News / Blog
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The latest news, events, blogs and more…
Ask Proactive – We have a resident who we are skilling related to a recent femur fracture. The principal diagnosis is S72.22XD, which maps to the Non-Surgical Orthopedic/Musculoskeletal Clinical Category, but it states “May be Eligible for One of the Two Orthopedic Surgery Categories”. How do we determine if it is eligible for one of the Orthopedic Surgery categories?
Q: We have a resident who we are skilling related to a recent femur fracture. The principal diagnosis is S72.22XD, which maps to the Non-Surgical Orthopedic/Musculoskeletal Clinical Category, but it states “May be Eligible for One of the Two Orthopedic Surgery...
Transitioning from QIES to iQIES for MDS Submission
To comply with federal security mandates, the Centers for Medicare & Medicaid Services (CMS) has initiated new security requirements for access control to CMS Quality Systems through Remote Identity Proofing (RIDP) via the Healthcare Quality Information System...
Winning at PDPM
Resident conditions and resource needs drive reimbursement under the Patient-Driven Payment Model (PDPM). Successful facilities have developed systems to effectively recognize and capture the differences among residents, particularly in the utilization of resources....
Ask Proactive – For the Quality Measure “Percent of Residents Who Newly Received an Antipsychotic Medication (SS),” is the initial assessment used in the calculation always an Admission or 5-Day?
Q: For the Quality Measure “Percent of Residents Who Newly Received an Antipsychotic Medication (SS),” is the initial assessment used in the calculation always an Admission or 5-Day? A: For this measure, the initial assessment is the first assessment completed...
Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP)
The SNF VBP program encourages SNFs to improve the quality of care provided to Medicare beneficiaries by awarding incentive payments to SNFs based on their performance in the area of reducing unplanned hospital readmissions. Currently, the SNF VBP program utilizes the...
Social Services PDPM Impact
The Social Service department plays a significant role in daily nursing facility operations. From patient care planning, patient adjustment to facility admission, discharge planning, engaging with family/representatives, and beyond, social service staff members wear...
Ask Proactive – We have a resident on Enhanced Barrier Precautions who will be staying at our facility long term. Are there criteria for discontinuing these precautions at some point?
Q: We have a resident on Enhanced Barrier Precautions who will be staying at our facility long-term. Are there criteria for discontinuing these precautions at some point? A: It depends on why the Enhanced Barrier Precautions (EBP) were implemented. For...
Assessing Resident Capacity to Consent to Sexual Activity
The updated abuse guidance issued on June 29, 2022, stresses that facilities must take steps to ensure residents are protected from abuse, including evaluating whether the resident has the capacity to consent to sexual activity. To understand how to appropriately...
Ask Proactive – We have a physician who has requested that all patients be seen in her office rather than on-site at the facility. Will this satisfy the physician visit requirements?
Q: We have a physician who has requested that all patients be seen in her office rather than on-site at the facility. Will this satisfy the physician visit requirements? A: The regulations do not specifically address a location requirement; however, according...
Ins and Outs of F582 Medicaid/Medicare Coverage/Liability Notice
Medicare beneficiaries in a SNF have rights and safeguards with regard to financial liability and appeal of the denial of Medicare services. Providers are required to inform beneficiaries of their financial liability and their appeal rights in writing by issuing...
Ask Proactive – We have a patient with a stage IV pressure injury to the ankle that is being treated with a wound vac, which is changed 3x/week. Does this meet the criteria for skilled coverage under Medicare Part A in the SNF?
Q: We have a patient with a stage IV pressure injury to the ankle that is being treated with a wound vac, which is changed 3x/week. Does this meet the criteria for skilled coverage under Medicare Part A in the SNF? A: The Medicare Benefit Manual Chapter 8...
Ask Proactive – Our facility has several residents that require the use of a mechanical lift for transfers. What needs to be included in staff education/training?
Q: Our facility has several residents that require the use of a mechanical lift for transfers. What needs to be included in staff education/training? A: Mechanical lifts are designed to provide safe and easy transfers. When used correctly, they minimize the...
Ask Proactive – Can you clarify the abuse reporting requirements in relation to what must be reported within 2 hours and what types of incidents do we have 24 hours to report?
Q: Can you clarify the abuse reporting requirements in relation to what must be reported within 2 hours and what types of incidents do we have 24 hours to report? A: All alleged violations for abuse, neglect, exploitation or mistreatment, including injuries of...
Respecting the Crime Scene
Every incident, whether it involves a crime, an accident, or a natural disaster, leaves traces of evidence at the scene. The goal of every investigation is to correctly identify the facts, reconstruct the events and deduce what occurred. When possible illegal...
Ask Proactive – Is it appropriate to skill every resident that tests positive for COVID-19? Does the waiver allow us to skill “in place” any resident who tests positive?
Q: Is it appropriate to skill every resident that tests positive for COVID-19? Does the waiver allow us to skill any resident who tests positive? A: There has been quite a bit of confusion surrounding the use of the waivers, especially when it comes to current...