News / Blog
Need to brush up on the latest industry news? Look no further! Proactive Medical Review consultants provide up-to-date blog postings to keep you in the know.
The latest news, events, blogs and more…
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:...
Ask Proactive – If a skilled or private pay resident is sent out to the hospital and the resident’s representative does not want to pay to hold the bed, is this an allowable discharge?
Q: If a skilled or private pay resident is sent out to the hospital and the resident’s representative does not want to pay to hold the bed, is this an allowable discharge? A: No, you must permit them to readmit to the next available bed if your facility can...
Post-Pandemic Nursing Home Infection Preventionist Priorities
An effective Infection Preventionists plays the part of guardian, detective, and scientist as they lead facility efforts in preventing and controlling infections through a robust Infection Prevention and Control (IPC) program. As facilities move beyond the COVID era,...
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...