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.
The latest news, events, blogs and more…
New SNF Audits Coming—How to be Ready
New SNF Audits Coming—How to be Ready The Minimum Data Set (MDS) plays a vital role in driving resident care through the resident-centered care plan process, regulatory compliance, Medicare and Medicaid reimbursement, quality outcomes, and reporting programs....
Home Health News: Emergency Preparedness for Home Health
Emergency Preparedness for Home Health Emergencies can strike without warning natural disasters, power outages, pandemics, or severe weather events all pose serious risks to home health patients and staff. That’s why an effective Emergency Preparedness Plan...
Ask Proactive – Our facility has been issued a Denial of Payment for new admissions due to survey deficiencies. Should we continue to submit the MDS for current and newly admitted residents?
Q: Our facility has been issued a Denial of Payment for new admissions due to survey deficiencies. Should we continue to submit the MDS for current and newly admitted residents? A: A Denial of Payment for new admissions (DPNA) is a CMS enforcement remedy that...
Home Health News: Navigating Home Health Targeted Probe and Education (TPE)
Navigating Home Health Targeted Probe and Education (TPE) Staying compliant with Medicare billing guidelines is essential. One of the tools CMS uses to ensure accuracy and reduce improper payments is the Targeted Probe and Education (TPE) program, a medical...
Ask Proactive – A resident was admitted with a diagnosis of acute on chronic respiratory failure requiring a new tracheostomy. The trach was placed during the hospital stay and the resident continues to require suctioning, respiratory monitoring, and oxygen therapy here in the SNF. Would we use the respiratory failure or presence of tracheostomy as the primary diagnosis?
Q: A resident was admitted with a diagnosis of acute on chronic respiratory failure requiring a new tracheostomy. The trach was placed during the hospital stay and the resident continues to require suctioning, respiratory monitoring, and oxygen therapy here in the...
F695—Respiratory & Tracheostomy Care in LTC
F695—Respiratory & Tracheostomy Care in LTC In today's skilled nursing environment, respiratory and tracheostomy care isn't just a specialized service—it's an essential competency. With increasing acuity among residents and heightened regulatory scrutiny,...
Home Health News: The Importance of Proper Orientation in Home Health Care
The Importance of Proper Orientation in Home Health Care Home health care is unique. Care is delivered in the patient’s personal space, where clinicians must adapt quickly while upholding high standards of safety, compliance, and compassion. A critical first...
Ask Proactive – Is there any federal regulation regarding how many references and job verifications must be done for a job applicant i.e. CNA or nurse?
Q: Is there any federal regulation regarding how many references and job verifications must be done for a job applicant i.e. CNA or nurse? A: There is no specific federal regulation that mandates an exact number of employment references or job verifications...
F678—CPR Appendix PP Revisions
F678—CPR Appendix PP Revisions CMS revisions to F 678 Cardiopulmonary Resuscitation were significant in bringing the regulations to align with current nationally accepted standards for CPR training. Here’s what you need to know to bring your training and...
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:...