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Survey Alert! Revised LTC Surveyor Guidance: What You Need to Know
Survey Alert! Revised LTC Surveyor Guidance: What You Need to Know Long-term care facilities are about to undergo significant changes as CMS releases revised surveyor guidance aimed at elevating care quality and resident safety. On November 18, 2024, the Centers for...
Understanding Hospital QMs, Episodic Care & the Impact on Post-Acute Providers
Understanding Hospital QMs, Episodic Care & the Impact on Post-Acute Providers In post-acute care, providers are accustomed to monitoring Minimum Data Set (MDS) accuracy and focusing on clinical programs in quality measure target areas in order to drive...
Ask Proactive – What are the top priorities for an effective Infection Prevention Program in long-term care?
Q: What are the top priorities for an effective Infection Prevention Program in long-term care? A: An effective program should focus on: Conducting a facility-wide infection control risk assessment to identify vulnerabilities. Implementing robust surveillance...
The Landscape of Skilled Service Justification in Skilled Nursing Facilities – Part II
The Landscape of Skilled Service Justification in Skilled Nursing Facilities Compliance and accountability related to justifying skilled services is more important than ever. In Part 2 of this blog addressing justification of SNF Skilled Care, we’ll take a deeper look...
Ask Proactive – Are there specific requirements for notifying the MD of incidents?
Q: Are there specific requirements for notifying the MD of incidents? A: Yes, specific regulatory requirements apply to notifying the physician, as incidents may fall under various categories. These guidelines ensure that physicians are informed in a...
The Landscape of Skilled Service Justification in Skilled Nursing Facilities
Skilled Service Justification in SNFs In the ever-evolving landscape of skilled nursing facilities (SNFs), the stakes have never been higher. With constant advancements in data analytics, regulatory bodies are sharpening their focus on compliance and accountability...
Ask Proactive – Can we place the room/bed number for a semi-private room on the Enhanced Barrier Precaution sign located outside the resident’s room to notify staff which resident requires PPE for high contact activities or is this a HIPAA violation?
Q: Can we place the room/bed number for a semi-private room on the Enhanced Barrier Precaution sign located outside the resident’s room to notify staff which resident requires PPE for high contact activities or is this a HIPAA violation? A: CMS addresses...
Keys to Active Diagnosis Documentation and the Provider Query Process
Keys to Active Diagnosis Documentation and the Provider Query Process Supportive documentation of active diagnosis is crucial—supporting quality care as well as playing a vital role in regulatory compliance, reimbursement, and overall patient outcomes. This week,...
Ask Proactive – I have a resident that routinely receives an injection of fluphenazine decanoate every 4 weeks. The injection was not administered during the 7-day observation period, but its a long-lasting medication. Should I code it under N0415A?
Q: I have a resident that routinely receives an injection of fluphenazine decanoate every 4 weeks. The injection was not administered during the 7-day observation period, but its a long-lasting medication. Should I code it under N0415A? A: Page N-9 of...
Mandatory Off-Cycle SNF Revalidation Process—What You Need to Know
Mandatory Off-cycle SNF Revalidation Process—What You Need to Know CMS will be notifying facilities via letter sent from their Medicare Administrative Contractor (MAC) sometime between October to December 2024 that they must complete the off-cycle revalidation...
Mandatory Update to SNF ABN (CMS-10055) – 10/31/2024
Mandatory update to SNF ABN (CMS-10055) – 10/31/2024 The Centers for Medicare & Medicaid Services (CMS) released an update to the Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN)—Form CMS-10055 in August. The revised form and updated...
Ask Proactive – We have a resident with a chronic stage IV pressure ulcer who recently had flap surgery to close the wound. Do I continue to code the stage IV on the MDS?
Q: We have a resident with a chronic stage IV pressure ulcer who recently had flap surgery to close the wound. Do I continue to code the stage IV on the MDS? A: According to the RAI (pg. M-6), if a pressure ulcer is surgically closed with a flap or...
Ask Proactive – Our social worker attempted to complete the BIMS with a resident, but the resident refused to answer the questions. As a result, the social worker coded all responses in C0200, 0300 and 0400 as “0” with a BIMS Summary Score of “00” at C0500. This seems odd because the resident’s previous BIMS scores have been 14 or15. When I interact with the resident, I don’t observe any cognitive decline, and the staff report no concerns either. Is this BIMS coding correct?
Q: Our social worker attempted to complete the BIMS with a resident, but the resident refused to answer the questions. As a result, the social worker coded all responses in C0200, 0300 and 0400 as “0” with a BIMS Summary Score of “00” at C0500. This seems odd because...
LTC Advance Directives: Key to Resident-Centered Care
LTC Advance Directives: Key to Resident-Centered Care As the population ages and more individuals transition into long-term care (LTC) facilities, ensuring personalized, dignified care becomes increasingly important.. One of the most essential tools in achieving this...
Ask Proactive – My facility is triggering high for the Quality Measure: Prevalence of Behavior Symptoms Affecting Others, but we don’t have many behavioral issues in our population. Why is this happening?
Q: My facility is triggering high for the Quality Measure: Prevalence of Behavior Symptoms Affecting Others, but we don’t have many behavioral issues in our population. Why is this happening? A: This measure may trigger if the most recent MDS is coded...