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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...
Ask Proactive – Do you anticipate significant changes in capturing depression end-splits for the nursing CMGs with the October 1st change to PHQ-2 to 9 from PHQ-9?
Q: Do you anticipate significant changes in capturing depression end-splits for the nursing CMGs with the October 1st change to PHQ-2 to 9 from PHQ-9? A: You’re not alone in contemplating the impact of the coming changes to capturing the depression end-splits;...
Ask Proactive – Should facilities include MDS and nurse supervisors in the daily nurse staffing data that we are required to post?
Q: Should facilities include MDS and nurse supervisors in the daily nurse staffing data that we are required to post? A: The requirement for posting staffing information at F732, is for hours worked by licensed and unlicensed nursing staff directly responsible...
Enhancing Medication Error Prevention: Beyond the “6 Rights”
Medication administration staff are well-versed in the "6 Rights" of accurate medication administration: Right Resident Right Medication Right Dose Right Route Right Time Right Documentation While these "6 Rights" form the foundation of safe medication practices, it...
Action Plan for Oct. 1st MDS Changes
The October 1st effective date of the revised MDS 3.0 item set (v1.18.11) is fast approaching. This updated version of the MDS brings with it many significant changes. The implications of these changes affect not just the completion of the MDS, but also will have a...
Ask Proactive – How do you code a Kennedy ulcer in Section M of the MDS?
Q: How do you code a Kennedy ulcer in Section M of the MDS? A: A Kennedy terminal ulcer is not a pressure ulcer. It is believed to be caused by end-of-life organ failure, with skin being the largest organ of the human body. This does not meet any of the skin...
Care Area Assessments – What’s Changing in October?
The Care Area Assessment (CAA) process is one of three components of the Resident Assessment Instrument (RAI). Another component, the MDS, identifies actual or potential areas of concern, and the remainder of the RAI process supports efforts to further assess Care...
Ask Proactive – In the past, when there have been significant updates/revisions to the RAI Manual, there has been changeover in the MDS Staff in our facility. How do you recommend that we prepare should this occur again?
Q: In the past, when there have been significant updates/revisions to the RAI Manual, there has been changeover in the MDS Staff in our facility. How do you recommend that we prepare should this occur again? A: While expecting change doesn’t make it any easier,...
Ask Proactive – How will the removal of section G affect my everyday workflow?
Q: How will the removal of section G affect my everyday workflow? A: Section G has been removed from the federally required MDS item sets effective October 1, 2023. However, some states will continue to use section G information to complete an Optional State...
F740 Elements of an Effective Behavior Management Program for Nursing Facilities
Elements of an Effective Behavior Management Program for Nursing Facilities Behavior management plays a crucial role in maintaining a safe and supportive environment for residents in nursing facilities. It involves strategies and interventions aimed at understanding...
Update on SNF 5 Claim Probe Audit Initiated June 5th 2023
A new CMS web page is now available devoted to the SNF 5-Claim Probe and Educate audit initiated June 5, 2023 as part of the effort to lower the SNF payment error rate. The webpage includes additional information and FAQs on what to expect as the review has gotten...
Care and Maintenance of the Maintenance Department
Maintenance Department staff are the spark plugs and oil of the facility engine. Without an operational physical plant and working equipment, the facility could not “drive” quality in all other departments. How effectively are you ensuring proper Care and Maintenance...
Ask Proactive – What medications should be considered for review as part of a gradual dose reduction program?
Q: What medications should be considered for review as part of a gradual dose reduction program? A: Gradual dose reduction (GDR) is a method used to reduce the dosage of a specific medication while closely monitoring the resident’s progress and potentially...