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Ask Proactive – Can I code fluids received in the hospital in section K for a diagnosis of Hypovolemia?
Q: Can I code fluids received in the hospital in section K for a diagnosis of Hypovolemia? A: Fluids coded in K0520A1 do have to be for nutrition or hydration. Oftentimes we may not see that specific verbiage in the hospital notes. In cases where the...
QAPI Expectations in Skilled Nursing Facilities
Quality Assurance and Performance Improvement (QAPI) is a vital component of maintaining and enhancing the quality of care in Skilled Nursing Facilities (SNFs). How can you move QAPI programming in your facility to the next level? QAPI is a comprehensive approach that...
Housekeeping Insights and Disinfection for Infection Preventionists
In the world of healthcare, cleanliness isn't just about appearance—it's a critical component of infection control and prevention. Effective cleaning and disinfecting practices are essential to maintaining a safe and sanitary environment in skilled nursing, long-term...
Ask Proactive – Patient was admitted with a stage IV pressure ulcer that healed (fully epithelialized) and several months later reopened at the same site. How should this pressure ulcer be staged when it reopens?
Q: Patient was admitted with a stage IV pressure ulcer that healed (fully epithelialized) and several months later reopened at the same site. How should this pressure ulcer be staged when it reopens? A: According to the RAI Manual guidance for pressure...
Managing Long and Short Stay Pressure Ulcer/Injury Quality Measures
Pressure injuries, also known as pressure ulcers and bedsores, are a significant concern in nursing facilities, particularly among residents with limited mobility. The development of pressure injuries can be a reflection of the quality of care a resident receives,...
Ask Proactive – We have a resident on Enhanced Barrier Precautions (EBP) due to an indwelling catheter that has completed therapy and is transferring to RNP. Staff will be providing partial/moderate assistance, which will involve extended high contact, during restorative ambulation in the hallway. Therapy staff wore gowns and gloves while working with him in the therapy gym, but what should restorative nursing staff do in the hallway?
Q: We have a resident on Enhanced Barrier Precautions (EBP) due to an indwelling catheter that has completed therapy and is transferring to RNP. Staff will be providing partial/moderate assistance, which will involve extended high contact, during restorative...
Ask Proactive – How does an interdisciplinary team contribute to effective discharge planning in healthcare?
Q: How does an interdisciplinary team contribute to effective discharge planning in healthcare? A: Discharge planning is a critical process in healthcare, involving an interdisciplinary team to ensure a smooth transition from one care setting to another....
F609 Reporting of Alleged Violations: Ensuring Timely and Accurate Reporting in Long-Term Care Facilities
Reporting alleged violations promptly is crucial for maintaining safety and compliance in long-term care facilities. Among the most frequently cited issues at the Immediate Jeopardy (IJ) level are those related to Abuse and Neglect. This article focuses on F609, one...
Facility Assessment Tipsheet: Addressing Behavioral Health Needs
CMS has issued updated guidance that surveyors will use to evaluate nursing home providers’ compliance with the expanded facility assessment requirements included in the minimum staffing rule, which become effective on August 8, 2024. Every nursing home provider must...
Ask Proactive – We have a Family Council starting in our facility. What is the facility’s responsibility to facilitate a successful Family Council?
Q: We have a Family Council starting in our facility. What is the facility’s responsibility to facilitate a successful Family Council? A: Requirements for Family Councils in Medicare and Medicaid Certified Facilities Medicare and Medicaid certified...
Enhanced Barrier Precautions—Are you in compliance?
The Centers for Medicare & Medicaid Services (CMS) released QSO-24-08-NH in March 2024, the Memorandum pertaining to Enhanced Barrier Precautions (EBP) in Nursing Homes. While many facilities already had these precautions in place in some form based on CDC...
Ask Proactive – We have a resident who has a progress note documenting that resident requested HOB to be elevated because when lying down flat he can’t “catch his breath.” He doesn’t have COPD but he does have pulmonary fibrosis which is listed on his hospital H&P and receives an inhaler to help with symptom management. Is it okay to mark at I6200 on his 5-day PPS assessment?
Q: We have a resident who has a progress note documenting that resident requested HOB to be elevated because when lying down flat he can’t “catch his breath.” He doesn’t have COPD but he does have pulmonary fibrosis which is listed on his hospital H&P and receives...
Navigating Advance Directives and End-of-Life Care in Nursing Facilities
Few topics are as sensitive and crucial as end-of-life care. At the heart of this complex and emotionally charged subject are Advance Directives (ADs) – legal documents that spell out a person’s wishes regarding medical care and treatment when they can no longer...
Ask Proactive – One of our long-term residents fell and fractured their femur requiring a hip replacement. They returned to our facility on a skilled stay. The IDT met and were discussing a primary diagnosis. Therapy believes we should use Z47.1 Aftercare following joint replacement surgery but some of the available hospital documentation uses S72.141A Displaced intertrochanteric fracture of right femur, initial encounter for closed fracture. Which is the correct code?
Q: One of our long-term residents fell and fractured their femur requiring a hip replacement. They returned to our facility on a skilled stay. The IDT met and were discussing a primary diagnosis. Therapy believes we should use Z47.1 Aftercare following joint...
Ask Proactive – We have a patient who has achieved ambulation in the hallways at supervision level using a walker. Our new case manager is insistent that we discharge as soon as possible, or our services could be denied by Medicare. The patient wants to return to PLOF, independent ambulation, so her therapists do not feel a discharge is appropriate at this time. Would this claim be at risk for denial?
Q: We have a patient who has achieved ambulation in the hallways at supervision level using a walker. Our new case manager is insistent that we discharge as soon as possible, or our services could be denied by Medicare. The patient wants to return to PLOF, independent...