News / Blog
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Every SNF to Undergo 5 Claim Medicare Audit Starting June 5th
On May 4th, CMS issued Transmittal 12015 instructing MACs to perform a 5 claim probe and educate medical review on every SNF in their jurisdiction. A 15.1% SNF error rate in 2022 based on the Comprehensive Error Rate Testing (CERT) program is the catalyst for this...
Mitigating Risk to Prevent LTC Litigation
Nursing home settlements involving abuse or neglect in the United States are estimated at an average of $400,000.00 when the case settles out of court (What is the Average Settlement for Nursing Home Neglect? (sgklawyers.com). If the case proceeds to a court trial,...
Ask Proactive – If we have a new admission on or prior to May 11th using the QHS waiver, what happens when they require a hospital stay?
Q: If we have a new admission on or prior to May 11th using the QHS waiver, what happens when they require a hospital stay? A: John Kane addressed this during the Open Door Forum (ODF) on March 2nd. The full transcript for this ODF is located under the Skilled...
Ask Proactive – Why is daily charting necessary and how do you tackle compliance with Medicare A charting?
Q: Why is daily charting necessary and how do you tackle compliance with Medicare A charting? A: Documentation is an important part of providing resident care, it is a means to facilitate communication among the healthcare team, allowing for collaboration and...
Insights into Compliance: F675-F680 Quality of Life Requirements
Quality of life is a fundamental principle that applies to all care and services provided to nursing facility residents. The Quality of Life regulatory requirements at 483.24 (F675-F680) cover Quality of Life, Activities of Daily living, CPR, and activities. F677, ADL...
F578 Resident’s Rights- Advance Directives
Advance Directive and resident’s rights related to medical decision making are addressed in the surveyor guidance under F578. Understanding how the guidance defines both advance directives and advanced care planning is critical to complying with the regulations:...
Ask Proactive – Does Cultural Competence include gender identity and sexual orientation?
Q: Does Cultural Competence include gender identity and sexual orientation? A: Attitudes toward sexuality in general and toward sexual identity or orientation are culturally defined. Gender identity and sexual orientation can be categorized as cross-cutting...
Therapy Department Report Card
A thriving therapy department can have a tremendous impact on nursing home care culture, quality outcomes, and the bottom line. Whether your facility has an in-house or contract therapy program, rehabilitation services should continually contribute to resident...
Ask Proactive – Is there a certain amount of time allowed before an RN needs to complete a resident fall follow-up? Also, what should a fall follow-up entail?
Q: Is there a certain amount of time allowed before an RN needs to complete a resident fall follow-up? Also, what should a fall follow-up entail? A: While there is no specified time frame for RN assessment, guidance tells us the proper actions following a fall...
Ask Proactive – What actions need to be taken in preparation for the end of the Public Health Emergency (PHE)?
Q: What actions need to be taken in preparation for the end of the Public Health Emergency (PHE)? A: The COVID-19 national emergency was declared on March 13, 2020. As a result of this, several blanket waivers were put into place. Additions and modifications...
New SNF PEPPER Now Available: Do you have outliers that may trigger medical review?
The Q4FY22 release of the Skilled Nursing Facility (SNF) Program for Evaluating Payment Patterns Electronic Report (PEPPER) with statistics through September 2022 is now available for download. Follow these steps to access your PEPPER and analyze any outlier billing...
Drug Diversion Prevention—Are You Doing Enough?
Drug diversion in a nursing home can have serious consequences and pose a risk to resident and staff health and safety. Facilities and their nursing staff are expected to be the gatekeepers of medications as a key component of ensuring quality care. Effective...
Proactive Director Comments on CMS Infection Control Enforcement Memorandum for McKnights
Shelly Maffia, MSN, MBA, RN, LNHA, QCP, CHC, CLNC, CPC, Director of Regulatory Services, comments on CMS Infection Control enforcement memorandum QSO-23-10-NH for McKnights Long Term Care News CMS Announces Strengthened Enhanced Enforcement for Infection Control...
5 Things to Do Now to Improve Care Plan Processes
Deficient practices related to care planning continue to be a frequently cited issue for providers. Effective care planning can be challenging and requires an IDT approach to ensure effective systems that will lead to better resident outcomes, as well as survey...
Ask Proactive – When a resident who has a feeding tube for nutrition is receiving speech therapy and has orders for a pureed diet/thickened liquid trials at lunch during therapy sessions, should this be coded on the MDS as a mechanically altered diet in section K0510?
Q: When a resident who has a feeding tube for nutrition is receiving speech therapy and has orders for a pureed diet/thickened liquid trials at lunch during therapy sessions, should this be coded on the MDS as a mechanically altered diet in section K0510? A:...