News / Blog
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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...
Ask Proactive – A Medicare patient was admitted to our SNF in the morning and went home AMA later that same afternoon. What MDS assessments need to be completed?
Q: A Medicare patient was admitted to our SNF in the morning and went home AMA later that same afternoon. What MDS assessments need to be completed? A: The Entry record and the unplanned discharge return not anticipated are required to be completed. In addition,...
Responding to an Allegation of Abuse
There are few things that can wake up a nursing home administrator faster than a phone call in the middle of the night from their facility reporting an allegation of abuse. Federal regulations require nursing facilities to promptly report any allegation of abuse,...
Avoiding the #4 Top Citation – F689 Free of Accident Hazards/Supervision/Devices
F689 is the fourth most cited deficiency in standard surveys and the first most cited in complaint surveys so far during the 2022 Fiscal Year according to CASPER data as of 4/17/22. F689 has been cited a total of 2,010 times during standard and complaint surveys 7%...
Ask Proactive – Can you please clarify if we can skill our patient returning to the facility following a 3 day qualifying stay at a psychiatric hospital? We have a new RAI Nurse who is hesitant to skill.
Q: Can you please clarify if we can skill our patient returning to the facility following a 3-day qualifying stay at a psychiatric hospital? We have a new RAI Nurse who is hesitant to skill. A: CMS speaks to skilled days following a psych stay in Chapter 8 of the...
Growing MDS Experts On Your Team
With staffing challenges and ongoing industry changes looming, it can be difficult to maintain a focus on MDS accuracy despite the considerable implications for care planning, QMs and reimbursement. Some facilities have needed to rely on their MDS Coordinator(s) to...
2022 5-Star Rating System Changes
Effective with the April 2022 Five-Star refresh, CMS is now implementing the planned, regular increases to the Quality Measure (QM) rating thresholds, that were originally announced to begin in 2019 but were delayed due to the public health emergency. With the April...
The Ins and Outs of Immediate Jeopardy
There are few things that raise the alarm quicker during a facility survey than the mention of possible Immediate Jeopardy. This level of deficiency scope and severity has a significant impact on the facility staff and residents in the present and going into the...
Ask Proactive – A nursing home resident rose out of his wheelchair, walked 2 steps, and stated “I am too weak to move any further” as staff noticed his knees beginning to buckle. Two aides assisted him onto his roommate’s bed. Is this considered a fall?
Q: A nursing home resident rose out of his wheelchair, walked 2 steps, and stated “I am too weak to move any further" as staff noticed his knees beginning to buckle. Two aides assisted him onto his roommate’s bed. Is this considered a fall? A: Yes, this is an...
Infection Preventionist Essentials: Infectious Diseases Common in Post-Acute Care Setting
Long Term Care facilities present unique infection prevention risks. Communal living environments, in general, provide an excellent breeding ground for bacteria and viruses with closed ventilation systems, regular use of common bathing facilities and shared dining...
SNF PEPPER Available: Do you have outliers that may trigger medical review?
The Q4FY21 release of the Skilled Nursing Facility (SNF) Program for Evaluating Payment Patterns Electronic Report (PEPPER) with statistics through September 2021 is now available for download. Follow these steps to access your PEPPER and analyze any outlier billing...
Ask Proactive – My facility considers October through March as “flu season.” Does this mean flu season is officially over for MDS Section O coding purposes?
Q: My facility considers October through March as “flu season.” Does this mean flu season is officially over for MDS Section O coding purposes? A: It’s best not to restrict yourself to specific date ranges for influenza vaccination seasons and reporting...
Ask Proactive – A resident went out to the ER, and while he was there, he received IV medication. Can I count that as ‘IV Medication while a resident’ under O0100H2?
Q: A resident went out to the ER, and while he was there, he received IV medication. Can I count that as ‘IV Medication while a resident’ under O0100H2? A: If the resident was not admitted to the hospital, then he would be considered a resident of the facility...