News / Blog
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Ask Proactive – How should you sanitize a glucometer when used for different residents?
Q: How should you sanitize a glucometer when used for different residents? A: To prevent the spread of pathogens among residents and to avoid a possible F880 citation, it’s vital to clean the glucometers both before and after each resident’s use. Blood...
Improving Resident Care & Reimbursement: The Role of the PHQ-2 TO 9© in Nursing Homes Under PDPM
In the dynamic world of nursing home care, ensuring the well-being of residents while managing financial stability is a constant challenge. Today, we'll explore a valuable tool in this endeavor – the PHQ-2 TO 9© – and its pivotal role in both delivering quality care...
SNF Certification/Recertification Compliance Check Up
MACs have begun rolling out the mandated 5-Claim Probe and Educate audit and will eventually review claims for every eligible SNF in their jurisdiction. SNF certifications and recertifications are important elements of SNF Medicare stay compliance and will be...
Ask Proactive – How long does the physician have to see new admissions?
Q: How long does the physician have to see new admissions? A: Per guidance at §483.30(c) (F712) "In a SNF, the first physician visit (this includes the initial comprehensive visit) must be conducted within the first 30 days after admission, and then at...
Proposed Minimum Staffing Standards for LTC Facilities – What You Need to Know
The Centers for Medicare & Medicaid Services (CMS) issued the long-awaited Proposed Minimum Staffing Rule on 9/1/23 with the stated objective of seeking “to establish comprehensive nurse staffing requirements to hold nursing homes accountable for providing safe...
Ask Proactive – My facility has been selected for a Schizophrenia Audit by CMS. How will the results of this audit impact our facility’s Five Star rating?
Q: My facility has been selected for a Schizophrenia Audit by CMS. How will the results of this audit impact our facility’s Five Star rating? A: Inaccuracies identified through these audits impact QM ratings as follows: The overall QM and long-stay QM...
Ask Proactive – We had a resident admit over the weekend. He is his own responsible party. His admission packet had only been partially completed. He did not have an advanced directive or physician’s order indicating code status order. While completing the nursing admission assessment, he indicated that he did not want to be resuscitated in the event of cardiac/respiratory arrest. Would staff still be required to perform CPR since there is no signed Advance Directive and Physician’s Order?
Q: We had a resident admit over the weekend. He is his own responsible party. His admission packet had only been partially completed. He did not have an advanced directive or physician’s order indicating code status order. While completing the nursing admission...
Meaningful Meetings in LTC
How much of your time is spent in meetings? Depending on your role, time in meetings may take more time than any other task or responsibility you have. Do you sometimes wonder if all these meetings are even necessary (“Could this have been an email?”) Days are busy...
Ask Proactive – While it is the resident’s right to refuse care, what are the responsibilities of the facility when this occurs?
Q: While it is the resident’s right to refuse care, what are the responsibilities of the facility when this occurs? A: As we see in the Federal Regulatory Grouping §483.10 Resident Rights, the resident absolutely has the right to refuse care. This is specified...
Missing the Boat Under Patient Driven Payment Model (PDPM)
PDPM has been in place for nearly four years, and with it came the shift from payment based on resource utilization to payment driven by patient characteristics and service provision. PDPM presents with many nuances and complexities that open the door to sinking...
Ask Proactive – What are some tips to determine if the completion of the optional Interim Payment Assessment (IPA) is appropriate to impact reimbursement?
Q: What are some tips to determine if the completion of the optional Interim Payment Assessment (IPA) is appropriate to impact reimbursement? A: The IPA may be completed when a Medicare Part A beneficiary’s condition and/or the care and services provided change...
Infection Preventionist Essentials: Multidrug-Resistant Organisms in Nursing Homes
As nursing home professionals, you play a crucial role in caring for vulnerable residents and maintaining a safe and healthy environment. One of the most pressing challenges faced by healthcare facilities is the emergence and spread of multidrug-resistant organisms...
Ask Proactive – My facility is going through a Medicare UPIC review and received a significant number of denials followed by a demand letter requiring repayment. What are our options for appealing the decision and what is the interest rate that will apply if we aren’t able to immediately issue repayment?
Q: My facility is going through a Medicare UPIC review and received a significant number of denials followed by a demand letter requiring repayment. What are our options for appealing the decision and what is the interest rate that will apply if we aren’t able to...
QM Insights – Long Stay Weight Loss
There are 3 primary facets to the effective management of the quality measure (QM) Percentage of Long Stay Residents Who Lose too Much Weight: 1. Understanding the ins and outs of the QM calculation2. Ensuring Correct MDS Coding of Weight and Weight Loss 3....
Role of the HIPAA Privacy Officer in LTC
HIPAA (Health Insurance Portability and Accountability Act) plays a critical role in nursing homes by ensuring the protection and privacy of resident’s sensitive medical information. Nursing homes handle vast amounts of personal health data daily including medical...