medicare Secondary Payer (MSP) rules ensures compliance and reduces the risk of...
Ask Proactive – Do we need to obtain prior authorization for every managed care resident who requires skilled services, even if they clearly meet criteria?
Q: Do we need to obtain prior authorization for every managed care resident who requires skilled services, even if they clearly meet criteria? A: Unfortunately, yes — at least for now. Most managed care plans (including Medicare Advantage) still require prior...
Home Health News: Home Health Proposed Final Rule CY 2026
Home Health Proposed Final Rule CY 2026 CMS issued the proposed home health rule (for Calendar Year 2026) which includes a proposed 6.4% reduction in home health payments—let’s review what you need to know… CY 2026 Home Health Payment Update (Proposed)...
In Case You Missed It….Major Update to Nursing Home Care Compare
In Case You Missed It….Major Update to Nursing Home Care Compare On June 18, 2025 CMS released update memos QSO-25-19-All and QSO-25-20-NH with significant information related to information to be made available via Nursing Home Care Compare. The first memo...
Ask Proactive – What is the difference between avoidable and unavoidable pressure injuries?
Q: What is the difference between avoidable and unavoidable pressure injuries? A: The determination of whether a pressure injury is avoidable versus unavoidable depends on the facility meeting the following criteria. The facility must ensure the following:...
Discharge Function Score: Getting it Right!
Discharge Function Score: Getting it Right! Are your Discharge Function Scores working for or against you? If you’re still treating Section GG like “just another MDS task,” you’re missing one of the most influential performance measures in the SNF Quality...
PBJ Policy Manual & FAQs Updated
PBJ Policy Manual & FAQs Updated PBJ Policy Manual Final - V2.7 - 06.30.2025 (PDF) PBJ Policy Manual FAQ 06.30.2025 (PDF) Updates were posted to the PBJ Policy Manual and FAQs on June 30, 2025. New Additions to the policy manual include: Facilities should...
Home Health News: Mandatory “All-Payer” OASIS Changes Effective 7/1/25
Mandatory “All-Payer” OASIS Changes Effective 7/1/25 As of July 1, 2025, every qualified home health patient—regardless of payer—must have a complete OASIS assessment reported. Exclusions remain unchanged. This update represents a shift toward more inclusive...
Ask Proactive – Our facility is thinking about implementing flexible time ranges for medications rather than a specific time to help us stay in compliance with our heavy morning and evening medication passes. What are the pros and cons of making this change?
Q: Our facility is thinking about implementing flexible time ranges for medications rather than a specific time to help us stay in compliance with our heavy morning and evening medication passes. What are the pros and cons of making this change? A: Deciding...
Top Nursing Home Missed Reimbursement Opportunities
Top Nursing Home Missed Reimbursement Opportunities Practical Strategies to Capture What You’ve Rightfully Earned In today’s long-term care environment, nursing homes are under more pressure than ever to deliver high-quality care while navigating increasingly...
Home Health News: Top Home Health Survey Deficiencies and How to Avoid Them
Top Home Health Survey Deficiencies and How to Avoid Them When it comes to home health agency compliance, survey readiness requires year-round attention. Let’s breakdown of the top home health survey deficiencies and actionable tips to prevent them. 1....
Ask Proactive – I heard a rumor that the antipsychotic QMs are about to go through a complete change. Is this true?
Q: I heard a rumor that the antipsychotic QMs are about to go through a complete change. Is this true? A: Not entirely - but there is an important change on the horizon. In a recent memorandum, CMS announced a significant update to the long-stay antipsychotic...
Is Your Facility Truly Prepared for an Emergency? The OIG Says “Maybe Not”
Is Your Facility Truly Prepared for an Emergency? The OIG Says “Maybe Not” Nursing homes play a vital role in keeping vulnerable residents safe, but recent emergencies in facilities (e.g., hurricanes, infectious outbreaks, fires) have revealed critical...
Home Health News: Boosting Staff Retention in Home Health: Strategies That Work
Boosting Staff Retention in Home Health: Strategies That Work In today’s competitive healthcare landscape, retaining qualified home health staff has become more challenging than ever. High turnover not only affects team morale but also compromises the...