News / Blog
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The latest news, events, blogs and more…
Ask Proactive – We recently received a letter from our MAC informing us of findings on the Comparative Billing Report (CBR) of SNF Short-Stays for PT / PT and NTA services. Our facility triggered greater than the 90th percentile as compared to our state and jurisdiction related to claims with PT/OT Short-Stays (0-20 days LOS). Wondering if we need to complete a self-audit? Have you seen this? What should be our next steps?
Q: We recently received a letter from our MAC informing us of findings on the Comparative Billing Report (CBR) of SNF Short-Stays for PT / PT and NTA services. Our facility triggered greater than the 90th percentile as compared to our state and jurisdiction related to...
Ask Proactive – Unacceptable Primary Diagnoses
Q: Our Medicare Part A claim was rejected due to “principal diagnosis is an unacceptable diagnosis. Correct and resubmit/rekey”. The principal diagnosis coded on the Medicare claim and in section I0020B of the Medicare 5-day MDS is B95.62 (MRSA infection as the cause...
How will a Recession Impact Your Facility?
As most facilities continue to focus efforts on recovering from the impact of the pandemic, the potential of an economic recession threatens to present the next major provider challenge. With increasing inflation, climbing interest rates, stock market declines,...
Becoming a Dynamic DON
Fulfilling the Director of Nursing (DON) role in a skilled nursing facility is not an easy challenge. In addition to an extensive list of formal responsibilities and job duties, those who are truly successful in the role have tremendous grit, a sense of purpose, and a...
Ask Proactive – I’m a new DON at a skilled nursing facility and the team meeting procedures don’t appear to help the facility manage the resident or team’s needs. What items should I be sure we cover to make these meetings both efficient and effective for the team?
Q: I’m a new DON at a skilled nursing facility and the team meeting procedures don’t appear to help the facility manage the resident or team’s needs. What items should I be sure we cover to make these meetings both efficient and effective for the team?I A: Ensuring...
Ask Proactive – If someone uses a lift for transfers, how should I code G0300E, Surface-to-Surface Transfer (Transfer between bed and chair or wheelchair)?
Q: If someone uses a lift for transfers, how should I code G0300E, Surface-to-Surface Transfer (Transfer between bed and chair or wheelchair)? A: The RAI Manual states “If a lift device (a mechanical device that is completely operated by another person) is used, and...
Clinical Meetings: Is Your Team Hitting the Mark?
With staff pressed on every side, ensuring clinical meetings are an effective use of time and resources is essential. Strong meeting processes can facilitate key objectives are met related to clinical quality, MDS assessment accuracy, risk management, and...
Ask Proactive – Under F761, what needs to be included on the label of multi-dose products that are pulled from the E-kit, brought from home or brought from the hospital?
Q: Under F761, what needs to be included on the label of multi-dose products that are pulled from the E-kit, brought from home or brought from the hospital? A: Multi-use products should be labeled with: The original manufacturer’s or pharmacy-applied label indicating...
PDPM Isolation and Supportive Documentation
Under the Patient Driven Payment Model (PDPM), resident characteristics are used to classify Medicare residents into payment groups. One of these characteristics is isolation due to an active infection. Being coded for infection isolation can have a significant impact...
Survey Ready! Staff Development & Competency Essentials
As states are working to catch up on annual recertification surveys across the nation, now is a good time to review and update your education calendar for the upcoming year. During annual surveys in 2022, surveyors will be paying additional attention to compliance...
Ask Proactive – I have a resident who was skilled under Part A services who was discharged but remained in the facility. They were subsequently picked up under Part A services again. Would the interrupted stay rules apply to this situation?
Q: I have a resident who was skilled under Part A services who was discharged but remained in the facility. They were subsequently picked up under Part A services again. Would the interrupted stay rules apply to this situation? A: Possibly, but timing matters. An...
Avoiding F656 Care Planning Deficiencies
F656 Develop/implement comprehensive care plans is the #5 most cited deficiency nationally. This week’s blog examines what you need to know about the regulatory requirements related to F656 and how to avoid issues commonly cited by surveyors. There are five standard...
Ask Proactive – Let’s say I have a resident fall with injury on January 1st. How many days have to pass before it will drop off and not count against us as far as our 5-star rating?
Q: Let's say I have a resident fall with injury on January 1st. How many days have to pass before it will drop off and not count against us as far as our 5-star rating? A: The fall with major injury will be included in the QM % for the quarter if it was coded on a MDS...
Ask Proactive – I conducted the pain interview with a resident recently and they stated that they have ‘almost constant’ pain and rated it as ‘moderate’. I reviewed the chart and the resident has PRN analgesic available, but never requests it, and the Q shift Pain monitoring on the MAR indicates no pain during the look back period. How should I address this on the MDS?
Q: I conducted the pain interview with a resident recently and they stated that they have ‘almost constant’ pain and rated it as ‘moderate’. I reviewed the chart and the resident has PRN analgesic available, but never requests it, and the Q shift Pain monitoring on...
Medicare Compliance: Avoiding Common Errors on SNF Certification/Recertification
According to the most recent Comprehensive Error Rate Testing (CERT) report released by the Centers for Medicare & Medicaid Services (CMS), $2.7 billion in improper payments were projected for Skilled Nursing Facility (SNF) services for 2021. Inadequate...